Multi-Disciplinary Teams (MDTs) in Primary Care GP Practices

IntroductionProvision of holisitc, accessible and high quality mental health care to the patients requires sharing of responsibilities & resources, enhanced communication & collaboration at the interface (primary care systems and secondary care mental health services). An innovative model of single point of care for people with severe and enduring mental health problems hosted at a primary care (GP) setting has been developed and evaluated in Walsall, UK.ObjectivesTo develop and evaluate an integrated (multidisciplinary) approach of managing health & social care needs of people with severe mental health disorders.MethodsPeople with severe & enduring mental health problems were reviewed in primary care (N=65). A comprehensive physical, mental and psychosocial assessments were undertaken by the clinicians that included GP, Psychiatrist and Care-Coordinator.The reviews included: 1) A review of physical health indicators based on the Lester toolkit by practice pharmacist/nurse, including lifestyle, body weight, BMI and blood pressure. 2) Individualised interventions included physical / psychiatric prescribing, social prescribing and advise on lifestyle changes. Stable patients were recommended for stepping down from the secondary care. Outcomes included Patient Satisfaction Questionnaire (PSQ).ResultsSatisfaction on the PSQ was rated from very good to excellent. Results highlighted multiple benefits including trust generation, improved communication among professionals, physical health screening and prompt clinical decision making (e.g. referral / prescribing). Other benefits included patient access & satisfaction, time and cost efficiency by reducing the number of reviews.ConclusionsThe integtrated CPA reviews offers efficient, holisitc & cost effective model of care with high satisfaction levels for patients and is replicable.DisclosureNo significant relationships.

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

Individuals with serious mental illness often are unable to access consumer- and family-oriented community care, resulting in repeated hospitalizations, incarceration, and homelessness. The "medical home" concept was developed in primary care to provide accessible and accountable services for individuals with chronic medical conditions. Building on the work done in primary care, the authors propose a "mental health home." The model of care incorporates medical home characteristics, such as access to and coordination of services, integration of primary and preventive care, adoption of recovery orientation and evidence-based practices, and family and community outreach. Barriers to and strategies for implementation of mental health homes are discussed.

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"

The nursing role in primary care is increasing in importance, particularly in the Australian health care system (Royal College of Nursing Australia [RCNA] 2003). The expanding nursing role in primary care has implications for the health of Australian society, nursing education, continuing professional development, health service policy, inter-professional politics, regulatory affairs and the monitoring of standards and professional practice. Professional nursing organisations represent the voice of their membership in influencing development of public policy, setting professional standards and in promoting the profession and raising awareness of its vital role and contribution to the health care sector (Australian Practice Nurses Association 2007; RCNA 2007).A range of variables has contributed to shaping the nursing role in the general practice setting. Perhaps the most significant of these to date include legal and industrial factors and consumer expectations. However, the political challenges of introducing change and innovation in nursing in general practice must also be given careful consideration. Professional leadership that successfully manages the complex interplay of these and other factors will be important in advancing the role in the future.As this nursing role evolves it is important that the nursing profession, including professional, industrial and regulatory representatives work collaboratively to promote the health and well-being of Australians. The impact of this role on health service provision also needs to be carefully examined through research processes in order to build an evidence-base. Evaluative data will be useful in developing and expanding the role in the future in defensible ways through policy development.In this special issue of Contemporary Nurse, McMurray (2007) emphasises the importance of leadership in primary care and provides us with useful strategies for promoting the health of communities. Hall et al. (2007) and Porritt (2007) trace the recent developments of the practice nurse role in Australian general practice and underscore the importance of policy in driving health care reforms and developing nurses' roles that are responsive to needs of contemporary health care systems.Models of nursing roles in primary care should complement and support the role of other health practitioners, particularly the general practitioner. The role for the nurse practitioner in general practice will evolve as multidisciplinary models of care are advanced, in order to enhance existing service provision and improve access to primary care for all consumers. Nursing is in a good position to influence development of these models, the end point of which must be improved health outcomes for consumers of these services. Consequently education initiatives in the undergraduate, post graduate and professional development sphere need to prepare nurses to work collaboratively with multidisciplinary colleagues, particularly in the general practice setting. Nurses working in specialist domains of practice should also establish links with nurse colleagues in the primary care setting to support their professional growth, promote the quality and continuity of clinical care and in developing practice-based research and scholarship.Over the last five years, nursing in Australian general practice has developed substantially and will evolve as multidisciplinary models of care are advanced to improve existing service provision and improve access to primary care for all consumers (Council of Deans of Nursing and Midwifery of Australia and New Zealand 2004). …

