4 May 2018

An integrated approach to working with health services

With a positive disposition, a little creativity and the support of key stakeholders, nothing is impossible. Gareth D Morewood outlines his alternative approach to organising CAMHS consultations.

Earlier this week posted a tweet about something I thought reasonably unremarkable.

Tomorrow we host CAMHS clinics at school.

Consultant & specialists come to school, students miss only one hour & I attend all appts... an inclusive process we often do, that has massive impact for YP & families.

Tomorrow is a truly powerful day.

— Gareth D Morewood (@gdmorewood) May 1, 2018

To my surprise this received a great deal of interest, not only through likes and retweets but a number of interesting discussions arose about how it had been possible and how others could replicate it.

In this post, I want to elaborate on some of the practicalities, explain how you can organise this form of joint working in your own setting and suggest what you could expect to achieve as a result.

I have written previously about our school’s collaboration with health sector colleagues on the development of ADHD Care Pathways, and more recently the ‘thrive model’. This joint working with health is paramount to supporting positive outcomes for young people with EHCPs and specific SEND.

As part of our continuing focus on improving outcomes and facilitating proper co-production, we are always looking for ways to work creatively. This is an example of one of those arrangements.

Rethinking our approach

Historically we were asked to facilitate CAMHS appointments by completing tick sheets, questionnaires and other forms. Sometimes these documents didn’t provide an opportunity to elaborate on specific areas and certainly didn’t allow for a dialogue – it was very much ‘one way’, us providing information to the CAMHS consultant.

I then thought that by actually attending the clinics, I could offer the educational perspective and engage more positively with the process. There were many young people and families who agreed to me attending and welcomed a joint approach.

However, this way of working was not appropriate for all young people. Moreover, travelling to and from the clinic and making time for delays meant that this was not the most time-efficient way of me attending the consultations. This is what eventually led us to discuss the possibility of holding the clinics in school, and the consultant travelling to us.

The overriding purpose of this approach is to ensure best outcomes for the young people and their families

The overriding purpose of this child-centred approach is to ensure the best possible outcomes, by:

reducing absence and disruption to the school day
alleviating the stress on families having to find and often pay for parking at the hospital
providing the consultant with access to additional educational information (as required)
reducing the non-attendance for clinics.

Holding consultations in school has meant that young people only miss time for the appointment itself, rather than a half or full day at the hospital, as was often the case.

Approval, confidence and trust

We agreed on the setting up of these clinics with families, and our CAMHS consultant contacted us with a list of appointments to schedule. I must stress that these appointments were agreed on in the previous clinics; the consultant asks the families if they are happy for the next appointment to be in school.

Not all families agree to this approach, and prefer appointments at the hospital. However, where families have agreed to their child meeting with CAMHS in school, every single appointment has led to positive, mutually agreed outcomes and clear, co-produced plans.

In having these joint discussions, we have also been able to make sure that any potential conflicting agreements or strategies that may be difficult to manage within the educational setting are discussed together, resulting in clear agreements that we jointly agree upon.

I don’t think this approach would be possible without:

the approval and support of families
the confidence of our young people
the trusting relationship we have with our consultant.

Some of our students and their parents have expressed uneasiness about having these appointments at school. In some cases, it has taken a while to establish trust, although some of our most powerful meetings have been with Year 7 students who have really grasped the opportunity to discuss the specific challenges they face and what that means to them. I am often blown away by the amazing insight some of our young people have.

It is also useful to point out that I have known our consultant for over 15 years, and we have delivered clinics through this approach many times previously. Strong school-health relationships are essential for this approach to work; with CAMHS provision ‘patchy’ at best, it is best that any thoughts you have about developing a similar model should be with caution, and good consideration of the points outlined above.

The discussions we had this week were wide ranging and to ensure anonymity the specifics of these appointments will not be identified in this post, merely the practicalities, risks to be aware of and benefits of such a model.

Could this work for you?

I think it is important to emphasise that, for many young people, getting the appropriate support from CAMHS and other health professionals is a significant issue. A recent survey found that only nine per cent of young people and six per cent of parents said they found it easy to get the support they needed.

However, this should not hold us back from thinking creatively. On the contrary it should encourage us to think about finding new ways to make the consultation process easier and more productive for everyone involved.