CWTCH
Aneurin Bevan University Health Board’s (ABUHB) Child and Adolescent Mental Health Services (CAMHS) team wanted to test the use of telehealth and telepsychiatry – delivering psychiatric assessment and care through videoconferencing – in supporting young people who are admitted to paediatric wards with eating disorders or issues of self-harm. It aimed to offer young people admitted to hospital with self harm or eating disorders the choice of a specialist assessment and safe discharge planning by the CAMHS team via videoconferencing, as an alternative to face-to-face contact.
The Health Foundation provided funding to the ‘CWTCH’ (Connecting With Telehealth to Children in Hospital/Healthcare) project.
By using virtual clinics and dedicated spaces, allowing young people (alongside family members) to access health professionals online – this technological solution intended to speed up assessments and improve support services. Virtual appointments were offered using an NHS-approved communication platform called ‘Attend Anywhere’. The project was built upon a base of existing international evidence demonstrating high satisfaction and good efficacy of telepsychiatry.
This use of information technology to support patients and staff is a component of ABUHB’s commitment to bring care closer to home, and forms part of its Clinical Futures transformation programme.
Project Aims
- Reduce waiting times and speed up assessments
- Reduce travel time
- Reduce costs
- Minimise other challenges e.g. experiencing distress when attending in-person appointments, decrease stress for patients and staff, etc.
- Improve support services
- Support staff on paediatric wards around the Health Board, especially those dealing with resistant and difficult cases
- Train staff to use telepsychiatry and feel comfortable interviewing patients using this method
- Develop patient information leaflets
- Develop guidelines for staff on issues such as consent, interview setting and management, and back-up arrangements for if technology fails or patients become distressed
- Aneurin Bevan University Health Board
- The Health Foundation
- Aneurin Bevan University Health Board
- TEC Cymru
- Royal College of Psychiatrists Wales
Evaluation Period
The project completed in April 2020, and was evaluated by measuring clinical outcomes, uptake and engagement, and staff, patient and carer satisfaction.
COVID Creates CWTCH Cymru
In March 2020, when the COVID-19 outbreak occurred, the project was developed further into ‘CWTCH Cymru’ to enable the rapid switch of CAHMS services and delivery online. At the same time, CWTCH Cymru went into partnership with the Welsh Government and Technology Enabled Care Cymru to develop and roll-out a new NHS Wales Video Consulting Service on an all-Wales basis for primary, secondary and community care.
Home Comforts Reduce Distress
In December 2019, a patient in Ty Bryn Unit was booked in for a regular follow-up appointment but was expressing distress about attending in person. A video consultation appointment was offered by her consultant psychiatrist as an alternative.
Emergency Cases - the First CAMHS Telehealth case in Wales
In September 2019, CWTCH conducted its first telehealth CAMHS ‘emergency assessment’ in White Valley, St Cadoc’s Hospital.
Initial Success
Following the implementation of CWTCH, there were four successful telehealth appointments between paediatric wards in Nevill Hall Hospital and Royal Gwent Hospital.
Medical Wards - Paediatric Wards
The original CWTCH remit was to link up paediatric wards and the CAMHS Emergency Liaison Team. The project was announced in June 2019.
Around 79% of users described the project as “fantastic” or “really good” and 80% said they were “very satisfied” with the service.
The CWTCH project has also proven to be cost efficient, saving around 129 hours of clinician time, around £2k in travelling expenses and 1.65 of C02e.
Young people and their families have appreciated the convenience as well as the ability to have an appointment in a comfortable and familiar setting.
Professionals have valued the ease of access video conferencing offers.
The success of CWTCH led to it being used as an exemplar and blueprint by the TEC Cymru team as the NHS Wales Video Consulting Service was rolled out across Wales in response to Covid-19.
CWTCH Cymru was endorsed by the Welsh Royal College of Psychiatry in March 2020.
“We're delighted to endorse the CWTCH project; the innovation has led to savings in efficiency, economy and environment, whilst maintaining quality in patient engagement. The innovation exemplifies Welsh Governments aspirations around health transformation and technology, as identified within 'A Healthier Wales', and we're excited to support its development and timely application.” Royal College of Psychiatrists Wales, March 2020
CWTCH Cymru won Psychiatric Team of the Year at the 2020 RCPsych Awards.
The CWTCH Cymru Toolkit is available on the RCPsych website.