The document provides information about the Children and Young People's Improving Access to Psychological Therapies (CYP IAPT) Programme in the UK. It discusses (1) the high costs of mental illness in children and the benefits of evidence-based practice, (2) how CYP IAPT aims to transform child mental health services (CAMHS) through expanding the workforce's skills in evidence-based practices, increasing collaborative and outcomes-focused care, and transforming participating services, and (3) some of CYP IAPT's achievements so far including developing national curricula for therapies and supervision, empowering young people, and linking service improvements to better adoption of evidence-based practices.

1. Children)and)Young)People s)
Programme)
Professor)Peter)Fonagy)
Na8onal)Clinical)Lead,)CYP)IAPT)
Kathryn)Pugh)
Programme)Lead,)CYP)IAPT)

2. The)context)of)CYP)IAPT:)Costs)
Mental illness during childhood and adolescence in the UK:
£11,030 to £59,130 annually per child
Lifetime cost of a 1-year cohort of children with Conduct Disorder: £5.2 billion
Costs of adult crime with history of CD
• £60 billion in England and Wales
• £22.5billion attributable to CD
Including costs of
various agencies
•
•
•
•
Health
Social services
Education
Justice
• £37.5 billion to subthreshold CD
Evidence-based practice has substantial clinical & cost benefits
Little & Edovald, 2012; Suhrcke, Puillas & Selai, 2008
Only 6% of current spending on mental health goes to services aimed at children and young people
Kennedy, 2010

3. How are we perceived?
VIDEO
(YouTube link)

5. Reports)on)CAMHS!
“children)and)young)people)are)s8ll)oIen)receiving)
fragmented!and!inconsistent!support!…)support)is)s8ll)
some8mes)provided)too!late!in)a)crisis,)and)
informa2on)is)not!easy!to)come)by”))(2008))
)

6. Reports)on)CAMHS!
“Urgent!ac2on!is)called)for)to)respond)to)the)mental)
health)needs)of)children)and)young)people.)Mental)
health)services)must!be!available!and!accessible,)
including)through)self7referral,)and)be)integrated)
with)other)services,)par8cularly)through)schools”)

7. Summary)of)the)issues)facing)CAMHS)
• Significant)shortages!of!trained!professionals!!
• Current)level!of!CAMHS!staff!training!is!‘poor!and)
geUng)worse’)
• Difficul2es!with!access!(very)few)services)offer)a)selfX
referral)route))
• Poor!handling!of!transi2on!between)child)and)adult)
services)
• Inappropriate!provision!of!adult!services!to)young)
people)
• Data)that)could)and)should)be)used)for)performance)
management,)selfXcri8cal)professional)prac8ce)and)
commissioning)is)rarely!collected!

8. A!Step!Change—A!Transforma2on!
CAMHS
CYP - IAPT

9. The)CYP)IAPT)Programme)
• Using)rou2ne!outcomes!monitoring))
• To)guide)therapist)and)supervisor)
• To)help!client!monitor!and)understand)how)
treatment)is)progressing)
• Across)ALL!professions!
• Empowering)YP)to)take)control)of)their)care,)
establish)treatment)goals,)choose)treatment)
approaches)and)take)opportuni2es)to)improve)
their)own)health)
• Improving)access)to!evidence7based!therapies!
• Introducing)evidence7based!organiza2on!of)care)

10. What)Is)CYPXIAPT?))
A)simple)evidence)based)implementa8on)of)EBP)
• CYP)IAPT)was)conceived)as)a)centrally!ini2ated!
modifica8on)of)CAMHS)in)the)direc2on!of!EBP!
• It)is)achieving)remarkable)degree)of)cultural!change!in)
terms)of)the)acceptability)of)principles!of!EBP!
interpreted!broadly)through)a)modest)investment)in:)
• service!change)
• training)service)leads!
• supervisors)and)therapists!
• Learning!collabora2ves!made)up)of)universi2es)and)
local!area!partnerships!offer)mutual)support,)problemX
solving)and)learning)networks.))

