Contemporary Issues in Healthcare Policy

and Practice

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Table of Contents
Introduction......................................................................................................................................1
Critical analysis of key issues identified within CAMHS...............................................................1
Applying frameworks and concepts in analysing and discussing the quality and effectiveness of
CAMHS services.............................................................................................................................5
Conclusion.......................................................................................................................................8
Reference.......................................................................................................................................10

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Introduction
Child and adolescent mental health services are critical in developing health issues regarding
children. The mental health problems need to be addressed to find effective solutions in respect
of the children as the prime stage of a human rest in childhood. In the adolescent period, a child
tries to recover the situations which are unwanted. The essay illustrates key issues regarding
driving forces and restraining forces according to Kurt Lewin`s management theory to
demonstrate how the changes reflect in the context of child and adolescent mental health services
(CAMHS). A chart is given under Force Field Analysis that assesses the forces and related
change proposal for the services at CAMH.
In regard to practitioners and managers, specific approaches as person centred, need to be based
and patient`s network and system approach been discussed. Furthermore, the essay demonstrates
at least two of the frameworks and concepts related to assessing the quality and effectiveness of
child and adolescent mental health services. The leadership theories presented under the context
of both national and local perspectives. Leadership theories and the equality approach presents
the issues that healthcare service providers need to assess. Both the management theory and
system theory reflects on the progress of CAMHS in applying the perspectives under given
consideration. In the essay, the evidence being presented under the context of the United
Kingdom and a local borough (Islington) selected to determine the application of the theories and
approaches.

Critical analysis of key issues identified within CAMHS

An examination/evidence
The current reality of children's adolescent and mental health reflects that 850000 children are
part of or becoming part of having mental disorders in the United Kingdom (Mowat, 2019). The
perspectives of data show that almost six percent of the children are facing conduct disorder and
3.3% of them having a problem with an anxiety disorder. As a result, the evidence of child
mental health problems relates to disruption to the development of the children. The examination
of the data on these issues also reflects on proving strong evidence on mental disorders in
childhood most likely to impact the individual to adult mental health problems. The evidence
shows that practical approaches to CAMHS considering change management theory and
leadership theories attribute to the change or improvements of services in CAMHS. The

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examination or evidence is a reflection on how the children can face negative life experiences
due to mental health problems during the adolescent period (The King's Fund. 2017).
Critical appraisal of relevant and approach evidence based in relation to CAMHS, both
nationally and locally (Islington borough)
Driving forces and restraining forces according to Kurt Lewin`s change management
theory in relation to CAMHS
Kurt Lewin’s change management theory is related to highlighting the human aspect of change
as part of social psychology. Born in Germany, the management theory argues the group
dynamic and group theories according to applying the field theory concept (Kaminski, 2011).
According to the model, a three stage model is utilised to place the learning within change
management to be rejected or replaced. Driving forces and restraining forces according to
CAMHS is provided below.
Driving Forces
In Kurt Lewin’s change management theory the driving forces relate to
 Causes the changes to occur
 Facilitating change in pushing the person or system to the anticipated direction
 Shifting the change in equilibrium in attaining the changes
Child adolescent in mental health service in the UK and in the local Islington borough requires
significant attention. According to the model, the driving forces include how to change the
perspectives of the viewpoint regarding children`s mental health services. As for national
perspectives, children`s health services demand significant changes in regard to building
effective CAMHS and Kurt Lewin’s change management theory`s stages can is productive in
improving the scenario. In terms of driving forces, the changes in CAMHS to occur to create
better perspectives of child care and second driving force are the health services to generate
actions to push the overall system to attain the changes (Olfson, Druss and Marcus, 2015). The
integration of addressing child mental and adolescent health requires directing the procedures in
involving the mechanism in involving the NHS developments. The third driving force would
effectively shift the current CAMHS in the United Kingdom to the platform of change in the
perspectives of improvement in dealing with child mental and adolescent health and fighting
inequality in the services.

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In Islington borough, almost 38 percent of children live under poverty and faces inequality. The
gap between the rich and poor is more than the other 32 boroughs in London as per the indicators
in the ranking demonstrates (Trust for London. 2019). Islington ranks 29 out of 32 boroughs in
the child poverty rate and ranks 11 out of 32 boroughs in terms of infant mortality. CAMHS
relates to improving the scenario in the borough and Kurt Lewin`s change management is
effective in solving the issues in various ways. Kurt Lewin’s change management theory of
driving forces is critical in creating the changes in the perspectives in Islington borough. For
instance, the children's poverty and overall inequality in health services may change through
understanding the issues relate to CAMHS and regarding the problem for the improvements. The
second driving force would put pressure on the local health services to adopt the changes
required to improve CAMHS and provide adequate support to the mental and adolescent health
of children (Singh and Tuomainen, 2015). The third driving force of Kurt Lewin’s change
management theory would assist in understanding the equilibrium changes in the system.
Restraining forces
The following are the restraining forces as regard to Kurt Lewin’s change management theory
(Kaminski, 2011)
 It can create anti-driving forces
 It can create hindrance to change and force to pushing the opposite direction to occur
 Opposing shift changes in the system
In the national perspectives, the UK government needs to address the driving forces in assuring
the improvements in the perspectives of the examination or evidence shown. The restraining
forces in changing the perspectives of child anxiety or mental disorder would hamper progress.
Besides, the changes or shift changes would not take place. In the local Islington perspectives,
the restraining forces may hamper the changes in the child's mental and adolescent health
realising the changes required in shifting or reducing the gap as per inequality perspectives.
Force Field Analysis suggested by Kurt Lewin
Driving Forces FOR Score Change Proposal Score Restraining Forces
Change AGAINST Change
Healthcare improvements 4 Worth Pursuing 3 Disruption
in meeting demand
services

