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COSI-CAPS: Main findings and conclusions
1. In the absence of alternatives
of proven effectiveness, there is a continuing role for CAMHS
inpatient units in England
Young people admitted to inpatient units have
more severe problems than those treated by existing community
services, improve substantially during their inpatient stay and are
generally satisfied with their care. However, these findings must
be considered in the context of very limited research about the
effectiveness, safety and cost of alternatives to inpatient care
for young people in England. It is possible that some of the young
people admitted to these units could have been cared for as well by
intensive community services. For other young people such community
services could shorten the duration of the hospital stay.
2. With the current configuration
of services, the independent sector is an indispensable element of
tier 4 CAMHS
It provides the commonest place for emergency
admissions and produces outcomes that appear to be as good as those
achieved by the NHS.
3. With respect to eating
disorders, specialist units tend to admit young people with more
severe problems than general adolescent units
At discharge, the severity of problems is the
similar for both groups.
4. Clinical outcome is affected
by treatment climate and specifically by ward
atmosphere
5. Patients and parents place
great value on the attitudes and interpersonal and communication
skills of staff
These attributes might be actively considered
at job interviews, discussed during supervision and might be
assessed by eliciting feedback from young people and parents
perhaps as part of a 360-degree assessment that might form one
component of staff appraisal.
6. The use of agency nurses to
cover shifts adversely affects young people’s experience of
care
The last review cycle of the Quality Network
for Inpatient CAMHS (QNIC) highlighted the problems faced by units
with recruitment and recommended that unavoidable long-term
absences should be covered by bank as opposed to agency staff.
7. The level of satisfaction
experienced by patients and parents is influenced by the quality
of information that units provide about the young person’s
problem and treatment, and about the unit itself
8. Young people with an eating
disorder have mixed feelings about whether it was better to be
admitted to a specialist unit or to a general
unit
With regard to the former, staff in specialist
units should be aware that there can be counter-therapeutic
interactions between young people with an eating disorder who live
together.
9. It is feasible to collect
information about clinical status and outcomes routinely for
admissions to CAMHS units
The team that led the COSI-CAP study have
worked with colleagues managing the Quality Network for
Inpatient CAMHS (QNIC) to build on this by offering units the
opportunity to continue with data collection as part of a system
for allowing inpatient staff to monitor outcomes and compare
casemix and outcomes with other units (see QNIC-ROM)
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