Child and Youth

For people delivering child and youth mental health and addiction services in DHB and NGO settings.

Indicators

These are our current Child and Youth stream Key Performance Indicators. Click on any indicator to read more about the technical definitions.

You can also read more about the definitions in this document.

 

Wait times

Days to first and third in-scope activity

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Whānau contact

Frequency of contact with whānau

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Did not attend (DNA) rate

Community did not attend (DNA) rate

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Wait times

Data source

PRIMHD

Technical notes

The process of service episode reconstruction is as follows:

1. Exclude any out of scope referrals, which are referrals where contact is not necessarily expected. These are any referrals that meet any of these criteria:

  • ReferralEndCode is RI, RO or DZ – referral was declined or discharged with no direct contact required
  • TeamType is 24 or 26 – Integrated Primary Access and Choice and Intellectual Disability teams
  • ReferralEndCode is in (DM, DG, DD, ID) AND there does not exist an in-scope activity on the referral – referral ended in a way that indicates contact may not have been expected, and there was no activity

2. Within each unique combination of tangata whai ora and organisation, combine all overlapping in scope referrals into service episodes. This can be achieved in various ways, but the KPI programme uses a ‘gaps and islands’ approach:

  • Sort referrals by Referral Start Date, Referral End Date, Referral ID
  • Calculate the Ranked Order for each referral (sorting by Referral Start Date, Referral End Date, and then Referral ID to tiebreak)
  • For each referral calculate the Previous End Date, which is the maximum Referral End Date of any referral with a lower Ranked Order (effectively the latest end date of any referral that started before this referral for this tangata whai ora at this organisation)
  • For each referral compare Referral Start Date to Previous End Date to determine whether this is an index referral or overlap
    • if referral Start Date <= Previous End Date this referral overlaps a previous referral and should roll into that service episode; set Index Referral?=0
    • if referral Start Date> Previous End Date this referral starts a new service episode; set Index Referral? =1
  • For each referral count the number of index referrals that have previously occurred for this tangata whai ora at this organisation, and append that value to the Organisation ID and HCU to form a globally unique service episode ID. For example the service episode for client ABC1234 at organisation G-0000 would be named G-0000_ABC1234_0; G-oo0o_ABC1234_1; etc.
  • Service Episode Start Date = Referral Start Date of the index referral in each service episode.

3. Within each service episode identify the earliest in scope activity on any referral in the service episode

a. Exclude all activities where either of these criteria are met:

    • ActivitySetting is one of these
      • WR Written correspondence
      • SM SMS text messaging
      • PH Telephone
      • OM Other social media, e-therapy
    •  ActivityType is one of these:
      • T08 Care/liaison coordination contacts
      • T24 Work opportunity/Employment/Vocational
      • T33 Seclusion
      • T35 Did not attend
      • T37 On leave
      • T43 Community support contacts
      • T44 Advocacy
      • T45 Peer support
      • T52 Health coaching contact
      • TCR MOH internal reference
  • b. Rank all remaining in scope activities by Activity Start Datetime, Referral ID, Activity ID

    c. Calculate the Ranked Order for each in-scope activity (sorting by Activity Start Datetime, and then Referral ID and Activity ID to tiebreak)

    d. Where Ranked Order = 1, this is the first in scope activity on the service episode

    e. First In Scope Activity Start Datetime = Activity Start Datetime of this first in scope activity

    f. Where Ranked Order = 3, this is the third in scope activity on the service episode

    g. Third In Scope Activity Start Datetime = Activity Start Datetime of this first in scope activity

    4. Calculate the wait time for each service episode:

    a. Wait time to first in scope activity = difference in days between Service Episode Start Date and First In Scope Activity Start Datetime

    b. Wait time to third in scope activity = difference in days between Service Episode Start Date and Third In Scope Activity Start Datetime

    5. Calculate additional service episode metadata for use in analysis:

    a. Service Episode End Date = maximum Referral End Date of all referrals within the service episode

    b. Service Episode End Code = Referral End Code associated with the referral that has the maximum Referral End Date of all referrals within the service episode

    i. Where multiple referrals share the maximum Referral End Date, if a DR exist then this is chosen. Otherwise the first alphabetical Referral End Code is chosen

    c. Count Referrals = count referrals included in this service episode

    d. Count Team Types = count of team types included in this service episode

    e. Initial Team Type = Team Type of the index referral

    f. Age at Service Episode Start = age in years on the Service Episode Start Date

    g. In Scope Activity 365 Days Prior – Same Org? = if there exists an in-scope activity for this tangata whai ora at this organisation in the 365 days before Service Episode Start Date, them 1 else 0

    h. In Scope Activity 365 Day Prior – Any Org? = if there exist an in-scope activity for this tangata wha ora at any organisation in the 365 days before Service Episode Start Date, then 1 else 0

    i. Client Type =

    i. If  In Scope Activity 365 Days Prior – Same org? = then “Recurring – same organisation” else

    ii. If In Scope Activity 365 Days Prior – Any org? = 1 then “Recurring – another organisation” else

    iii. “New”