To provide a model to estimate human resource needs for community-based mental health services in South Africa. A situation analysis was conducted of current community-based mental health service provision in South Africa, which comprise outpatient and emergency services, residential care and day care. Service utilisation rates and staffing needs were estimated for two levels of service coverage, using data from the situation analysis, local epidemiological studies and consultation with key stakeholders. For a population of 100,000 people, 7.3-23.8 full-time equivalent staff would be required to provide services in outpatient services, 14.9-41.6 in day care and 11.5-23.0 in residential care at minimum and full coverage levels respectively. The model can facilitate rational planning by requiring transparency and accountability in the assumptions used. This method can be adapted to a range of countries, by entering relevant country data. The model fills a gap, particularly in low- and middle-income countries, where community-based mental health services are sparse, and decisions regarding allocations to them are hampered by a lack of good quality data. The results of the model are limited by the quality of data and the assumptions upon which the modelling are based.

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

The Critical and Evolving Roles for Psychiatry in Health Reform

AimsTo study the impact of collaborative working, via consultation liaison, between Mental Health Liaison Practitioners (MHLPs) and Doctors within a secondary care mental health service. We hypothesise that this model of working may avoid unnecessary clinic appointments and waiting times, whilst providing patients with more efficient treatment.BackgroundMental health services are stretched, understaffed and under-resourced. It is estimated that 75% of people with mental health problems in England may not get access to the treatment they need. We therefore need efficient and innovative ways for people who seek help to receive support. Good practice consultation liaison involves face to face contact between clinicians; treatment can be delivered by supporting primary care whilst reducing the burden of secondary care mental health services.MethodRegular 30-minute sessions within an Assessment and Treatment Service, between MHLPs and Doctors, at both Consultant and Trainee level, were coordinated. Patients assessed by MHLPs were discussed by opening a dialogue whereby further management was discussed across a multi-professional team. A record was created of all patients discussed and the outcome.ResultNumber of MHLP/Doctor sessions: 10 across a six-month period.Number of patients discussed: 17.Medication advice provided for 16 patients. One patient required a referral for a clinic appointment.For several patients, integrated working procured alternative care pathways and resources to be considered, to incorporate into individual treatment plans.ConclusionRegular consultation liaison with MHLPs and Doctors is a model of working across the interface between primary care and specialist mental health services. It may provide patients with more efficient care, whilst avoiding unnecessary waiting times for clinic appointments. The consultation liaison working supported the development of an educative relationship between clinicians, with interprofessional learning. This is an example of an integrated and collaborative care model, whereby multi-professional working can provide efficient and effective treatment, whilst the support for the patient can remain in the primary care setting.

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

The central place of psychiatry in health care worldwide.

The American Academy of Pediatrics (AAP) policy statement entitled “The New Morbidity Revisited: A Renewed Commitment to the Psychosocial Aspects of Pediatric Care”1 from the Committee on Psychosocial Aspects of Child and Family Health is found in this month's issue of Pediatrics . Few experienced pediatric practitioners would disagree with this description of our life's work. Most embrace this “renewed commitment” to relevant and comprehensive care for our children and families. It is not hard to look past the examination room and appreciate the struggles, tensions, and morbidities that this complex world presents our patients as they grow and develop. But what about the complex world of our practices? We are well-intended, but are we well-trained, and are we able to follow through on our “commitment”? “ Mental health needs of children and adolescents are increasing while access to behavioral health, mental health, and substance abuse service is decreasing .”2 The rate of psychosocial problems identified by primary care physicians in the children they care for has increased from 7% to 18% in the past 20 years. Information accumulated by the Pediatric Research in Office Settings (PROS) group3 confirmed what practicing pediatricians already know: the children we see for earaches bring with them symptoms of their behavioral health. These children may have attentional difficulties, conduct issues, or significant problems of mood. They may suffer acute adjustment difficulties or evidence posttraumatic stress from physical, emotional, or sexual abuse, and may experience family poverty, family divorce, or a host of other intrinsic or situational problems that impact on their health and the ability of their family and caregivers to provide for their health. We are seeing more problems and, lacking referral sources, often have to provide more care. Skills needed to address the new morbidities are part of our …

