Introducing a single point of access (SPA) to child and adolescent mental health services in England: a mixed-methods observational study

Abstract

Background: In many high-income countries, primary care practitioners are the main point of referral for specialist mental health services. In England, Child and Adolescent Mental Health Services (CAMHS) are increasingly adopting a Single Point of Access (SPA) to streamline referrals and introduce self and parent/carer-referrals. This involves a significant shift of responsibility from primary care towards CAMHS who adopt a more active role as gatekeeper for their service. This study evaluates the adoption of a SPA in CAMHS across a large region in England. Methods: We conducted an observational mixed methods study in two CAMHS from January 2018 to March 2019 to evaluate the adoption of a SPA. We collected quantitative data from electronic patient records and qualitative data through ethnographic observation and in-depth interviews of staff and stakeholders with experience of using CAMHS. Additional data on volumes was shared directly from the SPAs and a further snapshot of 1 week's users was collected. Results: A similar SPA model emerged across the two services. Staff were positive about what the model could achieve and access rates grew quickly following awareness-raising activities. Despite the initial focus being on a telephone line, online referrals became the more regularly used referral method. Increased access brought challenges in terms of resourcing, including identifying the right staff for the role of call handlers. A further challenge was to impose consistency on triage decisions, which required structured information collection during the assessment process. Similar to GP referrals, those self-referring via the SPA were mainly from the least deprived areas.

How does reorganisation in child and adolescent mental health services affect access to services? An observational study of two services in England

“…In both Bucks and Oxon, the numbers of people accessing SPA climbed quickly following initial awareness-raising activities [ 22 ]. While much of the emphasis on SPA was on the phone line, as the service evolved, increasing numbers of requests were received online, as described in more detail by Rocks et al [ 22 ] The introduction of the SPA was associated with an increase in self-referrals, both from carers and children and adolescents, and a fall in the proportion of referrals from primary care [ 22 ].…”

“…(Staff Interview) [22] "We are meant to do two days a week in SPA, but because we've had so many calls. .…”

“….And definitely probably work an extra hour at least each day, and don't take a lunch." (Staff interview) [22] Barriers. Destabilising a strained system.…”

Perceptions of the key components of effective, acceptable and accessible services for children and young people experiencing common mental health problems: a qualitative study

“…For families self-referral enabled them to bypass the barriers created by gatekeepers, while for practitioners self-referral enhanced the quality of referral information as this came directly from CYP and parents themselves. Other studies have similarly suggested that self-referral can overcome some of the access barriers CYP experience [ 17 , 44 – 47 ], although the role self-referral plays in improving the quality of referral information for practitioners has not been previously recognised. Self-referral is dependent on CYP/parents being aware of what services are available and the opportunity for self-referral.…”

Mental well-being and school exclusion: changing the discourse from vulnerability to acceptance

“…Care and Department for Education 2017) and translated into a number of different strategies, including dramatic changes or 'Transformation' in child and adolescent mental health services (CAMHS) (Rocks et al 2020) as well as new initiatives to increase school-based provision and student-facing services (Wolpert M 2016). The school changes include encouraging schools to internally appoint a mental health lead as well as a new professional cohort of 'Educational Mental Health Practitioners' to provide early intervention and support to schools and pupils.…”