DDST Dual Diagnosis Street Team – CPFT – Highly Commended #MHAwards19

They are a small team of 5 very committed members of staff who walk on average 7 miles per day across the streets of Cambridge. They have shown great flexibility in how they deliver their service and have routinely inputted to the churches cold weather scheme working till 9 pm at night to help with the risk management and success of this scheme and make contact with potential service users. They have also contributed to the quarterly rough sleepers census walking the streets through the night to gather information. From the outset the team has worked with rough sleepers to ascertain what support would be beneficial and how this should be delivered.

Core hours 9-5 . Winter working through till 9pm

Highly Commended - #MHAwards19

Co-Production


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  • From start: No

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  • In evaluation: No

Evaluation


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  • Peer: No

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  • Academic: No

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  • PP Collaborative: No

Find out more

Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.

The team was set up in June 2017 as a two year pilot to work with entrenched rough sleepers with primary goal of creating a pathway into mainstream services to address mental health and substance misuse issues as well as to secure accommodation. The team has made a tremendous impact on this community & established fantastic networking relationships with other providers from whom they have clearly earned significant respect. “they are the rock stars of mental health “ . (Wintercomfort) They are a small team of 5 very committed members of staff who walk on average 7 miles per day across the streets of Cambridge. They have shown great flexibility in how they deliver their service and have routinely inputted to the churches cold weather scheme working till 9 pm at night to help with the risk management and success of this scheme and make contact with potential service users. They have also contributed to the quarterly rough sleepers census walking the streets through the night to gather information. From the outset the team has worked with rough sleepers to ascertain what support would be beneficial and how this should be delivered. Service users helped in designing the referral form for the service and inputted into DDST publications.

Rough sleepers shaped the whole referral process determining that only self referrals were accepted enabling the team to work with people from the outset. This prevented referrals being sent without consent. Charity “comfort packs” were developed closely with service users who stipulated what would be helpful to receive. The team have been part of the evaluation of Rough Sleeping Grant and Complex Needs SIBs being carried out by the Centre for Regional Economic and Social Research (CRESR) at Sheffield Hallam University, working in partnership with Heriot Watt University and the University of Cardiff. Its key objective is to bring together both qualitative and quantitative data to provide an evidence base on what works to reduce homelessness and improve outcomes for individuals who are in the cycle of rough sleeping and who have multiple and complex needs including mental health and/or substance misuse. The results of this study are not yet finalized for publishing but this work has involved DDST attending a meeting at the Ministry of Housing at Westminster.

 

What makes your service stand out from others? Please provide an example of this.

The team recently sat on an expert panel at St. Johns college in Cambridge for a Q&A session. They have also recently coordinated charity funds to organise “comfort packs” to distribute to their caseload. This has included a collaboration with a local refugee charity who have donated hand made blanket ponchos to be given out to those in need. Between July 2017 and Nov 2018 the team worked with 74 people. Following team input 51 had received a mental health assessment, 40 of the 74 received some sort of substance dependency programme. At the outset 39 were rough sleepers -following team involvement this reduced to 5. 27 service users received support to prevent homelessness. In June 2018 two members of the team presented at a national conference in Belfast around the work that they were doing and collaborated and shared good practice with a similar team bringing back ideas to implement locally.

 

Carer’s feedback : The DDST team worked with my father, XXXX, in 2017-2018 through their street outreach work. Sadly my father passed away last year, we had been estranged for 20 years and had no idea that he was homeless. It has been incredibly painful to learn about my father’s experience, but knowing that he had some great support around him means a great deal and I am certain that it would have meant a great deal to him. This is something I will never be able to thank the DDST team for enough and I will never forget that they were there for my father when he had very little. They were able to support my father with his mental health needs, work with a local charity to get my father into supported housing and enjoy a laugh from time to time. Their success was in making a huge difference to my father’s life through practical support and in encouraging in him some feeling of self-worth, well-being and enjoyment from life despite the enormity of what he was facing. Chair of Cambridge Churches Homeless project writing to the team manager: The DDST is much needed in Cambridge. You are the right service and recruited the right people into the right roles. You and your colleagues, Nadine, Iris and Conrad have been outstanding and will be hugely missed. A joy to work with, highly professional and whatever measures have been used to evaluate your work, from where I am standing you and your team have made a big, big difference to many people and you should feel incredibly proud of everything you have achieved. Thank you for all your hard work and the commitment that your team have shown to each of your clients.

 

How do you ensure an effective, safe, compassionate and sustainable workforce?

DDST is a small team of 5 staff – one team manager , one administrator and 3 core staff – an OT, social worker and CPN. The team meets on a daily basis to share working concerns. Co working is common place and all staff receive regular supervision. Supportive debrief meetings have been held following adverse events – eg service user death and these have been facilitated by psychologists from the local adult community team. DDST can also access group supervision, teaching sessions and psychological formulation via the local adult community teams. Staff have full access to CPFT wellbeing initiatives such as the Staff wellbeing service focused on muscoskeletal conditions, access to flexible working policies, access to Insight staff counselling service and Occupational Health. The team manager was supported to attend and complete the Mary Seacole scholarship in relation to management training and other staff have accessed conferences as appropriate, to link in with relevant audiences and topics pertinent to the team.

 

Who is in your team?