<b>PB-PG-0712-28011 – NIHR Research for Patient Benefit Programme – Final report</b><br /> <br /> <b>Project title: </b>Learning from women’s experiences: improving our understanding of the physical, psychological and emotional health impacts of domestic violence and abuse (DVA), help-seeking trajectories and outcomes<br /> <br /> <b>Authors:&nbsp;</b><br /> Dr Maggie Evans - NHS Bristol CCG&nbsp;&nbsp;<br /> ProfessorGene Feder - University of Bristol<br /> Dr Fiona Duxbury - Blackbird Leys Health Centre<br /> Dr Helen Salisbury - University of Oxford<br /> Professor Sue Ziebland - University of Oxford<br /> <br /> <b>Plain language summary</b><br /> <br /> It is estimated that 1 in 4 women experience Domestic Violence and Abuse (DVA) during their lifetime and may approach multiple agencies before they get help. On average women try to leave abusive relationships 7 or 8 times, but may encounter repercussions from their partner and difficulty in disclosing their situation to family members, friends, health care or other professionals. This can lead to extreme social isolation. We aimed to develop a web-based resource which gives real-life accounts of women's experiences of DVA and their outcomes. This may help to increase the options for women in an abusive relationship, suggest ways to improve their self-care, where to seek help and how to make plans to leave.<br /> <br /> We conducted in-depth video- and audio-taped interviews with 40 women across the UK, with a range of ages and ethnic backgrounds, who have experienced DVA, asking about the impacts on their physical and mental health, their help-seeking experiences, outcomes and any barriers experienced. The interviews are being used to develop (i) a web-based resource for women experiencing DVA, family members and friends, as part of www.healthtalkonline.org. (ii) a training resource for medical and allied health and social care professionals. Participants were recruited through Patient and Public Involvement groups, advertisements in the media, a dedicated website and specialist third sector agencies. Women were interviewed at a safe location by an experienced female researcher.<br /> <br /> We were very careful to ensure participants’ safety. Women who felt uncomfortable about videos or audio-recordings being available online are represented by actors, and real names of people and places are deleted.<br /> We found consistent themes in the women’s narratives, which have been written up as Topic Summaries for the website. For example, the data provide new insights into the experience of Coercive Control which is now a criminal offence but is poorly understood. We found new insights into the difficulties and dangers faced by women who want to leave an abusive relationship, which counter the often asked question: ‘Why didn’t you just leave’. We also found that women themselves were so isolated and controlled in the abusive relationship that they generally did not understand that they were experiencing DVA. Our study highlights the need for wide-ranging education into the reality of DVA, which will be part of the dissemination process.<br /> <br /> <b>Keywords</b><br /> Domestic Violence, Domestic Abuse, Women's Narratives, Women's Help-seeking, Women's Health, Qualitative study, Website study.<br /> <br /> <b>Summary of research findings</b><br /> <br /> Methods<br /> <br /> We recruited a purposive sample of 40 women across the UK who have experienced DVA. They had a range of ages and ethnic backgrounds. Women were recruited via DVA support agencies, patients at GP practices which operate the IRIS model for the identification and referral of women to DVA support agencies, a website set up for our study, twitter and FaceBook.<br /> <br /> Women were interviewed in a safe, convenient location using a topic guide that covered all aspects of their experience of DVA. Interviews were video- and/or audio- recorded. Women could chose the form in which clips of their interview will appear on the website, either video, audio, written or spoken by an actor. Three women decided not to have their data included on the website. All participants had the opportunity to check and give approval for the use of their interview data, making deletions if they wished to.<br /> <br /> Interviews were transcribed, anonymised and the data were entered into NVIVO software. The research team carried out a thematic analysis which was used as the basis for writing 27 Topic Summaries for the website, illustrated by clips from the interviews. These summaries represent the full range of women’s experiences of DVA, and reflect the most important themes. The topic summaries and associated clips are being processed by the technical team at the DiPEx charity in order for them to appear on the website. All video and audio tapes will be professionally edited.<br /> Some of the participants, DVA professionals and GPs, along with the research team formed an Advisory Panel that met twice during the study, to comment on the process and to advise on the content of the proposed Topic Summaries. They evaluated the material that had been prepared by the research team in June 2016 and, as a result, major changes were made to the format and content of the Topic Summaries, feedback that was valuable in developing the finished product.<br /> <br /> Key Findings<br /> <br /> We found consistent themes in the women’s narratives, which formed the Topic Summaries for the website. For example, the data provide new insights into the experience of Coercive Control which is now a criminal offence but is poorly understood. We found new insights into the difficulties and dangers faced by women who want to leave an abusive relationship, which counter the often asked question: ‘Why didn’t you just leave’.<br /> <br /> Women's narratives confirmed the devastating impacts of DVA on their mental health and also on that of their children, impacts that did not stop when the relationship ended. Specialized therapy may be needed to help women and their families recover from the trauma of DVA, and yet women's accounts reveal a widespread lack of understanding or appropriate support across a range of key professionals in healthcare, the police and children's services including CAFCASS.