11. Milestones
Three%task%groups%begin%work%
(Educa6on%and%Curriculum,%Outcomes%and%
Evalua6on,%Service%Development)%
CYP%consulta6on%via%YoungMinds%

12. Milestones
C%Paul%Burstow,%Ministerfor%Care%
Services%launches%first%year%
collabora6ves%
C%First%draI%IAPT%Dataset%and%
Rou6ne%Outcomes%Monitoring%
Measures%Launched%

13. Milestones
C%Applica6on%process%for%
2012C2013%announced%
C%Accredita6on%steering%group%
convened%
C%New%£%resources%announced%

14. Milestones
C%Key%Performance%Indicators%agreed%by%ERG%
C%Process%to%develop%accredita6on%of%courses%
and%individuals%for%CYP%IAPT%agreed%
C%Former%Minister%for%Care%Services%
announces%new%sites%
C%34%%of%England%now%covered%
C%YouTube%channel%launched%

15. Milestones
C%%25%new%CAMHS%partnerships%
joined%the%programme%in%year%3%
covering%54%%of%the%0C19%%
popula6on

16. Milestones
2,662%CAMHS%clinicians%will%be%
using%outcome%monitoring%
across%42%sites%rising%to%3,950%in%
a%further%12%months%

17. Milestones
Planned'recruitment'of'new'
CAMHS'to'join'for'year'4'
CAMHS&partnerships&will&cover&
60%&of&popula:on&0;19''

18. What)has)CYPXIAPT)delivered?)
• A)na8onal)curriculum)for)four)therapies))
• cogni2ve!behavioural!therapy!for)anxiety)and)
depression)
• parent!training!for)conduct)problems)
• systemic!family!prac2ce!for)depression,)ea8ng)
disorder)and)conduct)problems)
• interpersonal!psychotherapy!for)adolescent)
depression)
!

19. The)effec8veness)of)Interpersonal)Therapy)(IPT))for)depression)
n=71)
Childhood!Depression!Inventory!
Adolescents!with!MDD!
61%)
56%)
20)
48%)
15)
34%)
17%)
11%)
25)
24%)
18%)
10)
5)
0)
Pre)
Post)
IPT)
IPT)
Pre)
CBT)
Post)
Wai8ng)List)
3Xmonth)FXU)
IPT NNT: 4
CBT NNT: 8
CBT)
FollowXup)
WL)
Rossello)&)Bernal,)1999)

20. The)effec8veness)of)Family)Therapy)for)conduct)disorders)
NICE Guidelines in 2009 and 2013 have identified Family Based Treatments as the
most promising intervention for reducing adolescent antisocial and offending behaviour
3.5)
80)
3)
70)
60)
2.5)
50)
2)
40)
1.5)
30)
1)
20)
0.5)
10)
0)
0)
Pretreatment)Poshreatment)
Pretreatment)
Poshreatment)
Cur8s,)et)al)2009)

21. What)has)CYPXIAPT)delivered?)
• A)na8onal)curriculum)for)four)therapies))
• cogni2ve!behavioural!therapy!for)anxiety)and)
depression)
• parent!training!for)conduct)problems)
• systemic!family!therapy!for)depression,)ea8ng)
disorder)and)conduct)problems)
• interpersonal!psychotherapy!for)adolescent)
depression)
• A)curriculum)for)supervisors!!
• A)curriculum)for)managers)undertaking)service)
development)and)transforma8on)
• Supported)the)development)of)a)CYP)MH)e7pladorm.!

22. What is evidence-based practice in child mental health?
EBP$
Researcher$
Clinician$
Client$
Not$$
‘delivered$unto’$clients$
via$field$workers$$
from$researchers$$
on$high$

23. What)is)evidenceXbased)prac8ce)in)child)mental)health?))
Client)
EBP)
Clinician)
Researcher)
A)fundamentally)par8cipatory)and)coXproduced)(coXconstructed))
enterprise)in)which)client,)researcher)and)clinician)are)all)fully)engaged)