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 Funding for mental health 3 Re-adjustment 4 Cost
support required
Reducing waiting times in 3 Re-adjustment 4 Support from staffs
CAMHS required
Removing the inequality 3 Re-adjustment 4 Government funding
in providing healthcare required
services
Introducing effective 4 Worth Pursuing 3 Quality healthcare
leadership in structuring professionals
the system
TOTAL 17 18 TOTAL

Key features of driving forces and restraining forces for practitioners and managers
The practitioners in CAMHS need to identify the changes relate to providing services in
healthcare perspectives. The changes in action require the practitioners to adopt to the
development of the procedures. NHS is critical in guiding the practitioners and managers to
create a mental health support team to supervise the children`s mental and adolescent health by
collaborating services to focused on evidence based performance. Both the practitioners and
managers may perform person centred, need basing and patient involvement approaches to
building a patient`s network and system (Taylor, 2015).
Person centred approach: The approach related to treating service users with dignity and
providing care and support as required as part of personalised care (Senkubuge, Modisenyane,
and Bishaw, 2014). In CAMHS, the practitioners can involve the patient in understanding the life
experience of the children valuing the perspectives and designing support as required. Children
require person centred care to monitor themselves in as proper manner as possible.
Need based approach: The approach is to address the needs to ensure the procedures in
attaining the rights of the patient. In terms of CAMHS, the practitioners required to address each
and every need of the children in attaining their mental and adolescent health and provide child
friendly health care approaches. Meeting the driving forces according to Kurt Lewin requires the
managers to build a staff that meets the driving forces to bring effective changes in CAMHS.

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Patient` network and system: The approach is inevitably essential in meeting CAMHS
engaging the guardian of the children to produce effective child care and mental health support.
The managers of the healthcare services need to address family group conferences to address the
problems in this regard (Taylor, 2015).

Applying frameworks and concepts in analysing and discussing the quality and
effectiveness of CAMHS services

Leadership theories to analyse the progress in CAMHS

Trait theory

The theory is related follow specific characteristics as being a leader of the organisation. The
theory relates to factors as people skills, intelligence, decisiveness, competency, creativity, and
trustworthiness (Edbrooke‐Childs, et al., 2018). The trait theory focused on linking leadership`s
ability to perform in specific situations under given perspectives. As for professionals in child
and adolescent healthcare perspectives, the role trait theory is to generate patterns of behavior
that guide the professionals in helping the services users according to personal traits. To analyse
progress in CAMHS, the leadership traits can be reflected as follows.

According to trait theory, the leadership needs to build intelligence and perform action oriented
actions (Gopee and Galloway, 2017). In this regard, trait theory demonstrates that services
provided in CAMHS require action oriented progress and the practitioners need to adopt the
intelligence to deal with the matter of mental health of the children. Trait theory also reflects on
building eagerness to accept responsibility and creating competence in task management. The
role these traits relate to managing the demand of services in CAMHS determining the
responsibility that the health professional performs and achieve the task competence in the given
perspectives.

Furthermore, a trait theory explains decisiveness and adaptability which reflect on child and
adolescent mental health services as the traits can help the leadership to take firm and effective
decisions in challenges circumstances. Children`s mental health services need to adopt the

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critical factor of emotional guidance which a health professional leader can achieve through
following the trait of emotional stability.

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Contingency theory of leadership

Contingency theory explains that a successful leader requires other factors other than his or her
capabilities in pursuing the objectives of the organisation in developing a leadership style. The
basis of contingency theory is the ability of the leader to perform with different perspectives by
using the ability to perform. At child and adolescent health services, contingency theory of
leadership provide the leadership to answer according to High LPC score and Low LPC score.
The theory suits the outcome of CAMHS and provides the applicability of the leadership to
progress in the sector.

Fiedler`s contingency theory is applied at CAMHS in understanding the progress of the

leadership to exercise task structure position power in managing the circumstances in providing
care to the children (Hartley and Benington, 2010). For example, child mental disorder problems
require the service providers to handle the child with care and leadership in healthcare
organisation needs to assess the situations of the child under stress and require to perform high
intellectual abilities according to the understanding of the contingency theory of leadership. As a
result, the leadership in providing services at CAMHS require to showcase the range of their
experiences to produce better results in providing services under high stress scenarios.

