1. NICE Quality Standard 48: Depression in children and young people An audit of adherence to Quality Standards within Camhs Dr. Angela Brennan Principal Clinical Psychologist Dr. Qamaar Jabeen Specialist Registrar

2. Background  NICE Quality Standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health care.  NICE Quality Standard 48 (September 2013) covers the diagnosis and management of depression in children and young people aged between 5 and 17 (up to their 18 th birthday).

3. Goals of Audit  To evaluate adherence to NICE Quality Standards and to identify areas of strength and weakness  To provide Action Plan to improve:  Adherence  Service delivery  Service user experience  Audit evaluated Denbighshire Camhs against 5 Quality Standards. Some data from Conwy Camhs  BCUHB Audit department approval received in August 2014

4. Audit  Retrospective design  Referrals to Camhs from January 2014  22 case files reviewed in Denbigshire Camhs and 22 in Conwy  Data was anonymised  Excel used for data collection  Descriptive statistics used  Data stored on password protected document on BCUHB encrypted laptop.

5. Quality Statement 1  Children and young people with suspected depression have a diagnosis of depression confirmed and recorded in their medical notes (following confirmation after Primary Mental health assessment undertaken). 5 17 Denbighshire

6. Quality Statement 1 15 5 2 This highlights that a significant proportion of young people whose difficulties meet criteria for clinical depression are not having this clearly or explicitly explained to them. This has potential implications for them and their parents / carers. Of the 22 cases reviewed, a number of young people with suspected depression, (who on assessment met criteria for depression) were either recorded as “low mood” instead of depression, or no diagnosis at all was recorded in the notes or letter Denbighshire

7. Quality Statement 2  Children and young people with depression are given information appropriate to their age about the diagnosis and their treatment options ConwyDenbighshire

8. Quality Statement 3  Children and young people with suspected severe depression and at high risk of suicide are assessed by Camhs professionals within a maximum of 24 hours of referral. Conwy and Denbighshire

9. Quality Statement 4  Children and young people with suspected severe depression but not at high risk of suicide are assessed by Camhs professionals within a maximum of 2 weeks referral Denbighshire

10. Quality Statement 5  Children and young people receiving treatment for depression have their health outcomes recorded at the beginning and end of each step in treatment ConwyDenbighshire

11. Conclusions  Adherence to Quality Standards is variable  QS 1 – Low adherence – Identified ambivalence in some Camhs clnicians in giving depression diagnosis  QS 2 – Partial adherence – Denbighshire less likely to give or record giving information about depression or tx options to children and young people (link to diagnosis)  QS 3 – Adherent to assessing suspected severe depression and high risk of suicide  QS 4 – Partial adherence. Wales target at time of audit was 4 weeks – adherent to that  QS 5 – Partial adherence in recording outcomes routinely

12. Recommendations Quality Statement 1  Where depression is evident, children, young people and families are explicitly informed and that this is documented in letter written to family / referrer  Team training issue – diagnosis: depresssion v low mood Quality Statement 2  Information about depression and treatment options for depression needs to be more routinely given to children, young people and parents / carers, which is age appropriate (or documented that it has been given) Quality Statement 3  Achieved!

13. Recommendations Quality Statement 4  Welsh Government target from October 2015 is to see all urgent referrals within 48 hours – not achievable currently Quality Statement 5  Training in use of routine monitoring of Outcomes to be delivered  Develop local plan within teams to support initial and ongoing implementation (e.g. Clinical supervision)  Identify Outcomes lead / Champion in each team Overall – Repeat audit in 12 months time

14.  Questions?