Team manager/CPN Band 7 wte 1.0 OT Band 6 wte 1.0 Social worker Band 6 wte 1.0 CPN Band 6 wte 1.0 Administrator Band 3 wte 0.26

 

How do you work with the wider system?

The team works closely with substance misuse providers, housing, other homeless initiatives and the wider mental health network . These working links have been crucial to the teams success and effectiveness. Beyond just being a link DDST have been a crucial support to local voluntary sector homeless organisations in supporting the work that they do, working alongside and with each other to achieve best outcomes for shared service users. This has included a presence at the churches homeless scheme for winter, a supportive presence on the quarterly street homeless night census and to provide educational expertise around mental health issues. DDST have acted as strong advocates for their service users and needed to challenge decisions against current legislation.

There are well established close working relationships with secondary care mental health services as previously detailed characterized by advice, signposting, joint visits and clear communication between teams. Information sharing protocols were established from the outset and shared access granted to local authority homeless database which coordinated shared information from the voluntary sector agencies as well as DDST. DDST have provided support and advice to the local council following the need for them to adapt their approach to a more case working style as a consequence of the Homeless reduction Act 2017 . This support has taken the form of practical support as well as attending council team away day and team meetings to advice on council implementation with specific regard to mental health issues. Links with probation have resulted in an increase of referrals from them and worked with individual probation officers on specific cases. DDST has been involved in developing the provision of Naloxone. A change of substance misuse provider has temporarily stalled this work. Having shadowed a team in Belfast and their work around Naloxone harm reduction DDST were encouraged to share good practice they had witnessed on return to Cambridge as there was demonstrable evidence of a reduction in associated deaths

Do you use co-production approaches?

The team worked with service users at the outset to design the referral process, forms and leaflets. It was strongly felt that referrals should be done on a self referral basis. DDST have consistently accessed service user feedback to ensure that the service is meeting needs in the most helpful way. When applying to provide charity comfort packs DDST consulted their service users to see what would be helpful to provide.

 

Do you share your work with others? If so, please tell us how.

DDST was invited to attend and speak at The Royal College of Occupational Health annual conference in Belfast in 2018 and to speak at St Johns College in Cambridge to take part in an expert panel on homelessness , primarily about its approach and model of care delivery. DDST has also been externally evaluated by the Ministry of Housing, Communities and Local Government, via Sheffield Hallam University and the University of Southampton. Results from this have not yet been made public. The team have been involved in providing educational support to secondary care around housing and substance misuse problems and to voluntary sector organisations in particular with regard to mental health issues.

 

What outcome measures are collected, how do you use them and how do they demonstrate improvement?

Between July 2017 and November 2018 74 service users were worked with . Following intervention 51 of these 74 had received a mental health assessment via DDST and 26 of these people were being offered follow on care from an appropriate mental health service. At the point of referral 21 of the 74 service users were in contact with substance misuse services. This number was raised to 27 with an additional 3 having fully completed their substance misuse, 6 having continued intermittent and 4 having left the area and this therefore raises the number to 40 who have subsequently received some form of substance dependency programme. At the outset 39 service users were rough sleepers which at the end of the period of team engagement reduced to just 5. 27 service users received support to prevent homelessness once acquiring or recently moving into accommodation.

 

Has your service been evaluated (by peer or academic review)?

DDST has been externally evaluated by the Ministry of Housing, Communities and Local Government, via Sheffield Hallam University and the University of Southampton. Results have not yet been made public.

 

How will you ensure that your service continues to deliver good mental health care?

Ongoing funding has not been secured and the team will cease to operate from July 2019. I hope that this does not prejudice against eligibility for an award as they have undertaken fantastic work with proven positive results with a most challenging group of service users to engage with . Awarding a team in these circumstances I believe will only help to further demonstrate to commissioners the need for such a service and highlight and raise the profile of the team and its work for future business planning consideration.

 

What aspects of your service would you share with people who want to learn from you?

Setting up such a team, how to get started ,pitfalls, how to best engage with stakeholders and service users. Information sharing protocols. Measuring success of intervention. Substance misuse will be the outcome that takes the longest to affect and is likely to follow on from a more stabilized mental state and more secure housing situation. Emphasise the need for personalized approach, with in built flexibility, without time specific outcomes all best enabled through small caseloads

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How many people do you see?

Targeted to see 45 service users per year.

 

How do people access the service?

Self referral. Can access staff via various voluntary sector organisations and also via direct drop in to office. Staff walk the streets of Cambridge proactively outreaching to the entrenched rough sleeping community.

 

How long do people wait to start receiving care?

The team have been well placed to offer a responsive service without any significant wait.

 

How do you ensure you provide timely access?

Small caseloads and close working has enabled tight overview on referrals and response.

 

How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?

CPA assessment Care Act assessment Various psychological assessments

 

What support do you offer families and carers? (where family/carers are not the service users)

Cares champion offering advice, guidance and assessment , Specific family interventions . Carers support groups Pharmacy group fro service users and carers Trained carers as experts for service development

 

Have you implemented any of the mental health care pathways developed by the NCCMH (on behalf of NHS England)?

Early Intervention in Psychosis Services

Liaison Mental Health Services for Adults and Older Adults

IAPT Long Term Conditions Pathway

Emergency Mental Health Care

 

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