Implementing service transformation in a recession environment: findings from a qualitative evaluation of Children and Young People IAPT (CYP IAPT) Aris Komporozos-Athanasiou and Louise Lafortune*, University of Cambridge Background DOH 1 aims to expand Children and Adolescent Mental Health Services (CAMHS) to cover 60% of children and young adults in England by 2016, through “whole system transformation” powered by staff and managers training in evidence based practice, and routine outcomes measure (ROMs). Five Learning Collaboratives made up of local CAMHS partnerships (composed of NHS trusts, local authorities, voluntary sector organisations) and Higher Education Institutes have been set up to make this happen. And expansion is ongoing, with new partnerships being formed across the country. In the context of an economic recession, the dual challenge for the NHS is to transform CAMHS while managing the increased strains placed upon those who deliver (transforming) frontline services. NIHR CLAHRC Cambridgeshire & Peterborough Con References 1. DoH 2010 / 2. Doh 2012 / 3. Exworthy 2012 / 4. Pettigrew 1988 / 5. Dopson 2003 / 6. Census 2011 / Ferlie *Contact: Louise Lafortune at Objective & approach According to DoH 2, this challenge can be addressed through ‘sharing the success stories’ and through demonstration of the value of CYP IAPT, especially from the perspective of service users & frontline staff. We conducted a case study to examine how the shift towards an evidence-based environment and a focus on ROMs is negotiated in practice with other aspects of clinical work within the service, such as organisational culture, teamwork, and service user involvement. This work is part of a comprehensive evaluation, which looks at the implementation, outcomes and cost of CYP IAPT. Findings Perceived problem 1: Lack of buy-in from front line staff & low morale as a result of continuous organisational changes, cost cutbacks. Emergent solutions: Transformation should be operationalized in organizational governance (not as abstract concept) CAHMS managers should better engage with staff’s concerns around how IAPT data is used in relation to ‘performance management’ Reporting systems should be easy to use by staff Conclusions Our case study highlighted specific tensions that should be addressed for transformation to succeed. We suggest that more attention be paid to the cultural meanings of implementation and the emerging realities of networked governance that are needed in CYP IAPT. Methods Theoretical framing We conceptualize transformation not simply in relation to ‘clinical practice’ but also as a change in dominant ideologies, the underlying cultural systems of meaning, and the shifting power relations within the service. 3-5 Design Interpretative case study at the CAMHS in Cambridge (Dec 2012 – June 2013); part of the UCL/KCL Learning Collaborative which covers an estimated population of 1.3M aged 0-19 years. 6 Data sources Document analysis of CYP IAPT guidance notes, implementation records, meeting agendas and minutes covering a period of 18 months. In-depth interviews (n=11) with key stakeholders (Trust and clinical managers, consultant psychologists, CYP IAPT trained staff, voluntary representatives). Non-participant observation of meetings and related events (n = 6); and informal discussions. Findings Perceived problem 2: Collision of ethos between the multi-partnership and multi-agency culture of IAPT and the structure of health authorities resulting in the latter loosing touch of day-to-day enactment of transformation. Emergent solutions: (Some) members of the executive should be part of transformation steering boards Efficient integration of stakeholders from the voluntary sector, schools and commissioning groups Establishing and maintaining informal communication channels alongside formal meetings is very important Perceived problem 3: Conflict between evidence-based requirements and requirements of day-to-day clinical practice (e.g. appropriateness of ROMs re severity; perception of relevant ROMs varies among clinicians) Emergent Solutions: Embed conversations about putting ROMs into practice in team meetings to promote collaboration, discussions around the meaning and importance of different types of evidence. 7 Establish a clear mandate for service user involvement.