Enhancing Children and Young People’s Mental Health Services: A Quality Improvement Project on Routine Outcome Measures

The Kent and Medway Children and Young People’s Mental Health services conducted a Quality Improvement (QI) project aimed at optimising the utilisation of Routine Outcome Measures (ROMs), which has been implemented to increase compliance but also to build a qualitive foundation on which to make clinical and service-based decisions. The project aim was to increase compliance of paired outcome scores (known as the CQUIN report) from 20% in 2022 to 50% by 2024. The CQUIN improvements have received additional investment from ICB’s and not meeting targets can result in financial penalty. The team talks about outcomes, learning and next steps:

Impact of the QI Project

The successful implementation of this project led to significant outcomes:

• Increasing administration of ROMs increases the presence of patient voice within the service
• Through data cleansing the service was able to demonstrate that they were compliant with the target of 50% on average across the service  
• The entire workforce gained a deeper understanding of the clinical relevance and importance of ROMs via training, focused on clinical importance of administering ROMs rather than on paired score compliance which was viewed by staff as a non-clinical task. As a result, staff are more invested in the use of ROMs for clinical decision making and evidencing progress
• ROMs champions role defined and implemented in teams (Assistant Psychologists) to champion the agenda and support both existing and new staff. This role has increased understanding and use of digital tool (ICAN) and keeps the focus on ROMs within the teams. Regular meetings were held to monitor their activity and validate that they were carrying out the recommendation for their role in the guidance
• A fully trained workforce became proficient in administering ROMs and recording data using ICAN. Ensuring that staff understood that outcomes data is taken from ICAN only and if outcomes are recorded elsewhere on EPR, they are not counted and only able to be captured via manual audit, which is not sustainable
• Supervisors can use the CQUIN data and the ICAN individual patient charts to increase ROMs activity and to make clinical decisions for individual patients
• The Eating Disorders service, previously one of the poorest performing teams, emerged as one of the best during the project. The service selected the most useful outcome measure for their patients and the service. After reviewing their internal processes, they were able to identify a frequency of administration that made best clinical sense and satisfied compliance. The service went from 13% compliance in October 2022 to 52% compliance by March 2024. Maintaining this is in phase 2 of the project.

What have your learned about this process as a team?

• That thorough process mapping and planning is essential at the project outset  
• Do not consider options and actions until you have understood the challenge
• All recommendations need to be implemented for the outcomes to be achievable
• All levels of personnel need to be involved throughout to respond in an agile way on behalf of their peers

What advice would your team give to colleagues who may want to follow suit and implement your project for their service?

• Map your current process thoroughly, including issues, touchpoints and stakeholders
• Carry out a confidence and skills audit of staff
• Understand your data and work closely with performance colleagues
• Take time to understand the needs of each clinical pathway to select measuring tools that hold the most value for the patient and the clinical approach being applied
• Identify the benefits of improving performance for each stakeholder to ensure investment and ease of change management

Dissemination and Future Steps

• Complete the data cleanse across the service and update the locality/service QI plans to reflect the review
• Produce accurate data for each team and calculate a compliance percentage based on eligible cases – resulting in accurate percentage figures per team
• Meet with senior clinicians to explore how ROMs can be implemented for cases that are on Medication Care Plan
• Monitor data for all services over the next 4 quarters as we are expecting an upturn in activity
• Validate that supervision oversight is fully implemented across the service
• Further investigate how we can maintain keeping the data ‘clean’
• Monitor the utilisation of the CQUIN report to validate that the key staff are routinely accessing the data (performance team)
• Produce a monitoring schedule quarterly
• Update the guidance to include new recommendations following the data cleanse
• Produce qualitive data reports (quality of outcomes per pathway/service) once we are assured ROMs activity is at a reliable level
• Run a Trust Learning Event alongside the QI team so that all our services can access the learning from this project
• Rerun ROMs training for all staff with a strong recommendation they attend – keep register to monitor investment in process
• Run the new supervisor training to utilise the CQUIN report to continue to deliver increased accountable activity.

Overview

Sarah Thornby, the Digital Pathway Lead for CYPMHS Kent, states:

Application of this learning will continue to improve our paired patient outcome scores as well as the volume of outcome data. Once volume is achieved, we can introduce qualitative reporting to enable us to confidently use collated ROMs data to evidence effectiveness of treatment. We can then use this make clinical and service developmental decisions, ensuring that our service users voice is central to our service delivery.

As a result of being able to demonstrate compliance through data cleanse activity and evidence significant service investment, in this priority Kent and Medway did not receive a financial penalty at the end of last year. They continue to invest in patient outcomes and service user voice.