Perspectives in measuring organisational performance in public Child and Adolescent Mental Health Services (CAMHS)

Beagley, L 2017, Perspectives in measuring organisational performance in public Child and Adolescent Mental Health Services (CAMHS), Doctor of Philosophy (PhD), Health and Biomedical Sciences, RMIT University.

Document type: Thesis
Collection: Theses

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Title Perspectives in measuring organisational performance in public Child and Adolescent Mental Health Services (CAMHS)
Author(s) Beagley, L
Year 2017
Abstract As part of the public health system in Australia and internationally, the Child and Adolescent Mental Health Services (CAMHS) setting is a small, specialised, and unique environment – sharing the developmental context of paediatric health and the clinical mental health service delivery domains with adult and aged person’s psychiatric services (Kelvin, 2005; Ford, 2007). CAMHS services are grappling with a set of expectations imposed by a stressed social welfare system to manage the sequelae of extreme trauma, challenging behaviour and the impact of family violence and trauma on children and adolescents in their care (Wolpert et al., 2014; Bor et al., 2014).

CAMHS settings are subject to a pervasive set of expectations emerging from elected government regimes linked with the voting community regarding accountability, efficiency, and effectiveness. The rise of the transparency and accountability agenda within the public sector has been documented extensively (Armstrong, 2005; Gaventa & McGee, 2013; Van Belle & Mayhew, 2016). In such a paradigm, accountability is neatly and simplistically measured by the articulation of the task of the organisation and the application of metrics to assess performance against that task. The current study aimed to explore and better understand differences in assumptions, perceptions, and experiences of the organisation of public Child and Adolescent Mental Health Services (CAMHS). Further, the implications these differences have for clinical care, management, and leadership within the organisation itself but also for government in its performance-monitoring role of CAMHS services more broadly are also examined and described.

The current study sought to highlight individual perspectives and experiences as they relate to measuring organisational performance beyond finance, activity, and outcomes towards sustainability, process, emotional climate, culture, and organisational dynamics. Thus, the current study aimed to critically review current frameworks for measuring organisational performance and, through analyses of theoretical constructs and qualitative methodologies, to explore experiences, processes, and meaning. A framework is then proposed for considering organisational performance in public CAMHS that takes account of these new meanings and proposes the measurement of organisational performance across a range of domains.

The focus of interest was in what personal experience might convey about broader shared issues and themes at an organisational level, and the key data collection tool used was semi-structured in-depth interviews. To elicit data on personal experience, participants who were stakeholders of CAMHS as clients, families, referrers, clinicians, managers, policy leaders, and collaborative partners were the focus of sampling. The data was initially segmented and filtered across broad themes and then coded and gathered into more detailed categories.

Themes emerged relating to the expectations and impressions of CAMHS, the clients themselves and their stories of complexity and trauma, the experience of CAMHS clinicians, barriers to accessing services, the experience of services provided once ‘in’ the system, issues related to the interface between CAMHS and other services and stakeholders, and impressions on what factors might make a ‘good’ CAMHS. Overall, the findings underlined the view that CAMHS services should take an integrated multi-theoretical perspective, support wisdom in leadership, be accessible, and have sophisticated collaborative capacity. Furthermore a theme of shared power in decision making across a team including children, young people and their families, and other services emerged. Overall the findings are indicative of the fact that a performance framework that adequately addresses these complexities works against the risk that authenticity is lost when measures of organisational performance are reduced to one or two examples.

Recommendations for a performance framework for CAMHS are proposed. This includes a robust synthesis of the policy environment, a developmental lens across infant, child, adolescent and youth age groups, a clear definition of the primary task for CAMHS along with an understanding of the target client group, directly addressing the broadly conflicted interface between CAMHS and child protection services, attending to the organisational climate within CAMHS, and defining appropriate accountability measures.

Future research must focus on defining the target group for CAMHS, the best and most efficacious treatment models and clients experience of care. It is further recommended that future research explore models for understanding and leading or managing the unique organisational climate in CAMHS settings and particularly on the roles of clinical staff and leaders in the CAMHS settings. A particular area of focus should be in relation to the inherent stress of working in this setting, noting that this is not seen as weakness or poor performance, but rather as a a natural consequence of engagement in the task.

A key strength of the current study was that it sought to highlight individual perspectives and experiences as they related to measuring organisational performance and to explicitly place the roles and perspective of the researcher into this frame. The focus of interest was in what personal experience might convey about broader shared issues and themes at an organisational level.

In terms of limitations, the most significant was the fact that no child informants could be sourced, and that the time frame and design limited the number of participants and therefore possible perspectives. The qualitative research design did not use a mixed methods model to confirm findings and the generalizability is thought to be limited. The narrow theoretical lens for the research may be also considered a limitation (Chowdery, 2017). However, the theoretical model was chosen carefully as a sound platform on which to consider the complex issues presented from an organisational perspective.

In summary, the thesis seeks to make recommendations for a performance framework for CAMHS, and in doing so the author has sought to draw together the key elements emerging from the findings supported by the research community. If the comprehensive network of elements identified in the current thesis were all adequately addressed, it would have the potential to reliably bind public child and adolescent mental health services with a unique clarity of purpose in a community of care for children, adolescents, and their families.
Degree Doctor of Philosophy (PhD)
Institution RMIT University
School, Department or Centre Health and Biomedical Sciences
Subjects Mental Health
Keyword(s) Children and Youth
Public mental health services
Organisational performance
Systems psychodynamics
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Created: Thu, 31 Aug 2017, 08:45:33 EST by Denise Paciocco
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