Abstract
Background The concept of joining up services and managing young people’s mental health difficulties has never been more paramount. Covid has thrown us all into a world of uncertainty and this is exacerbated for young people with anxiety, underlying medical or psychiatric needs. At a time when linking people up to work and think together is the most needed, of course it is also the most challenging. Mental health presentations are an increasing part of the paediatric caseload and there is growing evidence that paediatric trainees feel ill-equipped to manage these patients. Equally CAMHS trainees reported they required greater access to seeing children under 5, assessing development and physical health. Only 33% of trainees we surveyed felt that their current training programme enabled them to achieve their curriculum requirements in paediatrics or mental health respectively.
Objectives We developed the concept of Thinking Together, to tackle this training gap. The scheme involves pairing paediatric and CAMHS trainees to share clinical encounters to foster a joint way of learning and working together, coming together to look at how we can link training to optimise patient care. CAMHS services are increasingly stretched, raising referral thresholds and making the need for closer working together across disciplines paramount.
Methods A pilot was launched in March 2016 where 30 trainees from CAMHS and Paediatrics were paired for a period of 6 months, attending at least two clinical encounters in each setting. Trainees were encouraged to explore a variety of learning possibilities, including clinics, referral meetings and signposting their partner to other relevant clinical opportunities.
In 2018 we extended the scheme in a second phase pilot to four centres across the UK. Feedback from participants involved was equally positive but there were logistical challenges. We reflected on feedback from the initial and second phase pilot and adapted the programme in 2019/2020. We aimed to consolidate the scheme in one centre and include workshops, which allowed focus on a topic relevant to both specialties, in addition to a forum for debrief discussions on challenging cases.
Results Prior to participating in Thinking Together, 70% stated they had no experience of working in a jointly delivered paediatric/mental health clinic. 93% of participants felt that their patients benefitted from access to jointly delivered clinics. Feedback was very positive and identified that the scheme met training gaps for both specialties. Th adapted version of Thinking Together that we rolled out in 2019–2020 was also met with positive feedback and proved to be particularly beneficial during the pandemic, when trainee pairs could still participate in Thinking Together via virtual workshops.
Conclusions Covid has clearly brought challenges to every aspect of our lives but this is a training model that has been able to adapt in this unprecedented time, by means of virtual workshops and the enthusiasm of the participants to continue to pursue learning opportunities, including joining referral meetings remotely. Thinking Together has evolved into a successful model that we would like to embed in everyday practice.
