The Enfield Early Intervention in Psychosis Service (EEIP) has been established for 5 years, during which time it has consistently been one of the highest performing services in the trust with relation to key performance and quality measures. It offers up to three years treatment, care and support to service users and their families following a first episode of psychosis.
The Enfield Early Intervention in Psychosis Service (EEIP) has been established for 5 years, during which time it has consistently been one of the highest performing services in the trust with relation to key performance and quality measures. It offers up to three years treatment, care and support to service users and their families following a first episode of psychosis.
It is a multi-disciplinary service with a strong focus on recovery and service user enablement, offering a range of NICE approved treatments.
EEIP was the first service in the Trust to offer a social inclusion programme for service users, focusing on social recovery, enhancing social skills, self-esteem and confidence of the service users, for which it won a Trust award.
Patient and carer satisfaction levels have always averaged 95% throughout the services existence suggestion high-level levels of satisfaction by those who use it.
EEIP offers a weekly clinic for the comprehensive assessment of service users physical health, operating on an appointment or walk in basis. Reports of all assessments are sent to the service user and their GPs.
There is an active programme of staff support including regular supervision and appraisal and an education programme for all staff.
EEIP has established and maintained relationships with local employment services, offering workshops to service users and one to one sessions to develop skills and confidence for employment
EEIP staff have provided information sessions for local colleagues focused on the mental heath needs of service users as well as outlining pathways to rapid treatment and support for those with mental health needs.
EEIP has been a service at the forefront of research with regards to the particular service user group and has been a pilot site for three research projects. The manager of the EEIP is a member of the London EIP Clinical reference Group, and is one of the only non- medical members.
The EEIP has a rolling programme of staff development, training and liaison which includes information session and workshops from allied services and organisations and has included such topics as diagnosis and treatment for autism spectrum disorders, staff and patient safety, PREVENT, sexual and gender identify, teenage pregnancy and third sector provided recovery programmes.
The EEIP clinical psychologist is the national lead for spirituality for the British Psychological Society, offering the opportunity for shared learning and practice with organisations across the country and has allowed the service to offer workshops on spirituality to service users.
The aforementioned social recovery programme has been facilitated by service users, with them taking a lead on planning and evaluating activities. Service users are members of interview panels for prospective new staff.
The EEIP manager has established an evening Carers’ Support group following requests from carers for such a service. This includes informal teaching sessions, over and service support to carers and includes carer contributions to the continued development of the service. The Manager regularly meets with individual service users and carers to seek their views on the service.
A peer support workshop was offered in 2015 with an agenda, which included evaluation of the service. Discussions are taking place presently regarding peer workers employed as part of the service.
Although there is a strong ethos of service user and carer involvement in the service presently, this was not part of the initial service development and given the opportunity to start again, this would be considered an essential component of the establishment and development of the service during its formative months and years.
The data collected by EEIP has been essential in producing non-mandated reports to the trust board and senior managers. Data collection has been a focus over the past two years, but it would have been helpful to have this as part of practice from the beginning of the service to allow for consideration of broader range of longitudinal data when evaluating the service effectiveness
Planning for and implementation of the Access & Waiting Times Standard for First Episodes of Psychosis, has bee a particular challenge to the service and remains so. The EEIP manager has been a member of, and the clinical representative, on the London
Programme for EIP for the past year offering opportunities to share learning from practice from other providers and CCGs, and has acted as expert on the trusts programme to meet the standard. Low levels of investment have meant that more has needed to be done with little or no increase in resources, but the service has been able to meet the standard for timely access to the service for the majority of months over the past year. Breaches have primarily been the result of late referrals to the service outside of the two-week pathway. To address this, the EEIP manager has advised the trust on a number of actions to help close this gap, including a online resources, direct liaison with other community and inpatient mental heath services and a staff workshop and information session, which is currently being devised. There has been regular liaison between the EEIP, performance and IT departments and trust senior managers to help identify the specific needs of the service and provide a range of solutions.
Limited investment in EEIP has resulted in limited opportunities to offer a full range of NICE concordant treatment. The Manager is in current discussion with the CCG and Senior Managers regarding the allocation of new and existing resources to try to address this unmet need
In addition to being a high performing and well-regarded service by its users, local mangers and commissioners, EEIP have worked with the CCG to produce the EIP service specification for 2016-17 to ensure that the service will continue to provide the necessary care and treatment for its service user group into the future.
The service is routinely evaluated by means of monthly Quality Assurance audits and peer assessments by managers of other services as well as internal audits. EEIP is in the process of completing a Team Recovery Implementation Plan (TRIP) to analyse indictors and performance that is concordant with an enablement focused and strength based model of care for service users. Although this process is not yet completed, early analysis suggests that the service is highly concordant with this approach EEIP have been part of a National Audit for the Royal College of Psychiatrists and two round of audit by NHS Benchmarking to audit the service.
EEIP were instrumental establishing a battery of self and clinician rated clinical and wellbeing measures to assess and evaluate the effectiveness of the service in respect to service user recovery, and the reduction of symptoms. These measures are used routinely at baseline, annual review and at discharge. Pooled results indicate increased levels of wellbeing, reductions in the severity of symptoms, and a reduction in the levels of disability caused by symptoms of psychosis in most service users during the treatment pathway and at the point of discharge.
Consistent audits have shown that approximately 75% of service users recover sufficiently from a first episode of psychosis to be discharged from EEIP and secondary mental heath services within three years 2015-16 Saw one of the lowest levels of complaints against any service in the trust: only one complaint, which was not upheld.
EEIP is amongst services receiving the highest number of formal compliments and expressions of gratitude for the treatment and support offered. The EEIP was nominated by the Clinical Director in the Trust’s 2015 awards and was Highly Commended.
The EEIP Manager, as part of the London EIP CRG, has chaired working parties on working party on entry and exit pathways to EP services in London, producing nationally available online guidance, has co-scripted, advised on and is represented as the lad character in an animation for mental heath staff on the Access and Waiting Times Standard, he has been filmed for an in production video about EIP service to form part of a training for GPs and information for members of the public.
EEIP have been part of the London Early Intervention Network for the past 4 years, contributing to a programme of information, education and practice protocols for London EIP services. EEIP initiated a trust wide steering group for EIP to provide the opportunity for sharing experiences from practices, developing an operational policy for all EIP teams in the organization and helped define agreed clinical and functional measures to be used routinely, which have been shared with other secondary community mental health services.
The EEIP manager and psychiatrist have recently established an Academic Forum for the borough, providing the opportunity for formal teaching and consideration of current research for community mental health clinicians. Resources developed by the EEIP have been made available to other community mental health services including a service user and care education programme, ‘welcome to the service’ packs, evidence based clinical and functional measures, admission and discharge protocols, a directory of resources and audit reports.
Treatment therapy groups offered by the EEIP are available to and have included service users form other community mental health services. EEIP clinicians are members of the trust’s clinical network for psychosis, have competed audits and shared findings, written protocols for practice and contribute to trust wide models of treatment and pathways.
