Work to date• Defining groups / pathways• Process mapping• Content analysis• Defining contentTo doDefine organisation and structure
Process Mapping - what we have learnt• Timeliness• Inconsistency / variation – procedures, standards• Specific / specialist – poorly defined and protected• Choice / Partnership the most planned part of our system
YES •SOCIAL CARE DECISION DECISION ERA LIASES ASSESSMENT ASSMT & RISK DECISION AWAIT GATEWAY GATEWAY •SCHOOLS POINT POINT WITH YES - MANAGEMENT POINT ASSESSMENT (HTT/TIER 4) ASSESSMENT •COMMUNITY SCAP •HTT INPUT REFERRER •WHO (HOSPITAL •REQUEST •COMMUNITY •GP’S •TIER 4 BED REFERRER EMERGENCY /ERA AND •WHEN WARD, HTT/TIER 4 ASSMT CAMHS 7 DAY •OUT OF B’HAM & YES •EXIT TELEPHONE •WHERE COMMUNITY, •STAY IN /COME ERA/MEDIC •JOINT PLAN FOLLOW-UP EXIT IN BHAM NO PATHWAY RISK NO - EXIT SCHOOL, CLINIC) INTO HOSPITAL REVIEW/ASSESSMENT WITH MH & SS •OTHER HEALTH ASSESSMENT FOR FURTHER •DISCHARGED PROFRESSIONALS • HANDOVER ASSMT & RISK SOCIAL CARE INPUT, TO SOCIAL •SCAP TO LOCAL EXIT E NO MANAGEMENT JOINT ASSMT CARE CAMHS TEAM, PATHWAY TO •INVOLVE SOCIAL PROVISION (NON-BHAM) CARE SCAP •DISCHARGE FROM HOSPITAL •POLICE OOH OOH OOH OOH OOH OOH OOH •EDT SOCIAL HANDOVER SWITCH ON CALL SPR , TELEPHONE SPR OR MANAGEMENT •HTT MAKES ARRANGMENTS CARE FROM ERA BOARD CONTACTS SPR INVOLVE RISK ASSESSMENT REGISTRA •HHT •ASHFIELD ADMITTED REFERRER •A & E TO ON CALL OR HANDOVER FROM CONSULTANT •ADVISE OVER THE ASSESSMENT •INPATIENT •EXIT, 7DAY FOLLOW UP •RAID SPR ERA CLINICIAN PHONE •ONGOING DEPENDING ON HANDOVER •SCAP •FACE TO FACE •CONTAINMENT •EXIT PSYCHOLOGY PSYCHOLOGY ERA CLINICIAN PSYCHOLOGY URGENT URGENT PSYCHOLOGY DECISION POINT ADMIT TO PAEDS BED DECISION PSYCHOLOGY TREATMENT AS •OUTPATIENT REGARDING ASSESSMENT USUAL, 2/3 •OUTPATIENTS WAITING LIST EMERGENCY PLANNED WITHIN RESOLVED •ON GOING (13 WEEKS) PSYCHOLOGY PSYCHOLOGY PSYCHOLOGY NEXT 24 HOURS WITHIN 3 TREATMENT HOSPITAL HP REFER TO REFERRAL DUTY NON URGENT (UNLESS SESSIONS •TREAT AS •LOCALITIES PAEDS BCH •PHONE PSYCHOLOGIST/ PSYCHOLOGY MITIGATING (ASSESSMENT INPATIENT CAMHS & OUT PSYCHOLOGY •FORM SPECIALIST – •PSYCHOLOGY OUTPATIENT CIRCUMSTANCES) COMPLETED, •LONGER PIECE OF OF B’HAM •VERBAL REVIEW REFERRAL WAITING LIST CARE PLAN) WORK MON-FRI 9-5 •SIGN POST ELSEWHERE OOH RING SPR KNOWN •ADVISE OR EXIT END /EXSISITING LOCALITY TEAM CASES •REFER TO A&E COMMUNITY •TELEPHONE •PHONE CALL REVIEW & CAMHS •IS SESSION •FACE TO FACE ASSESSMENT MANAGEMENT •TURN UP COMPLETED •FACE TO FACE •INCIDENT •SPEAK TO CONTACT COLLEAGUES •REFER TO ERA (WHO, WHEN , WHERE) LD ALL ABOVE MINUS REFER TO ERA ALL OF TIER 3 – INTERNAL PROCESS OF USING INTERNAL CLINCIANS (LESS ROBUST) LAC TRANSFER BACK TO T3 OOH •COMMUNITY CAMHS •TELEPHONE/FAX •TELEPHONE SCREENING DECISION POINT HTT RING SPR •POS ASSESSMENT (WITHIN 4 HOURS) ASSESS OR REJECT •ERA INPATIENT HTT INPUT, ALONGSIDE TIER 3 POLICE TO BCH POLICE DECISION POINT ASSESSMENT MHA DECISION POINT DECISION POINT ADMISSION TO T4 136 SUITE POS SWITCHBOARD, POS MEDICALLY FIT IN HOURS - DR / AMP (ERA) DETAINED NOT DETAINED MANAGE-MENT PLAN COORDINATOR UNFIT ED OOH – ON CALL SPR DUTY AMP REFERRAL FROM SCREENING CAMHS LIASON GENERAL PAEDS SIGNPOSTING END •ASSESSMENT ON GOINGLIASON CAMHS AT BCH, ERA ASSESS •CRISIS MANAGEMENT JOINT ASSESSMENT WITH REFERRER •LIASON MANGEMENT
Key issues regarding pathways• Importance of – good decision making (evidence driven) – making it simple and understandable (enhancing patient and clinical experience) – each component part doing its job well (competent + skilled workforce) – avoiding unnecessary hand offs, cul de sacs and passing on (enhancing patient experience, responsibility taking) – clarity regarding what people should do (keeping high standards) – organisational structure which supports the work people are expected to complete (making it manageable).
Clinical pathways• Each pathway have worked on content – What should people be providing, in terms of assessment, formulation and treatment – Expectation that clinical staff will follow structure and content of pathways – Possible to break the pathway into constituent parts with specific responsibilities to be completed at each stage (to a specific level)
Formulation and goal Emotion recognition (use Mindfulness/relaxation/g setting (use additional rating scales and mood rounding skills training assessment questions to monitoring forms, bag of (tracks available to help formulate as well as feelings, feelings cards) download from outcome measure Activity scheduling (may Cognitive strategies to questionnaires to identify need to involve parents address depression-specific in making sure activities distortions/deficits (use issues) are available and think good feel good Psycho-education about realistic) worksheets or Friends depression (direct to self- Problem solving skills red/green thoughts help materials as well as training worksheets ) discussing depression, Relapse what it is, how common prevention/blueprinting it is and how it affects you)Mood - assessment, formulation, psycho- education, intervention
Stock take• Each of the groups were asked, in preparation for the awayday to take stock• Some groups e.g. City wide CAPA, SCAP are in the midst of implementation and have coherent plans. LD probably in same place.• Neuro-developmental, Emotional / Behavioural are well positioned to look at implementation – fitting in with existing CAPA model. Some issues such as use of groups outstanding• STEP pathways – most challenging area not just content but also how to incorporate lean organisation – are there more radical patient friendly solutions• ED pathway – slightly out of kilter with other pathways (set up later) – some clear progress that can be made
Merged pathway – based on integration of clinical presentations (?interventions)
‘I skate to where the puck is going to be, not where it has been’Preparing for the future Things that can help us • Patient experience • IAPT • Training • Trust values • Valuing basic care (and tasks)
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