Need for change
At the beginning of 2015 we realised that the number of ROMs we were collecting as a service had started to fall. After a few staff changes the systems that we had originally put in place were becoming less effective and we needed a fresh approach. We began to search for new, more efficient ways to collect ROMs in the hope that this would ensure that the data we were submitting to the Department of Health accurately reflected the work we were doing. We were also hoping that we could make the experience of collecting data better for the young people with whom we work.
Who was involved?
We have an outcomes working party that includes lead clinicians, managers and assistant psychologists and this group started to look at a variety of systems that are available to CAMHS services. We were particularly attracted by those that had child friendly interfaces which allowed the children and young people (CYP) to input directly onto the system rather than having to complete paper versions. Our CAMHS participation group, which includes both young people and their parents, had a look at the systems and gave their feedback on them too.
We decided to introduce Includeme as it offered what we were looking for, was cost free, and provided us with the opportunity to work alongside the developers to make sure that it met the needs of our service. This system is an online platform which was designed by the Anna Freud Centre as a shared decision making tool. One of the tools it included was the ability to enter ROMs onto the platform and these would be scored immediately allowing clinicians instant access to the feedback.
12 months after introducing the system we have now spent time reflecting as a team on the effect that it has had on our service delivery, looking at the difficulties we encountered and how we have worked towards solving these.
- Staff being unsure how to use Includeme was the first hurdle we had to jump. We have a high staff turnover so creating a system for training to ensure everyone is able to use it effectively has been a process that has evolved. Initially we ran a whole team training day, followed by input into team meetings. Now we have a rolling programme of training sessions that staff can sign up to.
- We employ a full time administrator for inputting ROMs onto the system and since using Includeme the number of ROMs that he receives has reduced as CYP are now able to do this directly onto the system. This has meant that he is able to manage the workload without needing extra support from other staff.
- We have had to make sure that there were different options in place for those situations where an online platform was not the most appropriate system, for example where there are a number of family members completing them at the same time. In these situations paper versions of the ROMs are still often felt to be the most practical solution.
- Many of our locum staff are not assigned a laptop or iPad so we have put in place a system whereby they can borrow one for the day to use in their clinics. These are kept by the admin staff and signed out each morning as needed.
- For staff who feel that completing ROMs takes too long within their session, or who feel that the completing of ROMs does not complement the model within which they work we have appointed assistant psychologists who are available to complete ROMs with families outside of their therapy session. This means that the information is available to the clinician without having it interfere with their way of working.
- Initially there were technical issues which affected both the practical use of the system and staff attitudes towards it. Losing the Wi-Fi connection while in the middle of completing a questionnaire was especially problematic to both clinical practice and the relationship with the clients. Our service has invested resources to ensure that these issues are resolved. It may have been better on reflection to have resolved these issues prior to the role out of the program to reduce the amount of resistance from staff.
- After discovering that the way data can be accessed from Includeme did not match the format required for our data submission the IT team has been busy designing a system which will align them.
- The general feeling within the team is that if all the data could be recorded on one system that stored both clinical records and ROMs data this would be more efficient, and would make their clinical practice more effective as there are concerns that ROMs data will be missed. Staff now add a progress note onto Rio to state that they have completed ROMs on Includeme.
The main impact of this process has been an increased awareness of ROMs within the team. Staff are now frequently talking about ROMs, and everyone knows about them - even if not everyone is routinely using them yet. We have seen a shift in people’s thinking from ‘they are just something we do for managers,’ to staff seeing the clinical purpose behind them and starting to use them in a meaningful way with the CYP.
What we have learnt
There are many things that we have learnt during the last year about how to use ROMs within our service. The most important learning points have been that you will be most successful in changing the culture when staff see the advantage of completing them, and of using the Includeme system to do so. It has been evident that where clinical leads see the advantage of the changes and lead by example that the teams are motivated to use the new system. Once staff at all levels are able to start seeing the purpose of what we were asking them to do their levels of engagement increased. Training provided a large part of this and helped staff to feel confident with using them in their everyday practice. This is an area we will continue to build on to ensure it meets the needs of the team.
We have decided as a service to work towards the CORC accreditation scheme, and are hoping the experience of going through the self-review process will help us to develop a meaningful approach to the use of ROMs and that this will become embedded in the service. By doing so we hope to use the feedback we receive to drive change within our service.
Many thanks to Sarah Harrison for providing us with this case study.