<br /> <br /> We also discovered a number of significant barriers to women in seeking help, which form a Topic on the website entitled ‘Obstacles to seeking help’. Women across all educational levels revealed a lack of knowledge about DVA, so they were not able to understand their partner’s behaviour. Women described being manipulated into believing their partner’s behaviour was their fault and therefore they had no ‘right’ to ask for help.<br /> <br /> Other constraints to asking for help included a deep fear amongst women that they might lose custody of their children if their home situation was known about by professionals. Women also said that it was hard for them to open up to anybody about their experiences and urged professionals, family and friends to ask more questions but to be non-judgmental. The very real repercussions in terms of violence from their partner when a woman left was highlighted in the interviews and underlines the need for greater support at this time. For many women, getting a place in a women’s refuge was impossible owing to lack of availability and the need to be eligible for public funding. This was particularly difficult for first generation migrant women.<br /> <br /> Our study highlights the need for wide-ranging education into the reality of DVA, which will be part of the dissemination process. Our participants frequently experienced being let down by, for example, the police who had, in the participants’ view, little understanding of DVA beyond physical violence.<br /> <br /> Expected impact<br /> <br /> The study will be published online as part of the award-winning website www.healthtalkonline.org, a growing resource that specialises in disseminating qualitative studies of experiences of health and illness. The impact of a website is difficult to measure. The site currently covers over 70 health conditions and receives over 5 million hits per month. Following the launch of the DVA module, which is likely to be in March 2017, we will undertake dissemination work to maximise potential impact. We will receive regular bulletins of the number of hits per page from the website charity, so that we can monitor usage over time.<br /> <br /> We plan to expand on dissemination and impact measurement following the launch which will include a Press release and media coverage. We are working closely with Women’s Aid to facilitate dissemination. The DVA module will be introduced on the website by some video clips from key informants in the field of DVA. We have made an introductory video of Jenni Murray, Patron of Women’s Aid and presenter of Radio 4 Woman's Hour. Radio 4 has been covering DVA in the last two years through a storyline in the radio series ‘The Archers’ and Women’s Hour has made several reports on the topic. We hope to use this forum to advertise the website module.&nbsp;<br /> <br /> We have already taken steps to include findings and video clips in teaching modules for medical students and in academic and non-academic conferences and events. Clips and data from the DVA module will be incorporated in the training for the IRIS model for GPs and other staff in primary care (see www.irisdomesticviolence.org.uk). We hope that the range of topics addressed in the DVA module will strengthen the likelihood that primary health care and other commissioners will commission IRIS and other DVA resources. Small cards and/or posters giving the web address of the DVA module will be available to be distributed to interested parties, for example GP practices, hospitals, police stations, DVA agencies, other public places. Attempts till be made to disseminate into other professional areas such as the training of police or the education of young people. One potential method for doing this is to create a piece of ‘verbatim theatre’ in which actors speak the words of women survivors of DVA, taken from their narratives, and developed into a piece of theatre. We plan to apply for funding for dissemination and impact assessment work.<br /> <br /> The balance of the grant (under &pound;4,000) will be retained for 12 calendar months so that we can undertake planned dissemination work, which will include professionals' study and information days and attending international conferences about DVA (please see spreadsheet for details).<br /> <br /> Conclusions<br /> <br /> A resource such as the www.healthtalk.org&nbsp; module about DVA could be used in a variety of health care, social care and educational settings, to increase public and professional understanding of DVA. Most of the women said that, had they known about DVA in all its various forms, they might not have stayed so long in an abusive relationship, and they would have sought help earlier.<br /> <br /> A positive outcome was the number of women who experienced support from other survivors of DVA. For many women, simply talking to someone else who understood, was the beginning of their own journey away from abuse. Providing and evaluating information, resources and training to facilitate women in setting up and advertising peer support groups could be valuable future research proposals.<br /> <br /> <br /> <b>Patient and public involvement</b><br /> <br /> Working with our PPI group of women survivors of DVA has been essential to the success of the study. I feel strongly that PPI representation should not be tokenistic, such as one or two PPI members on a steering group that mainly comprises academics and other professionals, which will enable only the more confident or articulate to participate. I also resist the move towards the 'semi-professionalisation' of PPI members that I see in evidence around me, whereby individuals with a particular illness condition are recruited because of current or past professional skills that are relevant to the research rather than for their personal experience of the condition that is being studied. I have witnessed formal application forms and interviews for PPI positions, which I wholly disagree with. Our role as professionals is to objectify the condition under study and as far as PPI members are concerned it is important to prioritise their subjective experiences, not their confidence or articulate-ness or professional skills.