Funded by: NHS Service Delivery and Organisation
National Research & Development Programme (SDO)
Ethical approval reference: MREC 04/6/23
COSI CAPS Report
Background:
Different types of in-patient psychiatric care are provided for
young people including NHS, independent, specialised, general and
adult psychiatric wards (NICAPS, 2001). In-patient CAMHS are highly
specialised and effective (Green et al, 2001) but costly services,
which require central planning to ensure that they are available to
all who need them. To facilitate this availability, we need to find
out whether the different types of services for young people are
contributing to their varying clinical and social outcomes. It is
hoped that the findings to emerge from this study will influence
the development of these specialist services.
Research question:
Do services differ in terms of their a) cost, b) clinical and
social outcomes and c) the experience and satisfaction for the care
received?
COSI-CAPS: Main findings and
conclusions
1.
In the absence of alternatives of proven effectiveness, there is a
continuing role for CAMHS inpatient units in
England
Young people admitted to
inpatient units have more severe problems than those treated by
existing community services, improve substantially during their
inpatient stay and are generally satisfied with their care.
However, these findings must be considered in the context of very
limited research about the effectiveness, safety and cost of
alternatives to inpatient care for young people in England. It is
possible that some of the young people admitted to these units
could have been cared for as well by intensive community services.
For other young people such community services could shorten the
duration of the hospital stay.
2.
With the current configuration of services, the independent sector
is an indispensable element of tier 4 CAMHS
It provides the
commonest place for emergency admissions and produces outcomes that
appear to be as good as those achieved by the NHS.
3.
With respect to eating disorders, specialist units tend to admit
young people with more severe problems than general adolescent
units
At discharge, the
severity of problems is the similar for both groups.
4.
Clinical outcome is affected by treatment climate and specifically
by ward atmosphere
5.
Patients and parents place great value on the attitudes and
interpersonal and communication skills of staff
These attributes might
be actively considered at job interviews, discussed during
supervision and might be assessed by eliciting feedback from young
people and parents perhaps as part of a 360-degree assessment that
might form one component of staff appraisal.
6.
The use of agency nurses to cover shifts adversely affects young
people’s experience of care
The last review cycle of
the Quality Network for Inpatient CAMHS (QNIC) highlighted the
problems faced by units with recruitment and recommended that
unavoidable long-term absences should be covered by bank as opposed
to agency staff.
7.
The level of satisfaction experienced by patients and parents is
influenced by the quality of information that units provide
about the young person’s problem and treatment, and about the
unit itself
8.
Young people with an eating disorder have mixed feelings about
whether it was better to be admitted to a specialist unit or
to a general unit
With regard to the
former, staff in specialist units should be aware that there can be
counter-therapeutic interactions between young people with an
eating disorder who live together.
9.
It is feasible to collect information about clinical status and
outcomes routinely for admissions to CAMHS units
The team that led the COSI-CAP
study have worked with colleagues managing the Quality Network for
Inpatient CAMHS (QNIC) to build on this by offering units the
opportunity to continue with data collection as part of a system
for allowing inpatient staff to monitor outcomes and compare
casemix and outcomes with other units (see
QNIC-ROM)