CAMHS

What can Schools Teach CAMHS? Development and Evaluation of a Training Intervention for CAMHS Staff to Increase Joint Working with Education Services

Panos Vostanis
Helen Taylor, Research Associate
Crispin Day, Consultant Clinical Psychologist and Honorary Lecturer, King's College, University of London
Cathy Street, Research Consultant
Katherine Weare, Professor of Education, University of Southampton
Miranda Wolpert, Director of Evidence Based Practice Unit, University College, London
John Bankart, Medical Statistician, University of Leicester

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Recent policies in the UK highlighted the importance of joint working between child mental health and education services, and the development of evidence-based service models. Despite the strong evidence that child mental health and educational problems are frequent and often inter-related, thus requiring joint care pathways and interventions, so far there are limited models of joint working between child mental health and education services. The aim of this project was to develop and evaluate a training intervention for CAMHS practitioners to improve joint working with education services. The project consisted of five inter-related studies and an intervention development.

Study 1: Families’ experiences of joint working between CAMHS and education services were elicited through 25 interviews with children aged 7-11 years and their parents, who were attending four CAMHS. Children’s mental health problems were perceived to be related to bullying, a range of school behaviours, school refusal, relationship difficulties and poor school attainment. Children and parents described the impact of mental health on education, and vice versa. Both positive and negative experiences of CAMHS and educational interventions were described, although families were generally unaware of joint working between the two services, which they often attributed to limited communication. Children and parents expressed the wish for closer contact between CAMHS and schools, with their active involvement.

Study 2: Ninety six staff from four specialist CAMHS completed a questionnaire with 40 items on perceptions of knowledge, practice and attitudes towards educational issues and services, and three case vignettes. Despite the fact that participants reported frequent contact with children with education-related needs and with education services, they also highlighted concerns about their level of training and skills in this regard. Perceptions of knowledge and attitudes significantly predicted response to case vignettes. Previous training and experience were associated with knowledge, but did not predict case vignettes scores.

The training intervention (intervention development) was completed following consultation with staff, young people, and piloting. This included:

  1. Two half-day workshops, with input from educationalists, on the  relationship between child mental health and education, a practice  framework, assessments and intervention skills, and joint working with  schools. A Training Pack was developed to ensure fidelity by the  trainers.
  2. The Best Practice Handbook, as an information resource on education  policies, school systems, improving practice, and setting up joint  interventions.
  3. The 3 Step Tool as a guide to CAMHS practitioners in relation to  assessment, planning interventions, and working more closely and  efficiently with schools.

Eight teams from the four CAMHS sites (one team from each site) were randomly allocated to receiving the training intervention or acting as controls. The training was delivered to the four participating teams by pairs of trainers.

Study 3: Thirty-six staff who participated in the training were interviewed after three months.  Participants were positive about the presence of educationalists, and would recommend more input from and joint training with education services. There was mixed preference on information and practice-based techniques. The Best Practice Handbook was perceived positively as a reference tool, which will require updating, while the 3 Step Tool guide was considered more appropriate for newly qualified practitioners. Recommendations included the adaptation of the programme for different staff and service needs, and its integration to CAMHS induction and ongoing training.

Study 4:  A sub-sample of 22 staff who took part in the baseline assessments completed the same questionnaire, after six months. The tentative analysis predominantly consisted of descriptive statistics. The post-training findings suggest that, following the training intervention, there was significant improvement in CAMHS staff knowledge and confidence mean scores, although the changes were not significantly different to those of the controls; but there was more notable impact on their ratings of usefulness of and satisfaction with education services.

Study 5: Service templates on consecutively referred children aged 7-11 years over a period of one year were rated on CAMHS contacts with schools. Following the training, case notes were rated by a brief service template to provide information about the common mental health and school related problems observed over a period of one year. Three CAMHS sites took part in this study, however, as the service recording systems between the three sites differed, comparative analysis was confined to one site. Information on the intervention applied and the nature of contacts made with education services were reported, which indicated no significant difference between the intervention and the control staff group.

Duration: 2006-2010; Funding: £330,000, Department of Health

 

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