What is co-production, and why are we doing it?
Co-production is about involving people using a service in its design, delivery and evaluation. A co-production group will include staff, people who use the service, their families and friends and management, and everyone’s input will be valued with equal weighting. It is not the same as simply consulting people about decisions. It is about empowering people to shape their own services. An increasing body of evidence links co-production to both better outcomes for those who get involved in the projects, and better outcomes for the service.
BEH Co-production Project Case Study
The co-produced transformation of Barnet CAMHS under the Enablement Partnership
In the first year of the Enablement Partnership, we facilitated Barnet CAMHS to co-produce elements of their service transformation.
This took the format of two parent/carer consultation groups, attended by clinicians, managers and peer staff from Inclusion Barnet. Both groups were attended by 2 parents/guardians. There was also a consultation session held with young people using the service. There was a further option for parents/carers to give their input via telephone discussion.
The parents and carers activities were largely consultative feedback sessions to primarily unveil the new stepped model and to receive feedback and suggestions on this, and also to receive other suggestions around what would make CAMHS better for families. The young people’s sessions, however, were slightly more geared towards harnessing their experience of using CAMHS and generating suggestions based on this. CAMHS is a unique service to co-produce with, given the complication of collaborating as equal partners with people in the service, due to their age, and with parents, due to them not using the service directly.
Outcomes and action points
Parents and carers were happy with the new stepped model, and together with clinicians agreed on including the option to self-re-refer within 6 months, as this is the timeframe when young people might begin to present with difficulties again.
Parents and carers proposed that clinicians should have a directory of supporting services in Barnet available to refer people to. This has since been created by The Enablement Partnership and made accessible to the whole Trust.
Parents discussed the importance of receiving news via phone call instead of by letter.
They also asked for information about policies and pathways to be given in lay terms, and in accessible format, and for an open, honest dialogue about diagnosis to happen as standard with all families, and for more transparency about the triaging of referrals.
Young people asked for the pathways to be more accessible, and for more information to be available online, for instance via social media. There was also discussion of having young people who use CAMHS moderate the social media outputs. They also suggested including feedback from people in the service on the webpage, to instil accountability.
The issue of lengthy wait-times was discussed, and they proposed a peer-led, clinician-assisted support group could be set up for young people on the waiting list. They identified that loneliness is a major problem for young people, and that this could be a way to help combat that.
Young people discussed the importance of CAMHS working together with adult mental health services in the presence of the young person to do the handover, rather than liaising in the background without their input.
Other issues were discussed in relation to the building environment, such as displaying artwork in the corridors or combating an echo-y effect which may make appointments feel less private.
Evaluation of co-production
A major success of this initiative was the involvement of both young people and parents. It is good, also, that they were not involved in the same sessions, as this may have impaired their ability to speak freely. Parents’ busy lifestyles were considered, and they were offered multiple session times plus alternative channels of involvement via telephone, which is key to successful involvement.
All the sessions managed to create an open, positive culture, with a genuine receptiveness to feedback. Clinicians reported being pleased at how well they worked with parents/carers, and how easy some of their suggestions were to implement. Young people reported that clinicians responded well to their ideas, and rated their feelings of being listened to as ‘10/10’. This development of positive collaborative culture is perhaps the most important outcome, as it lays the groundwork for further embedding co-production into the way things are done.
The activities also established intentions for a number of future collaborations: co-producing evaluation methods with parents and carers, working more jointly with families in decision-making about complex cases which might not fit simply into any one pathway, and co-delivering a peer support service with young people, especially to help those on the waiting list. The latter is particularly important, as it incorporates co-delivery with those using the service. This is especially impressive to achieve in a service for children and young people.
It was also important is that the co-production activity was meaningful: people’s views were heard, discussed and acted upon. This improves the service and builds trust for the future.