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Development of a framework for prospective payment for child mental health services
Panos Vostanis1, Peter Martin2, Roger Davies3
1Professor of Child Psychiatry, University of Leicester, UK pv11@le.ac.uk.
Insights
Developing a fair payment system for child mental health services requires considering complexity, indirect activities, and outcomes, not just diagnosis. This improves targeted commissioning based on need and evidence-based care.
Area of Science:
- Health Services Research
- Child and Adolescent Mental Health
- Healthcare Payment Systems
Background:
- Current payment systems for child and adolescent mental health services (CAMHS) lack targeted commissioning due to limited clinical consensus, practice variation, and insufficient data on activity and outcomes.
- A national initiative in England aimed to address these limitations by developing a foundation for an improved payment system.
Purpose of the Study:
- To develop a basis for an improved payment system for child and adolescent mental health services.
- To enable more targeted commissioning based on fairness and need.
Main Methods:
- Qualitative consultation with CAMHS stakeholders (n=271) via surveys and workshops.
- Review of 15 national clinical guidelines.
- Quantitative analysis of resource use in 1774 children across 23 CAMHS teams.
Main Results:
- Stakeholders emphasized defining need beyond diagnosis, incorporating indirect service activities and outcome measurement.
- Clinical guidelines highlighted best practices but omitted contextual factors like complexity.
- Problem type and impairment level predicted resource use, with significant service variation observed.
Conclusions:
- An episode-based payment framework for CAMHS should integrate complexity, indirect activities, evidence-based care packages, and outcome measurement.
- Addressing diverse needs, including impairment and symptoms, is crucial.
- Standardized outcome measurement is essential for fair and effective commissioning.
Objectives:
There is a need to develop a payment system for services for children with mental health problems that allows more targeted commissioning based on fairness and need. This is currently constrained by lack of clinical consensus on the best way forward, wide variation in practice, and lack of data about activity and outcomes. In the context of a national initiative in England our aim was to develop a basis for an improved payment system.
Methods:
Three inter-related studies: a qualitative consultation with child and adolescent mental health services (CAMHS) stakeholders on what the key principles for establishing a payment system should be, via online survey (n = 180) and two participatory workshops (n = 91); review of relevant national clinical guidelines (n = 15); and a quantitative study of the relationship between disorders and resource use (n = 1774 children from 23 teams).
Results:
CAMHS stakeholders stressed the need for a broader definition of need than only diagnosis, including the measurement of indirect service activities and appropriate outcome measurement. National clinical guidance suggested key aspects of best practice for care packages but did not include consideration of contextual factors such as complexity. Modelling data on cases found that problem type and degree of impairment independently predicted resource use, alongside evidence for substantial service variation in the allocation of resources for similar problems.
Conclusions:
A framework for an episode-based payment system for CAMHS should include consideration of: complexity and indirect service activities; evidence-based care packages; different needs in terms of impairment and symptoms; and outcome measurement as a core component.
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