Reducing Non-Attendances and Improving Health Equity within the Neurodevelopmental Team at City and Hackney CAMHS
By Lorraine Dick-Charova (Clinical Team Lead for NDT) and Rebecca Itlas (Assistant Psychologist)
City and Hackney CAMHS launched a Quality Improvement (QI) project to reduce Missed Appointment rates within our neurodevelopmental pathway. This Tier three specialist service, serving a diverse population in Hackney and the City of London, observed a high number of missed appointments, particularly among young people living in postcode areas suggestive of multiple deprivation.
Guided by the Advancing Mental Health Equalities Strategy (NHS England & NHS Improvement, 2020) and recognising the intricate intersectionality of race and class in the UK (Khan & Shaheen, 2017), the core of the project is the commitment to reduce missed appointments amongst young people residing in postcode areas marked by multiple deprivation, thus improving access to our service and reducing mental health inequity.
Fig 1. Notice board is the reception area. This was useful in inviting young people, parents and staff to share their thoughts on non-attendances.
Suggestions for change ideas were gained from post-it note boards placed in the reception area and staff kitchen, allowing young people, parents, and staff to share their thoughts on non-attendances (Fig 1). An open day further facilitated community engagement, providing valuable insights into the reasons behind why appointments may not be attended. Following this we developed a driver diagram (Fig 2)
Fig 2. Theory of change setting out what we believe will contribute to reducing our non-attendances – Those who did not attend scheduled appointment).
The primary outcome of our quality improvement project was the creation of welcome leaflets outlining our missed appointments policy. These leaflets were disseminated in bionic reading format, catering for the needs of our neurodiverse service users. They were also translated to common languages spoken within the borough such as Yiddish and Turkish, ensuring that vital information and policy is accessible and meaningful to all services users and families.
Our most recent data (Fig. 3) shows a show a reduction in our non-attendances, from an average of 21.9% to an average of 10.5% following testing of automatic text message reminders. We continue to test and refine this change idea.
Fig 3. Chart showing our weekly DNAs within NDT team at City and Hackney CAMHS.
Future steps include developing the service’s website and continuing to refine our approach based on ongoing feedback and data analysis. Our team remains committed to improving access and reducing mental health inequalities for all service users.
We attribute the success of our project to the active inclusion of service users and carers in our Project team. We made time to explore the power differential that exists between clinicians and those they aim to serve, but also before starting our QI project, we reflected on how power can also operate within our QI Project Team. In naming this power imbalance, we collaborated on a terms of reference that addressed ways to mitigate these imbalances and the distress and iatrogenic harm (Taylor & Clarence, 2021) that they may cause.