24. EvidenceXBased)Prac8ce)
Culturally)
sensi8ve)
Con8nual)
measurement)
of)
effec8veness)
Acknowledges)
impact)in)
children)and)
families)
Organised)
around)client)
inten8ons)
ScienceX
informed)
EBP)
Takes)into)
account)the)
larger)social)
context)
Fonagy)&)colls.)(in)press))What%works%for%whom?%A%cri1cal%review%of%treatment%for%children%and%adolescents.%Second)Edi8on.)
)

25. Three)major)components)of)the)CYP)IAPT)transforma8on)
1.)Closing)the)skills)gap)in)CAMHS)
Enhancing)the)skills)of)
prac88oners,)
supervisors)&)service)
managers)in)EBP)
Appropriately)
skilled))
CAMHS)
workforce))

26. Performance)Evalua8on)
! Assessment)of)video)recorded)therapy)
sessions)
! Reports)of)individual)treatments)showing)
capacity)to)make)theory7prac2ce!links)and)
integrate!outcomes!informa2on)into)prac8ce)
! Reports)on)feedback)from)supervisors,)young)
people)and/or)parents))
! Summary)report)of)therapist s!clinical!
outcomes)over)the)training)period)

27. Three%major%components%of%the%CYP%IAPT%transforma6on%
2. Shift to collaborative
practice
Patient-reported
outcomes
Practitioner
Client
Clinical decisionmaking

28. Redressing!the!balance!of!exper2se!

29. Empowering)young)people)
Understand)and)
modify)treatment)
progress)via)PROMs)
Par8cipate))
in)service)design)
Par8cipate)in)training)of))
prac88oners)&)managers)

30. Empowering)young)people)enables)them)to….)
2.)Establish)
treatment)goals)
3.)Choose)the)treatment)
that’s)best)for)them)
1.)Take)control)of)
their)care)

31. Empowering)young)people)enables)them)to….)
4.)Improve)their))
own)health)

32. Three)major)components)of)the)CYP)IAPT)transforma8on)
3.)Transforma8on)of)par8cipa8ng)CAMHS)services)
Pa8ent)
preferences))
&)values)
BETTER)
Research)
Clinician)
evidence)
observa8ons)
CARE)

33. Adop8on)and)implementa8on)of)new)treatments)
More)than)a)technical)process,)a)social)process)
To obtain the desired outcomes, many
things must be in place
EBP)
Organiza8onal)
Social)Context)
Prac88oner)
AUtudes)&)
Behaviour)
Aarons,)Glisson,)Green,)et)al.,)2012)

34. MetaXanalysis)of)EBP)vs.)Usual)Care))
F(3,228)=4.18, p<0.007)
0.45)
0.4)
0.35)
0.3)
Effect 0.25)
Size 0.2)
0.15)
0.1)
0.05)
0)
Youth)
Parent)
Other)
Weisz et al., (2013) Do Evidence-Based Youth Psychotherapies Outperform Usual
Clinical Care? A Multilevel Meta-Analysis. Archives of General Psychiatry

35. Measurement!for!a!purpose:!
Guiding!treatment!to!beher!outcomes!
3)
TAU
EBP+Outcomes
Monitoring
EBP
2.5)
Number)of)diagnoses)Pre))
Number)of)diagnoses)Post))
2)
15%
33%
1.5)
1)
0.5)
0)
Usual care
Usual)Care)
Manualized therapy
Standard)Condi8on)
without Match
Therapy delivered on
Modular)
basis of Match
Weisz)et)al.)(2012).)Tes8ng)standard)and)modular)designs)for)psychotherapy)trea8ng)depression,)anxiety,)and)conduct)problems)in)
youth:)a)randomized)effec8veness)trial.)Archives%of%General%Psychiatry,%69(3),)274X282.)

