Getting Better: How Well Are We Assessing and Managing Anxiety Disorders in Community Camhs?

Abstract

Anxiety disorders are a common presenting problem for young people under the care of Melksham Community CAMHS. Guidelines from NICE outline recommendations for best practice in assessment and treatment of these disorders. A local gap analysis in 2017 identified areas for improvement in assessment of anxiety disorders. Measures were implemented following this, including training for staff. A repeat audit was conducted in 2021 and results compared.

Methods NICE guidelines were used to set audit standards, which were used for data collection in both 2017 and 2021. A proforma was developed. A pilot sample of five patients was used to test the proforma. A cut off of 80% compliance was used. Caseload screening by clinicians was used to identify all eligible patients, then a random sample of these was selected by the project leads. Case note review was then conducted. Patients with a diagnosis of autism were excluded from the sample. ROMS, SDQ, GAD-7 or general clinical observation was used as a measure of treatment response. In total in the 2021 sample, 22 patient records were audited.

Results Treatment and follow up for anxiety disorders was good or excellent in 2017 and remained so in 2021. Areas for improvement lay in the assessment of anxiety disorder. In the 2017 audit, there was poor documentation of: mental health history (this had improved from unacceptable to good by 2021), past treatments (improved from unacceptable to requires improvement by 2021), family history (improved from unacceptable to good by 2021), domestic violence/CSA (improved from unacceptable to requires improvement by 2021). Response to treatment was inconsistently documented in the 2017 audit. In 2021 there remained some inconsistencies in documentation. Improvements in recording response to treatment would assist with clearly evidencing compliance with the NICE standards.

Conclusion Overall, treatment and follow up for anxiety disorders was good or excellent (and remained so in 2021). Areas for improvement lay in the assessment of anxiety disorder. Recommendations to promote ongoing improvement include: 1) Circulation of re-audit results to the team 2) Brief recap of guidelines on assessment of social anxiety disorder to the team 3) Written/ email reminder to consider and document the other areas that received less than 80% compliance 4) Continue use of ROMS. Effective assessment and management of anxiety disorder is an important area of clinical practice for all clinicians in the team; we would recommend this is re assessed in 2023 to ensure standards continue to improve.