The average wait for a child to receive support from specialist mental health services in 2020 was more than a year. This average figure masks significant regional variation and has been further exacerbated by the pandemic. In order to better support young people with their mental health, Child and Adolescent Mental Health Services (CAMHS) might be able to deploy digital offers at various points of their pathway – whether this is while they are waiting for an initial assessment, support during treatment or maintaining wellbeing after treatment. Although it is widely acknowledged that digital has a role to play in the future of healthcare delivery, further understanding is required around which products might be the most suitable and safest, how these are to be adopted and how they might best support clinicians, young people and their parents and carers to improve outcomes. the Oxford AHSN has been working with commissioners and providers in the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System (ICS) to support transformation of services for children and young people’s mental health, with a particular focus on scoping digital support.
What is the challenge?
Over the past decade, NHS mental health service providers have adopted digital mental health provision in a piecemeal way, selecting and developing those products that – at a particular point in time – best met the needs of services and were deemed suitable to be commissioned. The advent of integrated care systems has presented an opportunity to review existing offers and explore potential synergies and opportunities for identifying and commissioning innovations that address gaps in provision. The challenges faced across the health system include the sheer variety and number of digital health offers currently available, the absence of a commonly understood system for identifying the safest and most efficacious digital treatments, issues around interoperability and procurement processes and the often limited technical knowledge of clinicians who, primarily, wish to offer the most appropriate treatments to their patients using their expert clinical knowledge.
What did we do?
In November 2021 the Oxford AHSN was approached by the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System (ICS) to support their workstream for transforming services for children and young people’s mental health, driving change and improvement using digital options and solutions. The BOB ICS and NHS trusts providing mental health services in the region have been working together to understand how best to meet the challenge of the growing emotional wellbeing and mental health needs of children and young people. This has included engaging with clinicians from across CAMHS services to seek their input as well as colleagues from across the national AHSN Network. Initially this involved gathering information about digital approaches commonly used or identified as being desirable across the country. Subsequent desk research was undertaken to identify what is available for those aged under 18 years to include current available evidence, details of adoption and commissioning models or approaches and where each offer sits within the i-THRIVE model. Once an initial list was compiled, the Oxford AHSN carried out a series of online interviews with health tech developers to gather additional insights and information about existing products and any planned or proposed developments in the near future. Subsequent engagement with clinicians and, separately, with young people was conducted in mid-2022 to better refine what might be required to make this process acceptable and successful in practice.
What has been achieved?
An initial report including 22 potential digital innovations was presented to BOB ICS colleagues. The information gathered from interviews with the creators of these products has been added to a spreadsheet which allows ICS colleagues to navigate and interrogate this material to identify potential products based on local needs. A webinar delivered by BOB ICS and the Oxford AHSN in June 2022 shared learning to date. More than 90 people registered to either attend live or receive a recording of the 90-minute session.
The final scoping report was published in November 2022. It is based on a snapshot taken in mid-2022 and presents the information available at that time about each product consistently without judgement or recommendation.
What people said
“Working with the Oxford AHSN has been a positive experience. Engaging the AHSN has allowed us to gather a wealth of information which we will use to develop a coherent strategy for a digital offer to children and young people. Our collaboration has developed and grown in response to our findings and the information gathered, including from clinicians and from local youth boards and events involving young people.”
Andy Fitton, Head of CAMHs and Eating Disorder Transformation, Oxford Health NHS Foundation Trust
“The collaborative working relationship with the Oxford AHSN has enabled a detailed review of digital approaches and possibilities, alongside the engagement of practitioners and young people who will be utilising these approaches. This is an important step in informing us as we review our use of digital solutions with an aim to improve timely access to information, support and interventions for children, young people and their families.”
Dr Mairi Evans, Clinical Director for Children, Young People, Families, All Age Eating Disorders and Learning Disabilities, and Senior Responsible Officer for CAMHS at BOB ICS
Engagement with the BOB ICS is ongoing. Key learnings and resources from this work will be spread to other ICS areas within the Oxford AHSN region and further afield.
There are many opportunities for digital solutions to be adopted throughout CAMHS pathways, enhancing traditional services, widening access and improving self-care. The greatest opportunities relate to accessing support at an early stage.
Our scoping report can be used by other healthcare systems to support commissioning decisions. The Oxford AHSN is well placed to carry out detailed evaluation of the most promising innovations which best fit patient needs ahead of wider adoption.