Challenge

Children and young people (CYP) accessing mental health support through Child and Adolescent Mental Health Services (CAMHS) routinely wait from referral until their first assessment. Many young people have been dealing with mental health challenges for extended periods of time and often it has been an act of courage for them to seek help. This extended waiting period frequently exacerbates their feelings of anxiety and causes a delay in getting treatment.

NHSX travelled round the country speaking to young people and their families to understand how to improve these experiences. They identified a number of opportunities to support young people trying to access CAMHS in the initial period before treatment. Building on those learnings, FutureGov partnered with NHSX to embed user-centred design methods in local trust teams. We worked across two pilot sites, Alder Hey and Oxleas, providing delivery, design and research expertise to support teams to use digital and design to improve outcomes for Children and Young People while they are waiting to access mental health services.

Approach

Working alongside teams from Alder Hey and Oxleas, we focused on two challenges identified by NHSX:

• what are the opportunities to support children and young people in preparation for their first visit, or subsequent treatment from mental health services?
• how might we embed user-centred design methods into local teams to help them test ideas that improve outcomes for children and young people waiting to access mental health services?

We worked in a blended team with clinical and operations staff within the trusts and NHSX, taking a hypothesis led approach and rapid research methods to build our understanding. To identify the biggest problem areas we spoke to young people in the waiting room, calling people on waiting lists, speaking to clinicians and analysed referral data and wait times.

Running workshops with the trust teams was a chance for trusts to come together, share challenges and learn more about user research and prototyping. We introduced agile ways of working, design services and service models, and introduced different ways to solve a problem and upskill around prototyping tools and approaches.

Alder Hey

Building on the insight generated by NHSX, we worked in a multidisciplinary team, introducing agile ways of working and design thinking. After mapping the current system, we chose to focus on the pre-referral and referral phases of our user’s journeys.

Pre-referral

By improving the pre-referral service and providing easier access to better quality information for young people and parents we could achieve better support and outcomes for people using these services. Through user research, we helped the team understand where people search online for mental health information and what information they’re looking for. We discovered that The Alder Website receives the most visitors, however, the CAMHS specific pages are the least viewed due to inconsistencies and accessibility issues. We made a number of recommendations surrounding these findings.

Referral

By improving the referral process, the trust can receive more useful information, reducing time spent making and receiving referrals and enabling them to deliver better outcomes for children, young people and the service. We could also reduce rejected referrals through the use of a digital solution.

Together we built a clickable online referral prototype using the NHS Prototyping Kit. Using the kit meant we were using components that have already been tested with users and are known to be accessible. We conducted 1-hour remote interviews with professionals (GPs and YPAS practitioners) who had referred someone to CAMHS in the past 6 months. They tested an e-referral prototype to assess whether a more user-friendly referral experience would make it easier for professionals to complete referrals with the necessary information. This would ultimately ensure CAMHS receives better information, enabling them to deliver better outcomes for children, young people and the service.

Oxleas

Working closely with the clinical teams at Oxleas, regularly meeting and working with a principal clinical psychologist and the Greenwich CAMHS Operational Manager we built on the work of the NHSX discovery to understand challenges at Oxleas, looking at data on referrals and wait times. We took time to understand the other projects they were working on; DNAs, a digital service for self-referral and online ADHD support. We spoke to young people in the waiting room, calling those on waiting lists and spoke to clinicians to build our understanding.

We prototyped an automated SMS service, developing a clickable mockup conversation between a young person who has been referred and the CAMHS service with questions and information related to different topics introduced over an 8 week period. We tested the concept with young people to identify the desirability of the service.

The young people we spoke to were positive about the prototype and the value of its features. Many of those highlighted the links to advice and services that might help them, the immediate value and the reassurance they hadn’t been forgotten as positive elements.

NHSX Mental Health Service Model

Using our insights from pilot sites, we developed a framework for supporting local NHS providers to adopt user-centred service models. This would ensure they can best support trusts to deliver service transformation projects. Especially given that digital capabilities, team capacity and needs vary significantly amongst trusts.

Impact

Following our recommendations, Liverpool CAMHs created accessible web content. They now also have clear HTML content providing more consistent and better-designed information focused on the needs of young people using the service.

In Alder Hey, getting the e-referral form right will help to correctly record the story of the young person’s presenting issues. The trust team learned how to start small and prototype different ways to solve a problem, test ideas with users to understand their needs and iterate based on feedback. They are continuing the work using this approach.

In Oxleas, our testing showed there was a lot of potential in the automated SMS service to help manage young people’s expectations around CAMHS. Young people were happy to share their story over SMS and they understood that it would be useful for their assessment. Some recognised the intrinsic value of working through the questions and tools recommended as a way into the therapeutic process. The trust is planning to develop a basic, automated version of the service as a next step.