A new approach to address the health needs of children

Anto Ingrassia, Consultant Child and Adolescent Psychiatrist with the Children and Young People’s Health Partnership, blogs about the programme and how they are helping to meet the mental and physical health needs of children and their families.

Introduction

I joined the Children and Young People’s Health Partnership (CYPHP) in February 2017, attracted by its ambitious aim to deliver better healthcare for children, young people and their families, and its unique set up as a mixture of researchers, clinicians and transformation managers.

Having worked for about 20 years in multidisciplinary mental health teams, initially with adult patients and then with children and families, I could recall numerous examples of the separation between physical and mental health often occurring within our healthcare system:

“A teenage boy who has been recently diagnosed with epilepsy struggles to attend college, is getting more irritable and often has arguments with his parents. Information about his mental health and emotional wellbeing is not routinely collected as part of his overall care and treatment plan for epilepsy”.

“A six-year-old girl, who lives with her mum and two younger siblings, has chronic constipation and regularly soils at home and in school. Her mum has a long history of anxiety and depression. The mother’s own treatment needs, which influence her parenting capacity and the way she seeks and accepts help to address her daughter’s health difficulties, are poorly understood by the health professionals treating the girl”.

These are just a few examples of the challenges CYPHP is trying to address, by bringing mental health experience and expertise into its core multi professional clinical service, its core aim is enshrined in Article 24 of The United Nations Convention on the Rights of the Child,

“Children have the right to good quality health care – the best health care possible”.

What is the Children and Young People’s Health Partnership (CYPHP)?

The CYPHP Programme aims to improve the health of children and young people in Lambeth and Southwark through the delivery of a comprehensive approach to children’s healthcare. The programme is funded by Guy’s and St Thomas’ Charity and delivered through a cross-organisational partnership between Lambeth and Southwark GPs, Evelina London, King’s College Hospital and South London and Maudsley NHS Foundation Trusts, Lambeth and Southwark Clinical Commissioning Groups (CCGs) and Local Authorities.

Central to the success of the programme is the work of the multi-professional clinical team focusing on common (such as constipation or eczema as exemplars for learning) and/or complex (such as asthma or epilepsy) health conditions by promoting integrated care, proactive management and patient/families/professionals’ education, all supported by good quality information. For example, one of the programme’s aims is to create a web-based portal eligible families can use as an entry point for information, advice, and to access clinical services.

The CYPHP Health Team brings together clinical skills and expertise across different disciplines and professional groups. It is comprised of Clinical Nurse Specialists in Asthma, Epilepsy, Primary Care, and Mental Health, a Family Therapist, a Specialist Pharmacist, a Child Psychiatrist (myself), General Practitioners, Public Health Consultants, and Paediatricians. Crucial to our development from a disparate group of professionals to a functioning and integrated team has been our weekly clinical meeting. This is a dedicated (though not the only!) time when we discuss our work with children and families, use each other’s knowledge and expertise to improve the care we deliver and meet the challenges of complex clinical issues and presentations.

Our clinical team is community, rather than hospital based, working at the interface between primary care and secondary/tertiary care, in order to deliver services closer to home for our patients and their families, thereby facilitating engagement, improving satisfaction and clinical outcomes.

What is unique about CYPHP?

The CYPHP Programme has set an ambitious aim to rigorously evaluate its impact. We intend to add a significant contribution to existing literature on child health and to support thinking about how services for children should be organised and delivered in the future.  

The delivery of clinical services is informed by crucial themes which are embedded thoroughout the programme:

• Education and training - to promote a culture of continuous improvement
• Public health - to ensure that early intervention, health promotion, and equity are central to our approach
• Mind and Body - to ensure the whole child is cared for. This has been a most exciting development, particularly as we strive to focus on a whole family approach to better understand and address the health needs of children in the context of their families, schools and communities.

The story so far

Since the launch of the Programme in May 2016, we have provided clinical care to numerous children, young people and their families at home, in schools, in our community clinics run by specialist nurses and by our pharmacist, and in our “inreach clinics”, a joint effort between Paediatricians and GPs, bringing specialist care closer to home. The added value to our work has been the appreciation of the intimate link between children’s general health issues and the emotional, psychological and mental health issues affecting them and their parents. We have done this through screening, offering consultations, assessments and intervention, but also through training and raising awareness so that our whole health team, not just us mental health professionals, can be in the position to have meaningful and helpful conversations about mental health needs.

So far, so good but, as they say, it’s a work in progress!

To find out more about CYPHP visit the website.