Building consensus on the core clinical competencies and outcomes related to effective child and adolescent mental health services (CAMHS) crisis team provision: findings from a Delphi study
Clau Nader, Lucy Tindall, Kapil Sayal, Josephine Holland, Catherine Elizabeth Hewitt, Paul A TiffinBackground
Young peoples’ mental health is worsening, increasing demands on Child and Adolescent Mental Health Services (CAMHS) crisis teams. However, evidence is lacking regarding the effectiveness of such services. To pave the way for service developments and robust evaluation, it is crucial to establish a consensus on the core competencies for CAMHS crisis clinicians and the most desirable outcomes from their input.
Objective
To elicit and establish consensus among experts, including those with relevant lived experience, regarding the most important staff competencies and outcomes in this service context.
Methods
A three-round Delphi study was conducted with young people (aged 18–25 years with relevant lived experience of CAMHS crisis team input), parents/carers and mental health clinicians/academics. The study aimed to establish consensus (≥70% agreement) on which core staff competencies and outcomes were perceived as ‘essential’/‘very important’ in relation to CAMHS crisis services.
Findings
Of 69 initial participants, 43 (62%, mainly young people) completed all three rounds. A broad consensus was reached, with over 90% of proposed items meeting the consensus threshold. The strongest agreement was found for competencies in the therapeutic alliance domain, particularly cultural competency (93%) and validation (91%). For the case formulation domain, a holistic mental state examination (91%) was highly prioritised. Key outcomes with high consensus included improved communication with support networks (91%), better understanding of the young person (88%), feeling validated (88%) and reduced involuntary inpatient admissions (88%). The findings were integrated into a Theory of Change-based logic model illustrating how these skills and knowledge could lead to the desired outcomes.
Conclusions
Our results demonstrate a clear stakeholder consensus prioritising relational, validating and personalised approaches to assessment and intervention over an emphasis on administrative or diagnostic processes in CAMHS crisis care. The findings also highlight a desire to move from a perception of a paternalistic risk management style to collaborative, community-based support.
Clinical implications
These findings underscore the need for crisis team clinicians to be trained and supported to deliver care that is relationship-based, trauma-informed and culturally responsive. These should potentially translate into better outcomes for young people, their families and the crisis team workforce itself.