    6. Calculate additional activity flags for analysis:

    a. Details of the first in scope activity based on its ActivityType

    i. FirstInScopeAcitivityIsInpatient? = 1 if ActivityType in (T02, T03, T04)

    ii. FirstInScopeActivityIsCommunityCrisis? = 1 if ActivityType in (T01, To5)

    iii. FirstInScopeActivityIsCommunityNonCrisis? = 1 if ActivityType not in (T01, T02, T03, To4, T05)

    iv. FirstInScopeActivityIsCommunityResidentail? = 1 if ActivityType in (T25, T26, T27, T28, T29, T30, T48)

    v. FirstInScopeActivityIsCrisisorInpatient? = 1 if ActivityType in (T01, T02, T03, T04, T05)

    b. Count out of scope activities before first in scope activity = count of all activities on a service episode where Activity Start Datetime < First In-Scope Activity Start Datetime and where the activity is not in scope (per the standard ActivityType definition)

    Additional notes

    An overlap is established by comparing referral start and end dates, not datetimes. For example, if Referral A ends at 09:30 on 01/01/2020 and Referral B begins at 23:30 on 01/01/2020, this is an overlap and these referrals will be combined. On the other hand, if Referral A ends at 23:30 on 01/01/2020 and Referral B begins at 00:30 on 02/01/2020, this is not an overlap and these referrals will be in separate service episodes (assuming there are no other referrals for this tangata whai ora).

    When combining referrals, be careful not to simply sort referrals by start date and check for an overlap with the previous referral; tangata whai ora may have a single ongoing referral that overlaps multiple other brief referrals and forms a single service episode even though none of the brief referrals overlap one another.

    Open referrals (Referral End Date = null) are included at step (1) regardless of whether an in-scope activity exists on that referral. This is to ensure that we reconstruct accurate service episodes, rather than discard pieces of a service journey.

    The wait time is calculated using calendar days, not 24-hour periods. For example, a service episode starting at 09:00 on 01/01/2020 with the first in-scope activity at 23:30 on 01/01/2020 would have a wait-time of 0 days. A service episode starting at 23:30 on 01/01/2020 with first in-scope activity at 00:30 on 02/01/2020 would have a wait-time of 1 day.

    There is no mechanism to categorise a service episode as urgent.

    When identifying the Third in-scope activity, there is no correction for duplicate activities, and activities that occur on the same day are all considered individually. This is how a single service episode can have 0 days to both first and third in-scope activity, when three separate activities occur on the day of service episode start.

    When allocating a service episode to a reporting period, we use the Service Episode Start Date.

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    Whānau contact

    Data Source

    PRIMHD

    Description

    The frequency of contact with whānau.
    Measurement dimensions for whānau contacts within the reporting period
    • Percentage of all whānau contacts that occurred within 14 days of the previous whānau contact (not necessarily within the reporting period)
    • Percentage of whānau contacts that are in the first 6 months of the start of the referral that occurred within 7 days of the previous whānau contact
    • Percentage of whānau contacts that are after 6 months of the start of the referral that occurred within 21 days of the previous whānau contact.

    Denominator

    The total number of community treatment days on which one or more activities are recorded for a service user by an in scope community team. The activity may involve the service user directly or indirectly, for example it may be in relation to the service user’s care but the service user may not necessarily be present. Activities coded as T35 (DNA) are excluded.

    Numerator

    Treatment days with family whanau involvement: Total number of community treatment days provided by the mental health and addiction service organisation’s community mental health and addiction services within a three month reference period that include:

    • Family whānau participation only, without the service user present and
    • Family whānau and service user participation

    Technical notes

    1. Reporting entity: DHB of Service
    2. Reporting period: Quarterly based on the date of the whānau contact
    3. Age bands: 0-4, 5-12, 13-19 with age determined as at the whānau contact date
    4. Ethnicity: Māori, Pacific, European, Other
    5. Contact types: All, contact within the first and after the first 6 months from the start of the referral
    6. Eligible whānau Contact:

    a. In scope activity types:

    i. T32 contact with family whānau, consumer not present

    ii. T36 contact with family whānau, consumer present

    iii. T47 support for family whānau

    b. Out of scope activity settings:

    i. WR written correspondence

    ii. SM SMS text messaging

    iii. OM other social media, e-therapy

    7. Inclusion of open referrals, i.e. where referral end date = NULL

    8. Exclusion of Alcohol & Drug Teams (AOD) and Forensic Services

    9. Exclusion of NGOs

    10. Results reported for the most recent one to two quarters are highly likely to be preliminary when first eligible face to face activity or first whānau contact are retrospectively submitted to PRIMHD.

