Setting

This audit was performed in a child and adolescent mental health service (CAMHS), but can be adapted to any service where there is frequent interaction with non-mental health organisations such as social services or education.

Background

Multidisciplinary approaches to complex cases referred to CAMHS are both mandated and necessary, but multidisciplinary working is time-consuming and resource intensive, especially where processes are not functioning optimally. CAMHSs are envisioned as providing a mix of direct and indirect (consultation and liaison) services. The approach requires communication between agencies with different backgrounds, roles and working practices. The aim of this audit was to assess the use and outcome of time allocated for this purpose.

Standards

The standards were derived from principles laid down in the National Service Framework (Department of Health, 2004), Every Child Matters (Chief Secretary to the Treasury, 2003) and Good Medical Practice (General Medical Council, 2006):

ᐅ Referral pathways, the organisational process and the aims of the consultation should be clear.

ᐅ Communication, discussion and decisions should be documented and accessible after the consultation.

ᐅ Attendance should be documented and named workers should be made responsible for recommended actions.

Method

Data collection

The process used to arrange consultations with non-mental health organisations was identified. Notes from those consultations were located to determine the presence of the following:

ᐅ the attendees and their designations

ᐅ the discussion, decision and action plans.

Data analysis

The percentages of cases in which information was clearly documented according to the above standards were calculated.

Resources required

People

This audit can be carried out by a single person of any discipline, although in large services more than one person may be required.

Time

The time required will depend on the size of the sample and the process in place locally. In the first stage of the audit, data collection took around 20 hours for 115 potential cases, from which only 12 relevant cases were found. In the second stage only 4 hours was required for 28 potential cases, from which 14 relevant cases were found, with two auditors in each case.