Operational policy update

1. Operational policy update May 2009

2. These slides are to let you know about… • Changes made recently to the policy • Future changes (At the end there is also a reminder of the structure of the policy and the process for reviewing it)

3. Changes this month Changes have been made to EIS policy re • All new clients to be on full CPA • A new consent form • Fewer routine assessments for clients accepted by EIS • Further clarification of psychiatrists role • Accepting referrals to EIS from cmhts and pcmhts

4. Core module – full CPA Under the new CPA arrangements in place from 2008, some clients of mental health services will not be on CPA. However all new EIS clients do need to be placed on full CPA.

5. Core module – consent form (1) There is to be a new EIS consent form - the content is being finalized and will be circulated soon. This will give clients the options of consenting at a single time to a number of things (though they can of course withdraw their consent to these things at any time) This form will need to be filed at the front of the case notes.

6. Core module – consent form (2) Clients will be asked to indicate whether they agree • That they have had explanation of confidentiality policy • For the team to contact schoolor college • For anonymised information from their records to be used for research aiming to improve services. • For the team to contact a named relative or friend to give information about events or opportunities • To be contacted by telephone for feedback on the service. • For copies of letters to be sent to them at a specified address

7. Core module – assessments (1) Following the away day discussions, we have greatly reduced the list of structured assessments that will be offered routinely to clients accepted by EIS. In doing this, we aim to have a list of assessments which • Is definitely achievable for all clients (ie. Realistic for case managers to do • Will help us provide good care for individuals and understand how the service is performing

8. Core module – assessments (2) From now on, the only structured assessments which case managers will be expected to offer all clients are these: • LCFT mandatory assessments (HSCNA, HoNOS, safety profile, carer assessment) • PANSS + estimation of DUP based on PANSS interview • Timeline and genogram • A social inclusion measure (Denver social inclusion scale, plus GAF for the time being) • LUNSERS (for clients on antipsychotics) • EIS feedback questionnaire (for client to complete)

9. Core module – assessments (3) Second line measures Some clients will need additional structured assessments eg. for depression, substance misuse, personality difficulties, developmental disorders The service will develop a list of recommended second line assessments and of indications when they should be used.

10. Core module – assessments (4) Importance of the health and social care needs assessment • The HSCNA is the starting point for deciding if additional assessments are needed. • It is crucial that this is a live document which is updated as new information becomes available. • We are not using a specific assessment for assessing trauma history, but it is very important to always enquire about this and to record on the HSCNA that this has been done, even if findings are negative • More training will be provided around these issues.

11. Core module – assessments (5) Recording of structured assessments • Paper copies should be stored in the assessment section of the case notes • They should be scanned onto edms when this becomes routine practice • An entry should be made on ecpa daily record that the assessment has been done and filed and scanned in.

12. Core module – assessments (6) What about…. • CAARMS? – in future this will only be done in the LEAD clinic and in the local assessment clinics which will replace the LEAD clinic evenually • SCIPANSS? – you can continue to use this if you like. Or you can score PANSS on the basis of a conversation with the client which covers each of the PANSS items, but which does not necessarily use the SCIPANSS format. • Other assessments we use at the moment? – eg. Beck,Calgary etc. You can continue to use these if you wish where you feel it would be helpful with an individual client. In time the service will develop some recommendations regarding use of other assessment instruments.

13. Organization and processes - psychiatrists roles (1) There are two changes you need to be aware of but please re-read the whole section on psychiatrist roles to put these in context.

14. Organization and processes - psychiatrists roles (2) First change A minimum frequency for psychiatrist appointments. From now on we will aim to offer appointments with a psychiatrist (consultant or other psychiatrist) at the very least • When a client is first accepted into EIS • After a hospital admission, within 4 weeks of discharge • At 12 month intervals • On discharge from EIS (unless care co-ordinator, psychiatrist and client agree this is not needed) Most appointments with psychiatrists will continue to be arranged in response to clients’ needs, and will be more frequent than this.

15. Organization and processes - psychiatrists roles (3) Second change Always having a next psychiatrist appointment booked. After each appointment with a psychiatrist, a further appointment will be booked. This will be in a maximum of 12 months time, but will often be sooner if this is indicated. The secretary booking the appointment will need to cancel any psychiatrist appointments already in the diary for this client.

16. Organization and processes - referrals from cmhts A new paragraph added to clarify expectations of other teams: ‘Referrals to EIS from other teams need to be accompanied by a Health and Social Care Needs Assessment and safety profile as per CPA policy. However if a GP referral appears to have been sent in error to another team rather than the EIS, then this referral may be accepted by the EIS without the other team being asked to see the patient first. This will only happen once the other team has clarified with the GP that the referral was sent in error rather than because a same day response was needed. ‘

17. Possible future changes Please help to improve the policy by sharing your ideas Comments very welcome on • The recent changes • Anything else you think needs attention In June there will be a major revision to the section on referrals, to take account of the new assessment clinics which will eventually replace the LEAD clinic.

18. Possible future changes Please pass on your comments by • Contacting any of the members of the review group (Jeff Warburton, Warren Larkin, Mark Butler, Louella Bielby, Vicki Sherrington, Meryl Crawford, Amardip Prihar) • Coming along in person to an operational policy review group meeting if there is something you would particularly like to discuss (Next meeting September 9th 1.30-3pm)

19. A reminder of the structure of the policy (1) There are 3 detailed documents for use by EIS staff. These are the ones to refer to if you have questions about what we are intended to be doing. These cover • Referrrals • Core module • Service organization

20. A reminder of the structure of the policy(2) There is also a summary document is suitable for sharing with people outside the service, and as a starting point if you are reading the policy for the first time. It contains information about the service philosophy and structure which aren’t in the other documents. The sections on referrals, core module and organization and processes don’t contain anything that isn’t in the other three documents.

21. And a reminder of how changes get made Anyone can make a suggestion for changes An operational policy review group meets 6 monthly to discuss suggestions and agree proposals for changes The proposed changes are then agreed (or not agreed) in the Standards for Better Health group, which is the main EIS management group.