    Process of identifying and collapsing overlapping eligible episode from PRIMHD:

    1. Filter for referrals with eligible face to face activities
    2. Index referrals by referral ID, individual client and service organisation in order of referral start datetime
    3. Determine whether each referral overlaps the one before and/or the one after
    4. Where the start date is within 28 days of the end date of another collapsed referral, this is considered as one continuous episode
    5. Roll up continuous or overlapping referrals with the same service organisation into one collapsed referral (episode)
    6. Order eligible whānau contact within the collapsed and filtered referrals
    7. Assign age at whānau contact and filter for clients where age is between 0 and 19
    8. Determine the time between whānau contacts (if they exist).

     

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    Did not attend (DNA) rate

    Data source

    PRIMHD

    Description

    Percentage of DNA contacts against total number of contacts, including DNAs, for in scope community services in the reporting period.

    Measurement dimensions

    • percentage of community DNA rate for all ethnicities
    • percentage of community DNA rate for Māori
    • percentage of community DNA rate for Pacific.

    Numerator

    Total number of DNA contacts for in scope community services in the reporting period.

    DNA –  T35 Did not attend

    Denominator

    Total number of contacts, including DNAs, for in scope community services in the reporting period.

    Eligible planned face to face activity types. Any activity types where activity unit type is ‘Contact’ except the following:
    •   T01 Mental health crisis attendances
    •   T05 Crisis respite care
    •   T08 Care/liaison coordination contacts
     Out of scope activity settings:
    •   WR Written correspondence
    •   SM SMS text messaging
    •   PH Telephone
    •   OM other social media, e-therapy

    Technical notes

    1.  Reporting entity: DHB of service
    2.  Reporting period: Quarterly based on activity start date
    3.  Age bands: 0-4, 5-12, 13-19 with age determined as at the activity start date
    4.  Ethnicity: Māori, Pacific, European, Other
    5.  Denominator – eligible planned face to face activity types
    •  Any activity types where activity unit type is ‘Contact’ except the following:
      •   T01 Mental health crisis attendances
      •   T05 Crisis respite care
      •   T08 Care/liaison coordination contacts
    •  Out of scope activity settings:
      •   WR Written correspondence
      •   SM SMS text messaging
      •   PH Telephone
      •   OM other social media,  e-therapy
    6. Numerator – DNA
    •  T35 Did not attend
    7. Exclusion of forensic services
    8. Exclusion of NGOs
    Process of identifying and collapsing overlapping eligible activities from PRIMHD:
    1. Filter for eligible planned face to face activities
    2. Assign age at activity start date and filter for clients where age is over 19
    3. Index activities by activity ID, referral ID, individual client and service organisation in order of activity start datetime
    4. Determine whether each activity overlaps the one before and/or the one after
    5.  Where the activity start datetime is within 1 minute of the end datetime of another activity on the same date, this is considered as one continuous activity
    6.  Where multiple activities have the same start datetime, it will be prioritised in the following order:
    •   Priority rank per activity e.g. T42 individual treatment attendance being the highest priority
    •   If tie, pick the activity with the earlier start datetime
    •   If tie, pick the activity with a smaller Activity ID
    •   If tie, pick the activity with a smaller Referral ID
    7. Roll up continuous or overlapping activities for the same client on the same day with the same service organisation into one “collapsed” activity
    8. Flag if DNA exists within the collapsed activity for numerator count
    9. Assign activity to the corresponding reporting period based on the collapsed activity start date
    10. DNA rate is calculated by:
    • Numerator – DNAs flagged for each collapsed activity
    • Denominator – Number of “collapsed” activity

     

     

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    Youth forensic variation

    In May 2020, the KPI Programme received an 18-month contract variation from the Ministry of Health to explore the development of a youth forensic KPI stream. As part of this variation, the KPI Programme is undertaking research to provide an evidence base for potential indicators that relate to the national youth forensic model of care. Development of potential indicators is done through a collaborative process with the sector and the Ministry of Health.

    If you are interested in finding out more about the work we are doing in youth forensic mental health services, or would like to contribute to the scoping of this potential new stream, please contact us.

    Child and Youth stream leads

    Our Child and Youth stream leads represent our sector contributors and work alongside the KPI Programme team to deliver sector events and guide continuous improvement initiatives. Get to know our current stream leads.

    Enys Delmage

    Consultant, Adolescent Forensic Psychiatry, Nga Taiohi (3 DHB) - Capital and Coast DHB

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    Sammie Dudley

    Youth Consumer Advisor - Werry Workforce Whāraurau

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    Angela Field

    Clinical Manager iCAMHS - Lakes DHB

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    Emma Williams

    Clinical Coordinator - iCAMHS - Nelson Marborough DHB

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    James Knight

    Psychiatrist - Hawkes Bay DHB and Psychiatrist Regional Forensic Services - Capital and Coast DHB

    Miriam Swanson

    Child and Youth Director - Pathways and Real

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