About us

We are…

Dr Ann York

Consultant Child and Adolescent Psychiatrist, and Clinical Team Leader South West London & St George’s Mental Health NHS Trust, Honorary Senior Lecturer, St George’s Medical School, London

And

Dr Steve Kingsbury

Consultant Child and Adolescent Psychiatrist,Hertfordshire Partnership Foundation Trust

We are both ordinary outpatient child and adolescent psychiatrists working in community multidisciplinary child and adolescent mental health teams (CAMHS). Like you, we struggle with relentless demands on our services, target pressures and lack of time.

We have been privileged in being able to visit other teams around the country in many roles. Some of this has been as colleagues, sharing ideas and practice. At other times it has been more formal. We are both reviewers for the Health and Social Care Advisory Service (HASCAS) and Ann was a clinical governance reviewer for the old Commission for Healthcare Improvement (CHI) and was clinical advisor to the Healthcare Commission until HC dissolved in 2009. She is a member of the Advisory group for the Quality Improvement Network for Multiagency CAMHS (QINMAC).

We have both been Honorary Secretary of the Faculty of Child and Adolescent Psychiatry of the Royal College of Psychiatrists. This experience has allowed us to make contacts nationally and have roles on working and advisory groups, developing and reviewing policy. All have helped us in our clinical jobs by understanding issues for grass root services and national directives and how the two can meet.  We have also both been the CAMHS advisor to the Department of Health in England. Steve in 2006 – 2007 and Ann from 2007 – 2009.

This is our ongoing story…

We have been fascinated in how CAMHS teams organise themselves for as long as we can remember. Our drive has always been passion for solving how to deliver high quality services to children and families whilst managing the targets and pressures on us without burning out!

Pressures of long waiting times and reduced funding in the context of rising referral rates benefited our services to rise to the challenge and be creative and redesign. Like most teams we found that some of these changes worked and others didn’t or weren’t sustained.

In 2003/4 we did training in demand and capacity theory, Steve from the Modernisation Agency in Leicester and Ann from the London Learning Partnership and through the National Institute for Mental Health (England, NIMHE) training in her Trust. We suddenly understood why some of the changes in our services had worked and others hadn’t. Demand and Capacity theoretical understanding enabled us to design systems that were likely to work rather than using our previous methods of trial and error!

In the summer of 2004 we wrote the 7 HELPFUL Habits of Effective CAMHS to make demand and capacity theory friendly for us and our colleagues. A few months later the Modernisation Agency published ‘10 High Impact Changes for Service Improvement and Delivery’ (NHS Modernisation Agency, 2004). This excellent guide validated our ideas but was still acute service focussed.

The first workshops we ran were at the annual conference of Child and Adolescent Psychiatrists in September 2004. There we described a mythical service, CAMHS on the Wold, who used traditional models that ended up holding them back. We linked their processes to demand and capacity theory and helped people think about what would work better.

Following this we had requests to run more detailed days on demand and capacity management in CAMHS. We ran our first in January 2005 at the King’s Fund in London, inviting clinicians and managers. Such was the interest we held further national workshops that year and soon had requests to visits regions of the country and whole teams.

At these original workshops we concentrated on the 7 HELPFUL Habits and how to use them. We described very little about the clinical system we used in our own services that originated from the Habits.  But people naturally wanted to know what we had done in our teams and we adapted workshops in response to this curiosity.

We were aware of why our clinical system worked, based on demand and capacity theory and others became curious too. So in response to this we began to describe it in more and more detail, and labelled the overarching model and it’s principles the Choice and Partnership Approach (CAPA). Our first book, The 7 HELPFUL Habits of Effective CAMHS and the Choice and Partnership Approach: a workbook for CAMHS, went to two editions (2005 and 2006), the second giving further detail about CAPA in response to requests to know more. 2005 also saw the launch of the website www. camhsnetwork.co.uk to further support teams wanting to change.

At the time of writing (August 2011), we have run over 100 workshops, in all the countries of Britain, in Ireland and Belgium, spent weeks in New Zealand as well as workshops in Australia (Perth and Sydney). Although most of our work has been with CAMHS we are now beginning to work with learning disability, adult mental health (esp. in New Zealand) and paediatrics too!

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