Eight Months to Eight Weeks: Reducing Waiting Times in a Child and Adolescent Mental Health Service
| Published date | 01 June 2004 |
| Date | 01 June 2004 |
| Pages | 15-19 |
| DOI | https://doi.org/10.1108/13619322200400015 |
| Author | Ann York,Yvonne Anderson,Morris Zwi |
| Subject Matter | Health & social care |
Eight Months to Eight Weeks: Reducing
Waiting Times in a Child and
Adolescent Mental Health Service
Ann York
Consultant Child and Adolescent
Psychiatrist
St. George’s Mental Health NHS Trust
Yvonne Anderson
Service Development Adviser
HASCAS
Morris Zwi
Consultant Child and Adolescent
Psychiatrist
St. George’s Mental Health NHS Trust
Case Study
Introduction
Many child and adolescent mental health services
(CAMHS) struggle with increasing demands, long
waiting lists and keeping waiting times for first
appointments to within government guidelines. An
audit of 7,000 successive new referrals to CAMHS
found that the average number of attendances was
4.52 and only 11% of families were still in treatment at
six months. Eighty-five per cent of families attended
six sessions or fewer and 32% were only seen once
(Hoare et al, 1996).
Clinicians may believe that families and children
need long-term treatment, yet we know from our
experience and the literature that most will not engage
in long-term interventions. Dropout rates increase as
the waiting time for an initial appointment increases,
and 30 weeks appears a crucial cut-off after which
most families give up. Providing brief, focused
interventions is one approach and some CAMH
services have found offering as few as three sessions to
be helpful. Seeing families relatively quickly, yet
perhaps not sooner than a month, may be ideal
(Foreman & Hanna, 2000). Combining the two
strategies results in a potential model for providing
brief, focused interventions over three to eight
sessions within a period of four to 30 weeks of referral.
There is a growing literature on the use of brief
interventions for managing child and adolescent
mental health problems. Stallard and Sayers (1998)
describe an opt-in, brief three-session problem-
solving, empowerment approach developed in their
CAMHS. Average initial HoNOSCA scores were 9.23
(range: three to 25). The majority of families were
satisfied with the service they received and both they
and their clinicians indicated an improvement in
symptoms at the end of contact.
Goldberg and Campbell (1997) also describe a
three-session approach developed in their community
adolescent service. They use techniques from
solution-focused therapy, brief motivational
interviewing, interventive interviewing and cognitive
behavioural strategies in a collaborative model of
working with families. Both they and Weltner (1982),
who also uses a three-session model, report that the
method produces change and is seen as helpful by
families. Spoth et al (2000) describe a seven-session
intervention for parents and young adolescents that
was successful in reducing aggressive and hostile
behaviours.
Partridge et al (1999) developed a brief, focused
family therapy service and reported that 48% of
families were seen on one occasion, 26% on two
occasions, 15% on three occasions and 11% on four or
more occasions. Of the 30 families whose treatment
was completed, only two were re-referred within a
year of discharge. Allison et al (2000) reported that
brief therapy resulted in significant improvement in
the majority of the children seen in their service but
The Mental Health Review Volume 9 Issue 2 June 2004 ©Pavilion Publishing (Brighton) 2004 15
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