<br /> <br /> With this in mind, we recruited a group of women survivors, some of whom had worked with us on previous studies, and who met regularly during the lifetime of the study. Meetings were held at the University, pre-paid taxis were booked to enable women to attend, lunch was provided and shopping vouchers of &pound;20 were provided in appreciation of their time and contribution. Four members of this group volunteered to join the project Advisory Panel that also included professionals from Women's Aid, the local DVA agency, the IRIS programme, GPs with expertise in DVA and the core research team.<br /> <br /> PPI members were involved in developing the funding application, helping to prioritise the research aims and develop the methodology. They provided important insights into issues of confidentiality and safety in terms of recruitment, data collection and use of the data on the website. When funding was secured, PPI members assisted in the development of participant information resources, commenting on the design and wording of all research documents such as participant information sheets, consent forms and topic guides. We agreed to implement a safety button on each page that instantly closes the website down should a woman be disurbed while One innovation that arose from this process was the design and use of a coloured flyer which was widely disseminated. It showed a woman's face with speech bubbles asking key questions to identify DVA. This was used as the initial stage of recruitment, before the full information sheets were provided. Another example was the agreement to include a safety button on each page that quickly closes the website down if a woman is disturbed while accessing the site.<br /> <br /> We held two Advisory Panel meetings during the lifetime of the study, which were lengthy working sessions. All members were sent data in advance and invited to comment. At the second of the two meetings, we drafted the Topic Summaries for the website and we had a very lively meeting following which I changed the focus of the data analysis in line with the feedback from the survivors. Drawing on their own experience they were able to steer the way in which the data was analysed, so that we reduced the emphasis on some topics and expanded others. One example of this is the use of a large amount of data in the interviews relating to the effects of DVA on children, some very long-term, and women's struggles to get help and support for their children. We had not originally processed this data as it seemed to take the focus off the women and we also feel that we have enough data on children to potentially write another healthtalk module! However,&nbsp; all the women felt that impact on children was one of their prime concerns. When we analysed the data we realised that the impact on children was both a reason for women to stay in an abusive relationship and also a reason for women to get away. Although the analysis and processing of this data provided a lot of extra work, we feel that the module is better as a result. Our panel representative from the HERG unit at Oxford (which leads the research for the website) commented that it was one of the best, well attended and inclusive meetings she had attended.<br /> <br /> The PPI women continue to be involved, some have offered to proof-read the material for the website, others are personally attending conferences and meetings to speak about their experiences of DVA and their experiences as research advisors. When the module is ready, we will involve PPI women in a short evaluation and checking, followed by the&nbsp; launch. We will continue to consult and involve the women in our dissemination plans.<br /> <br /> <b>Data sharing statement</b><br /> See link <a href="https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253">[https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253</a>] for the NIHR position of the sharing of research data.&nbsp; The NIHR strongly supports the sharing of data in the most appropriate way, to help deliver research that maximises benefits to patients and the wider public, the health and care system and which contributes to economic growth in the UK.&nbsp; All requests for data should be directed to the award holder and managed by the award holder.<br /> <br /> <b>Disclaimer</b><br /> This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0712-28011). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.<br /> <br /> This project was carried out between September 2014 and November 2016 . This final report has not been peer-reviewed. The report was examined by the Programme Director at the time of submission to assess completeness against the stated aims.

views and personal experiences of people who have especially contributed to the evolution of ideas in the Journal's field of interest.

The importance of establishing effective inter‐agency working between adult mental health services and child care services in order to safeguard children has been repeatedly identified by research, policy, inquiries and inspection reports. This article reports on the evaluation of an initiative in one health and social care trust in Northern Ireland that aimed to facilitate joint working and so improve service provision and protection for children and families. The Champions Initiative involved identifying a Champion in each multidisciplinary community mental health team and in each family and child care team that would have responsibility for providing information, promoting joint working and identifying any obstacles to better cooperation. The evaluation of this Initiative assessed levels of experience, training, confidence, understanding and awareness in the Champions and their team members at baseline. The Champions and their Team Leaders were then followed up after six months to obtain their qualitative views of the impact of the initiative. The results include comparisons between mental health and child care staff, and crucially, views about whether the initiative has had any impact on working together. This study also generated recommendations for further service development in this complex and important area of practice. Copyright © 2010 John Wiley &amp; Sons, Ltd.‘Identifying a Champion in each multidisciplinary community mental health team and in each family and child care team’