What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

Harrow admits ~10 children to acute CAMHS annually, at £850 daily, totalling £765,000. Despite preventative support, there are gaps in early intervention. Our collaboration across Harrow Council and Northwest London (NWL) ICB seeks to improve services for CYP with mental health and other complex needs not well-served by existing systems:

• There is a cohort of CYP who typically access A&E in crisis and are admitted to an acute bed via psych liaison services.
• Once safe to be discharged, their complex social situation and the lack of suitable placements prevent them from going home
• They remain in hospital beds while the Local Authority (LA) and NHS attempt to resolve the situation, often for months

Placement options for CYP with such complexities are scarce. Improving the LA-NHS interface for these children can reduce risk to the children involved, ensure timely, appropriate support for their needs, and reduce avoidable costs for health services and LAs.

What does your project aim to achieve?

This project will set out to identify cohorts of CYP for earlier intervention, by conducting a retrospective, longitudinal study of NHS and Local Authority data. The analysis will focus on CYP who meet a predefined crisis criterion.

These analyses will provide a comprehensive view of CYP’s journey through Health and Local Authority systems and identify common presenting factors, patterns of service contact, risk factors and accessing of urgent care to develop an initial ‘risk model’. This can be used by practitioners to:

• Develop a methodology for early identification and support with evidence-based interventions with CYP at higher risk of mental health crisis.
• Provide CYP with personalised, integrated interventions, including preventative therapeutic intervention, prior to hospitalisation, to:
  • Reduce emergency admissions.
  • Reduce length of hospital stays.
  • Keep CYP in crisis safe.
• Stimulate the therapeutic placements market to improve outcomes for CYP and chances of successful placement.

How will the project be delivered?

This project will be delivered by a collaborative team of:

• Researchers from Imperial College London – Analysis and academic insights.
• Practitioners from Harrow Council, NWL ICB and VCFS – Interpreting findings based on experience.
• Social Finance – Facilitating data infrastructure and access.

We are uniquely positioned to explore this, with access to joined up CYP health records with children’s services data from statutory returns, and links into wider work.

By leveraging NWL data-sharing infrastructure and funding from London Data Accelerator, we will reduce barriers to data access, ensure scalability of outputs and lay the groundwork for incorporation of additional standardised datasets.

Impact will be measured both through usage data on outputs, and outcomes for CYP going forward, and cost-effectiveness assessed by comparison of inputs against these outputs/outcomes.

An oversight group will be established across involved organisations to steer the direction of the work and mitigate risks around capacity and competing priorities across organisations.

How is your project going to share learning?

There is a widespread belief among CYP Mental Health communities that the increasing complexities presented by CYP is a trend, making it imperative to share learning beyond NWL.

Our project will share learning around three main areas:

• Communicating the insights from analysis and engaging a wider community in ideation around how to address these (via published research outputs, conference presentations and a communication plan tailored to reach those working in CYP services both within NWL and more broadly across the sector), and testing with CYP voice networks where possible.
• Enabling replication of this analysis by CYP services in other regions (via open-source data analysis and code, and drawing primarily on statutory datasets to ensure replicability).
• Sharing learnings for wider teams looking to conduct analysis at the intersection of system boundaries (via detailed reports, and communicating methodologies and necessary support to help integrate new methods smoothly into regular operations)