Transformational leadership: The leadership model demonstrates two elements regarding

showcasing support for making changes in the existing services and engaging in developing
microsystem improvements by the leadership to achieve the objectives of the organisation. In
CAMHS`s perspectives, transformational leadership is dedicated to creating connections
between the staff and the departments in the healthcare services. According to the leadership
concept, the leader needs to assess patient mortality, patient satisfaction and maintain the quality
of life. In CAMHs, the transformational leadership can reduce the constraint of services at the
micro level and ease of demand for services. The leadership style is suited to bringing positive
attitudes adopting an evidence based approach in CAMHS to provide proven services through
initiating training for the staff of the service providers.

Equality approach

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Marxist theory of equality is part of demonstrating the philosophy of ensuring equality in the
process to remove inequality in any of the processes (Gopee and Galloway, 2017). Equality
approach at CAMHS is critical as the child and adolescent are vulnerable to the context of
receiving care in the society. As a result, the role of the equality approach becomes necessary in
leading the community to help the development of the mental health of children. In the process,
two principles of equality are addressed as to understand the needs of the service users at
CAMHS.

Children and adolescent patients are the most affected in terms of inequality perspectives. The
provided evidence at the national and local level (Islington borough) suggests that it requires
critical approaches to solve the issues. The equality approach can provide the guidelines to
CAMHS at national and local levels and how to remove the perspectives of inequality. The
approach ensures that the organisation follows the discrimination Act that prohibits any
discrimination or inequality in providing services. At CAMHS, the healthcare professionals
require to create formidable relation with the service users following the Equality Act 2010. The
professionals need to follow the Act under the guidelines of CAMHS and ensure the
effectiveness of services in this sector.

Islington borough is determined in showcasing commitment and approach to equality. In the

locality, the discrimination which is unlawful is not accepted and the borough is committed to
performing equal service to everyone under any circumstances. The borough id committed to
establishing equality legislation (Cherry and Jacob, 2016). Islington is also committed to
monitoring equality data to enable the service users to attain equal access and the borough
addresses main areas in inequality in Islington. As for the guideline, the equality approach is
linked to the demonstration of ensuring the rights of children and the respective borough can
continue to progress through ensuring the rights through the approach.

Management theory application to analyse CAMHS

Fayol`s management theory: The theory of Fayol of management is dedicated to fourteen

principles in generating an understanding of the role of management to formulate actions and to
perform control in the organisational perspectives. To analyse CAMHS, fayol`s management
theory can be attributed to the understanding absence of attention to issues within the context of

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an organisation`s management process (Hartley and Benington, 2010). For example, child and
adolescent mental care require to answer sensitive requirements of the children the management
theory assists in regard to ensuring a structure that ensures the services provided as per
requirement. At CAMHS, it is critical to maintaining the unity of command to perform the tasks
in assisting the children and the element is mentioned in the fayol`s management theory. The
theory is applicable in meeting increasing of demand of services in CAMHS both nationally and
locally.

Taylor`s scientific management school: FW Taylor explains in his management theory about
performing tasks or actions under the given working environment (Almaaitah et al., 2017). The
management theory demonstrates the management`s ability as per productivity and efficiency. At
NHS, the specialised tasks such as CAMHS involve the key perspectives of the management
theory presented by Taylor. To analyse CAMHS, the management theory is applicable as for the
managers and staff working in the health services. The difficulties in handling patients and
reducing waiting time at CAMHS require the management to adopt training platforms for the
staff and practitioners in understanding how and what to be done in the challenging scenarios.
Child and adolescent mental health services require new methods to be applied and the
management theory agrees on the perspectives of crafting efficiency at CAMHS.

System theory to analyse improvements in CAMHS

System theory is a useful understanding which defines approaches of the organisation in

maintaining the classical approaches using the sub-system of the organisation. The theory
provides a comprehensive viewpoint of the organisation and theory linked to understanding
improvements in CAMHS both nationally and locally (Islington Borough). The system theory
provides variables that make sense in developing relationships between structure and human
behaviours (Foreman, 2016). In CAMHS, the service providers need to adopt the system theory
concept to assess the interaction between a service provider and child and adolescent. Human
behavioural perspectives are key in dealing with children and their mental health to assist them
to recover from various problems and anxieties. The context of CAMHS in Islington requires the
borough to adopt the required disciplines that can attribute the healthcare professionals to
perform as per expectations. For example, evidence based application of system theory has

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proven the improvements in CAMHS as per the perspectives of child healthcare in the UK and in
the local borough.

Conclusion
Children and adolescent period health issues have cared at CAMHS and it is critical to
implement a proper system within the services to ensure quality services to the service users. The
effectiveness of CAMHS ensures upholding the rights of the children at facing multiple
problems. The evidence of children`s mental health and difficulties require further consideration
under the guidelines of National Health Services to ensure that CAMHS is functioning properly
under the guidelines. The leadership approaches and system theory is applicable in the context of
improving the performance of CAMHS both national and local perspectives.

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Reference

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