Outcome Research and Interagency Work with Children: What Does it Tell us About What the CAMHS Contribution Should Look Like? Anne Worrall-Davies* Leeds Institute of Health Sciences, School Of Medicine, University of Leeds, Leeds, UK David Cottrell School of Medicine, University of Leeds, Leeds, UK
Child and adolescent mental health (CAMH) services in the UK have a long history of multiagency working. In this article, we explore the difﬁculties in agreeing an evidence-base for interagency work, and describe some of the challenges this poses for practitioners and service planners. We use current literature to outline the barriers and facilitators to good multi-agency practice and explore the outcomes of integrated professional work with children and young people, the development of ‘comprehensive CAMHS’ positions, and CAMH work as an exemplar of a multiagency service. Ó 2009 The Author(s). Journal compilation Ó 2009 National Children’s Bureau.
In this article, we aim to deﬁne and explore the meaning of evidence-based practice, examine the difﬁculties inherent in agreeing an evidence base for interagency work, and describe some of the challenges this evidence base poses for individual practitioners when deciding on interventions for individual young people and for service planners responsible for conﬁguring multi-agency services. We will use the current literature to demonstrate what factors and aspects of multi-agency work act as barriers or facilitators to such good practice and explore the outcomes of integrated professional work with children and young people. Many countries have seen an increased emphasis on integrated work with children and young people, sometimes referred to as ‘joined-up’ working. Indeed, this is now embedded within the culture of working practices and legislation, although its practical exposition is perhaps more patchy. Alongside this development, has been a focus on ‘outcomes’ as a desirable measure of service delivery. There is an increasing body of evidence emerging concerning the effectiveness of interventions in Child and Adolescent Mental Health Services (CAMHS), but this body of evidence is not always easy to interpret. We will ﬁrst deﬁne evidence-based practice and outline its development over the last decade.
What is ‘evidence-based practice’?
Recent interest in the health service in ‘evidence-based practice’ has its roots in the Department of Health Evidence Based Medicine Working Group (1992) at McMaster University in Ó 2009 The Author(s) Journal compilation Ó 2009 National Children’s Bureau
Outcome Research and Interagency Work with Children in CAMHS
Canada. This group became concerned about the way that treatment decisions in physical medicine were often based on unsystematic observations from clinical experience and described a ‘paradigm shift’ they felt would be required for the implementation of an evidence based medicine, where clinical experience would still be crucial, but systematic reproducible observations would become the fundamental basis for taking clinical decisions. An important principle was that clinicians should be ready to accept (and live with) uncertainty, because clinical decisions are often made in relative ignorance. In the UK, David Sackett, a founder member of the EBM Working Group, was appointed chair of Medicine at Oxford in the early 1990s and has been inﬂuential in promoting this model of evidence-based practice (EBP) across the UK. Although these ideas have grown out of practice in physical medicine, the principles are just as applicable to multi-agency CAMHS and come at a time when here has been an exponential increase in published research, technological developments in electronic databases that allow access to that research, a growing consensus about what constitutes evidence, and the concurrent development of a set of techniques...