Routine outcome monitoring in CAMHS: how can we enable implementation in practice?

Abstract

Background Many CAMHS teams across the UK are now required to use Routine Outcome Monitoring (ROM). However, some clinicians hold negative attitudes towards ROM and various practical implementation issues have been identified. Method The aim of this study was to explore clinician experiences of using ROM in the context of an ‘enforced’ initial implementation initiative. Twenty clinicians were surveyed at the beginning (T1) and end (T2) of the six-month period in a large UK CAMHS network adopting CYP-IAPT practice. Changes in the use of and attitudes towards ROM were investigated, as well as barriers to implementation. Results Overall, a small but significant increase in clinician use of ROM was observed from T1 to T2, but attitudes towards ROM did not change significantly. On the whole, clinicians were more positive than negative about ROM during the implementation period, but key implementation challenges included clinician concerns about the value and (mis)use of ROM data, poor technological support and additional workload demands. Conclusions CAMHS clinicians will not necessarily become more receptive to ROM simply as a by-product of being asked to use it more. Seeking clinician feedback at the early stages of implementation can help provide a focus for improvement efforts. Ideas for future research and important limitations of the study are discussed.

Challenges in Investigating the Effective Components of Feedback from Routine Outcome Monitoring (ROM) in Youth Mental Health Care

“…There might have been confusion about which clinician was supposed to discuss the feedback with which participant (child or adolescent and parents), with the consequence that no discussion of the feedback took place. Previous research has consistently confirmed that mental health clinicians only infrequently engage in ROM practices in both adult and child mental health care (e.g., Lyon et al 2016;Mellor-Clark et al 2016;Waldron et al 2018). Specifically, Bickman et al (2016) and Brattland et al (2018) showed a direct effect of successful implementation of ROM on treatment outcome.…”

Implementation of the norwegian ‘Starting right’ child health service innovation: implementation adjustments, adoption, and acceptability

“…Routine outcome monitoring—for example, in mental health services—is considered important to individualize care and use resources effectively. The implementation of such systems in collaboration with, and training of clinicians is needed [ 19 ]. The relatively high adoption among CSHNs using the tool in the pilot implementation phase indicates that such collaboration was welcome and that it was possible to manage appropriately.…”

“…Besides the implementation of an online child health assessment tool, the project also changed clinical routines by integration of parent-reported measures and structured decision support. Even though structured screening is supported for identification, decision support, and evaluation in the literature [15][16][17][18][19][20], implementation of such routines and tools comes in addition to online systems implementation. New routines, tools, and systems might thus interact to both enhance and reduce nurses' and parents' adoption and acceptability, respectively.…”

“…This has also been confirmed at a global level [ 21 ]. Universal screening and routine outcome monitoring can in addition improve earlier identification of child problems [ 16 ], create opportunities for evaluation of early interventions and preventive services [ 17 ], enhance user involvement and communication with families as well as interdisciplinary collaboration [ 18 ], and help services improve [ 19 ]. Hence, Norwegian child and school health centers may benefit from implementation of structured screening assessments.…”

“…In a systematic review, Lines et al [15] reported that nurses worldwide working with children at risk at all levels of health services hesitate to act for fear of damaging the parent-professional healthcare worker relationship, and that they request enhanced decision support. Structured evidence-based assessment tools may provide such decision support, in addition to several opportunities and gains [16][17][18][19][20][21]. For instance, population-based screening of general mental health using the Strength and Difficulties Questionnaire (SDQ) has been implemented successfully in Scotland, and is reported to add valuable decision support and to identify more cases for interventions [20].…”