POD is an innovative psycho-social approach that involves working with the whole family/network at the point of crisis using the knowledge, assets and strengths of all involved. It places shared understanding and ‘shared decision making’ for treatment decisions. The Kent POD team is the 1st team in the country to become operational and has led the way in measuring outcomes in the 1st year via an internal portfolio study (support by a Health Foundation grant) and are co-applicants in the NIHR £2.4m RCT ODDESSI trial. The service is an alternative to the current crisis pathway and provides support at the point of crisis through to recovery/ discharge without the transition between a CRHT and CMHT.
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
POD is an innovative psycho-social approach that involves working with the whole family/network at the point of crisis using the knowledge, assets and strengths of all involved. It places shared understanding and ‘shared decision making’ for treatment decisions. The Kent POD team is the 1st team in the country to become operational and has led the way in measuring outcomes in the 1st year via an internal portfolio study (support by a Health Foundation grant) and are co-applicants in the NIHR £2.4m RCT ODDESSI trial. The service is an alternative to the current crisis pathway and provides support at the point of crisis through to recovery/ discharge without the transition between a CRHT and CMHT.
The approach is an adaptation of the Open Dialogue model from Western Lapland, Finland. Practitioners have trained for a year in the approach including psychiatrists, psychologists, social workers, nurses, OT and Peers. The core principles of Open Dialogue are; 1. Immediate help 2. Social network/family perspective 3. Flexibility and Mobility 4. Responsibility 5. Psychological continuity 6. Tolerance of Uncertainty 7. Dialogism In essence the approach is a way of delivering services where the first meeting is held with 24 hours of contact. The service user decides who will attend- family, friends and any relevant professionals. The same clinicians remain throughout care and meetings take place as often as needed during crisis. Hasty decisions about treatment are avoided and there is a distinct form of therapeutic conversation call ‘dialogic practice’. The clinicians reflect in the presence of the family and all decision are made in front of and with all present at the network meeting. The approach elicits multiple view points and psychotic utterances are normalised. The approach uses a relational focus in the dialogue to create new meaning and understanding of ‘what has happened’.
What makes your service stand out from others? Please provide an example of this.
Effective leadership. A steering group was set up in 2014 to ensure the governance of the training and development of a business case for a pilot team. The steering group has reported to the different operational service groups and executive leadership group. Prof Kinane has supported the strategic fit of the service development to ensure it meet the Trust objectives and has formed a component of the Kent STP. Leadership has come from operational and clinical leadership but also from ensuring that the steering group had service user and carer input as equal participants at all stages of development. Good team-working. All members of the operational team have been trained at a foundation level in Open Dialogue. To ensure clinical adherence to the model the team have reflective clinical supervision weekly and attend a CPD day approximately every 3 months. Engagement of patients and carers.
The outcome measures used in the previous section have ensured there is continued feedback from service users and carers/families/networks. Continuous service development is based on feedback and outcomes alongside the peer and carer lead contributing to the strategic development. Service users and families have actively engaged in presentation and workshops both internal and external to the organisation and are valued as equal voices at all levels of service development. The service development has attracted interest from other mental health organisations both nationally and internationally with invitations to share the service development at national and international forums.
How do you ensure an effective, safe, compassionate and sustainable workforce?
The Multidisciplinary Team (MDT) has undertaken special training in the model, sought funding opportunities for development and disseminated their work widely. The belief in the model to deliver best quality care with continuity of professional within the service user’s chosen place is making all the difference to outcomes in terms of effectiveness, safety and experience.
Who is in your team?
Name of team member Job title Prof Catherine Kinane Executive Medical Director Dr Rosarii Harte Consultant Psychiatrist Yasmin Ishaq Service Lead (social worker/Psychotherapist) Dr James Osborne Clinical Lead (Consultant Psychologist) Jo Fiakkas Occupational Therapist Lyn Richardson Occupational Therapist Ben Sanders Occupational Therapist Emma Hogwood CPN Paul Roberts CPN Heather Jeays CPN Annie Jeffrey Carer Lead Michael Bowley Peer Support Worker Dr Vicky Clark Higher Trainee Psychiatrist Dr Uma Chockalingam Consultant Psychiatrist Louise Jessup Peer Support Lead Marcus Colman Research Assistant
How do you work with the wider system?
The Health Foundation Grant awarded in 2016 for an innovation from another country transferred to a UK setting enabled the set up of the service with an evaluation process embedded from the beginning to support it development. Heath Education Kent Surrey and Sussex supported the project with £120,000 for training and educational development of the approach. The service has worked with over 100 referrals and routine outcomes have been collected and analysed as part of the internal portfolio study
Do you use co-production approaches? If so, please illustrate how you involve individuals, families and carers to drive improvement and deliver services?
The Health Foundation Grant awarded in 2016 for an innovation from another country transferred to a UK setting enabled the set up of the service with an evaluation process embedded from the beginning to support it development. Heath Education Kent Surrey and Sussex supported the project with £120,000 for training and educational development of the approach. The service has worked with over 100 referrals and routine outcomes have been collected and analysed as part of the internal portfolio study. In the Friends and Family survey (64 responses) 83% of those surveyed stated they were highly likely to recommend the service with 17% likely to recommend the service. The tables below show some of the initial outcomes for the 1st year of operational service. The service development has attracted interest from other mental health organisations both nationally and internationally with invitations to share the service development at national and international forums.
Do you share your work with others? If so, please tell us how.
Articles have appeared in Context (family therapy magazine), Nursing Times and Community Care. There are currently 3 article being prepared for publication focusing on the 1st year outcomes including staff wellbeing.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
The business case submitted and agreed identified the transfer of open dialogue trained staff to a standalone team that would take work commensurate with their previous acute and community care work. Evaluation of the cost effectiveness of the Open Dialogue service compared to TAU is currently being undertaken including reduced use of inpatient care. The larger scale multi centre RCT ODDESSI trial will evaluate this with a more formal economic evaluation across 5 Trusts. c) Evidence of improvement resulting from the team’s work. The Tables above show initial evidence of better qualitative outcomes for service users and families/networks. Staff wellbeing is also being measured via analysis of focus groups transcripts (underway) and staff sickness since the 1/2/17 to date is 0.6% compared to the trust average of 5.9%. A CQC report reported in April 2017 that “the trust had made a commitment to strengthen and evaluate the peer-supported open dialogue (POD) approach”.
Has your service been evaluated (by peer or academic review)?
The service has worked with over 100 referrals and routine outcomes have been collected and analysed as part of the internal portfolio study. In the Friends and Family survey (64 responses) 83% of those surveyed stated they were highly likely to recommend the service with 17% likely to recommend the service. Articles have appeared in Context (family therapy magazine), Nursing Times and Community Care. There are currently 3 article being prepared for publication focusing on the 1st year outcomes including staff wellbeing.
How will you ensure that your service continues to deliver good mental health care?
* Work with commissioners • Ongoing funding • Ensuring your service continues if management changes * Co-production
What aspects of your service would you share with people who want to learn from you?
Challenges encountered and solutions Engagement of patients and carers. Launching the service Evaluation
Further Information
In 2016 we were highly commended in the Positive Practice Awards for this service.
Highly Commended in 2016 Positive Practice Crisis Care Pathway Award
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