How To Do CAMHS Participation, Without a Group!

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No CAMHS GroupNearly every CAMHS service we’ve visited or spoken to has a regular participation group, or two.

They are the de-facto norm for young people’s participation. They guarantee you a regular group of young people to go to for consultation and to enlist for events and projects.

But groups have their draw backs too. Typically they only represent the most engaged groups, and take a lot of time to set-up and maintain, meaning you have less time to engage with a wider sample of young people.

So, what if you dared not to run a participation group?

That’s what Sophie Allan has been doing for the last 18 months at Cambridgeshire & Peterborough CAMHS. Sophie is the patient and parent involvement lead, working only 3 days a week, across 4 sites. Working since January 2014 she is also the first ever post holder.

And as yet, she hasn’t yet run a regular participation group.

So what’s she doing instead? And is it working?

What Cambridgeshire are Doing

The ‘Magic Wand’ Questionnaire

The trust’s existing methods of gaining feedback were hard to accept as representative of users’ experiences. For instance, trust targets for their own ‘Children’s Community Survey’ are only 10 a month for each team. In addition, the CYP IAPT Experience of Service Questionnaire (ESQ) isn’t anonymous sparking Sophie’s concerns that young people might feel less able to comment negatively.

So Sophie created the ‘Magic Wand’ snapshot questionnaire and for 2 weeks got receptionists across the four sites to give it out to all young people and parents who walked through door.

The last magic wand snapshot generated 113 responses and achieved a broad spectrum of feedback from both engaged and non-engaged young people. This was a big improvement on previous questionnaires and provided a rich range of data to aggregate and compare with PALS data, complaints data and the ESQs that were received. Sophie also presented the results as a poster at an internal conference, achieving a special mention in the poster prize awards.

Interview Panels

Interview panel soloLike many services the Trust routinely involves young people in staff interviews. Sophie trains young people and they then run the interview. Recently they helped recruit a senior manager and a Consultant Psychiatrist.

Post-interview decision making isn’t always easy. When her young people disagree, Sophie’s challenge is to remain impartial and make sure all their voices are heard. This can depend on the evaluation mechanism used to judge a candidates suitability. When one candidate was appointed, not all young people agreed on the appointment. So Sophie requested that the appointing officerwrite to the whole panel, explaining why that person was appointed.

Measuring Participation Impact

We know that participation is a valuable resource that makes for healthier services.

But we, like local participation workers, are the converted.

The problem is the lack of well collected evidence that articulates the impact that we see every day.

Fed up with this lack of evidence Sophie has set up a steering board with Duncan Law and the London and South East collaborative to address this lack. The board’s agenda includes gathering and showing the evidence as a means to protecting participation worker roles from financial cuts.

Why It Works in Cambridgeshire

Yes, it works without a steady participation group. Here’s why.

Good Advice

Sophie cites the best advice she was given when starting the role was to make “why not?” her mantra. We’ll let her explains this…

Making “why not?” my mantra helped me be determined when up against change blocking red tape. For example it took months to get a radio for the waiting room: we needed a license, assurance that the receptionist would lock it away at the end of the day, etc. We now have a radio, but it took lots of determination!

Doggedness

cambridge camhsImplementing “why not?” requires doggedness. Sophie’s enthusiasm, combined with a doughty unwillingness to let things go has achieved change in the face of opposition. For example young people at one clinic commented that the glass between them and the receptionist made them feel stigmatised. The trust’s health and safety department objected to its removal on the grounds that young people might throw pens “as missiles” into the receptionist bay. However Sophie is continuing to campaign against the glass. Without a dogged approach it would be very easy to give up on issues like this.

Senior Support

In Sophie’s view “being a participation worker is like having a cross service management role but without the power”. However her line manager is both a service manager and Head of Nursing. She also has support from the Clinical Director which is valuable. Their support and enthusiasm gives Sophie the flexibility to shape participation delivery the way she thinks it should be.

Peer Support

Every month Sophie meets up with participation colleagues from across London & the South East. She says “It’s the best meeting I go to. We all have same goals and frustrations and it’s great to see what everyone else is doing. Without it can feel like you are the only one flying the flag.”

Challenges Faced

But group or no group, there are still challenges. Of course.

Staff Defensiveness

Changing services isn’t just about developing more participatory or young people friendly structures, environments and processes. If you’re a participation worker you’ll know that staff culture is probably as hard to change. Staff can get very worried about negative feedback and its potential implications for their role or banding.

This is understandable given the pressure they’re under, however, when negative feedback is received Sophie tries to ‘close the loop’ on it, creating constructive responses to show how it can lead to positive change. At the same time she also uses the larger volume of positive feedback to provide context and support staff morale.

Achieving the Impossible

With doggedness and the right support most challenges are achievable. But some seem impossible. When feedback about long waiting lists comes in staff feel powerless to change them. Hopefully new investment in the service will reduce wait times. But without more resources it’s one of the hardest things to change.

Job Uncertainty

What do you do when your post is on a short term contract? Long term plans don’t fit into a 12 months contract, however the post is still expected to deliver long term results. If funding appears to be temporary then efforts to involve young people and tackle service transformation from their perspective can feel tokenistic (luckily it doesn’t have to be that way).

The future is waiting…

There’s a tonne of stuff that Sophie wants to achieve before her contract expires… starting with making her job permanent!

Then to employ young people, perhaps as apprentices or assistants. Having them around the workplace is one of the most potent ways to support change and challenge culture.

She also wants to make interview panels standard practice in all new recruitment events as currently only about 10% involve young people. Staff are willing to involve young people but unfortunately it’s something they often forget…

And she wants to redecorate the waiting rooms in Cambridge and Huntingdon with money raised by one Tough Mudding nurse…

Let’s give Sophie the final word on the future…

“Participation is about playing the long game. I was a support worker in a CAMHS home treatment team before this role. In that team, I could see young people getting better over weeks or months, but with participation you’re trying to change the culture of services which happens much more slowly. It can be less satisfying day to day but slow and steady wins the race. Change does happen: it’s just a marathon not a sprint!”

Profile photo of Joe Roberson About Joe Roberson

Joe is an ex-children's mental health advocate and participation worker turned digital innovator. He co-wrote the groundbreaking Headspace Toolkit (2005) and Through the Maze (2008). For the last 18 months he's been leading MOMO, running MyAPT and writing for Innovation Labs.

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