36. Service)improvements)linked)to)EBP)
• Reducing!varia2on!in!referral!
rates!through)
• Improved)triage)and)
treatment)alloca8on)
• Improved)reahendance)
rates)
• Reduced)length)of)
unnecessary)treatment)
• Reduced)inpa8ent)care)

37. Service)improvements)linked)to)EBP)
• Reducing!varia2on!in!referral!
rates!
• Adop2ng!best!prac2ce!
• Pathway)management)
• Opera8onal)management)
• Improved)pa8ent)flow)
through)the)system)

38. Service)improvements)linked)to)EBP)
• Reducing!varia2on!in!referral!
rates!
• Adop2ng!best!prac2ce!
• Increase!staff!produc2ve!2me!
through)rigorous)redesign)of)
methods)and)skill)mix)

39. Service)improvements)linked)to)EBP)
• Reducing!varia2on!in!referral!
rates!
• Adop2ng!best!prac2ce!
• Increase!staff!produc2ve!2me!!
• Create!flow!and!eliminate!
waste!from)poorly)designed)
systems)and)the)consequences)
of)demand)generated)by)
failures)and)errors)

40. Service)improvements)linked)to)EBP)
• Reducing!varia2on!in!referral!
rates!
• Adop2ng!best!prac2ce!
• Increase!staff!produc2ve!2me!!
• Create!flow!and!eliminate!
waste!!
• Reduce!complexity!X)a)
significant)driver)of)costs)&)
errors)based)on)inefficient)
clientXtoXclinician)feedback)

41. Amount potentially saved
!
Annual)es8mated)savings)associated)with)
service)transforma8on)and)EBP)
40
£34,085
£27,000
30
20
10
0
£12,875
£3,430
2011-12
!
2012-13
!
2013-14
!
2014-15
!
Based on assumption of £3,000 as the average cost of a CAMHS case
80% of cases seen fall into the category where benefits from outcomes
monitoring and 63% where improvement associated with NICE prescribed
treatment is relevant

42. Strategies)for)sustaining)change))
• Participation embedded in the service and
organisation
• Involving commissioners
" Embedding outcomes monitoring in the teams
" CYP IAPT principles embedded in the overall
strategic model for CAMHS service delivery with
partner agencies
" Self referral growing in year 1 and 2 sites
" Improving supervision structures within teams

43. Sustainability of CYP-IAPT: Today
Governance Structure: feedback and learning
Quarterly
report
Sites%
FEEDBACK%
Collabora6ves%

44. Sustainability of CYP-IAPT: Today
Governance Structure: feedback and learning
Quarterly
report
Monthly%
Reports%
NHS
England
NHS IQ
Cabinet
Office
Data analysis by CAMHS Outcome Research Collaborative and Nexus
Lessons learned will be placed on the web

45. Knowledge)Management)to)Ensure)Sustainability))
“Best!value!
Mechanism!to!
Curricula!!
system!
facilitate!
&!case!
templates”)–)
knowledge!
Network!to!
management!
shared)with)all)
transfer!!
support!those!
approaches!
consor8a)as)a)
HEIs)to)
in!leadership!
for)par8cular)
model)of)
partnerships)to)
posi2ons)
disorders)
improvement)
commissioners)
across)NHS)

46. Sustainability)of)CYPXIAPT:)The)Future)
When)the)central)team)is)no)longer)present…)
Staff)turnover)
Changes)in)
funding)streams)
Modifica8on)
of)programme)
requirements)
Development)of)a)na8onal)system)of)quality)assurance)
• Training)
• Performance)
• Service)characteris8cs)
Management)Training)
• Organisa8onal)culture)
• Climate)

47. Sustainability+of+CYP1IAPT:+The+Future+
Development+of+a+Na?onal+System+of+
Accredita)on,

48. CYP)IAPT)X)The)Future)
• Programme)needs)to)demonstrate)effec2veness)and)
Key)Performance)Indicators)))
• MindEd!eXportal)allows)CYP)IAPT)curricula)to)be)placed)
on)web,)available)to)all)prac88oners)
• Outcome!monitoring!needs)to)be)built)into)all)clinical)
curricula!!
• Developing)a)workstream)to)support!commissioners!!
• Accredita2on)will)support)long)term)embedding)of)
CYP)IAPT)ideals)))

49. How are we perceived?
VIDEO
(YouTube link)

50. THANK&YOU&
&
Thanks&to&everyone&
&
THIS&HAS&BEEN&A&TRULY&COLLABORATIVE&
EXPERIENCE&