In November 2016 after a lot of hard work the team piloted an All Age Urgent Response Service, which triaged all urgent requests for service from people of all ages and learning disabilities and provided appropriate care from the appropriate service and the most appropriate time. From this we are now looking at implementing the service across the North Yorkshire Locality and to dovetail into the CAMHS Crisis Service.
Co-Production
From start: Yes
During process: Yes
In evaluation: No
Evaluation
Peer: No
Academic: No
PP Collaborative: Yes
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Lauren Dowson - Crisis Resolution and Home Treatment Team & Street Triage Team Manager, Tees Esk and Wear Valley Trust
In November after a lot of hard work the team piloted an All Age Urgent Response Service, which triaged all urgent requests for service from people of all ages and learning disabilities and provided appropriate care from the appropriate service and the most appropriate time. From this we are now looking at implementing the service across the North Yorkshire Locality and to dovetail into the CAMHS Crisis Service.
The team are also working on piloting a service for Repeat Attenders to services, including the Police, Emergency Department, Social Care and Ambulance service. This is to provide collaborative working with the service user to help them identify their difficulties and what services can do differently so they can feel more in control of their situation and reduce the number of presentations.
We are also working towards reducing the amount of people needing to be placed on a Section 136 and having to be brought to a place of safety but improving links with the Police Service and Social Care and looking at alternatives such as the offer of a voluntary attendance for assessment by the Crisis Team and Street Triage Team.
Wider Active Support
We have worked closely with North Yorkshire County Council, North Yorkshire Police, the Emergency Department at Scarborough General Hospital for all of the improvements being made to the services. With a huge help and vision from colleagues across Tees Esk and Wear Valleys NHS Foundation Trust in Service Development, Crisis Team Managers, Locality Managers and our Head of Service. Also external stake holders such as GP’s and voluntary agencies. we have liaised with medics to look at reducing the waiting time for assessment in section 136 suites.
Co-Production
We have involvement and feedback from service users and carers at the planning stage of these services and at feedback events. I have a focus group arranged with service users, carers and voluntary agencies in Scarborough, Whitby and Ryedale in regards to the work on Repeat Attenders. My staff will often attend the Carers and Services User Meetings and I have champions in both areas. We complete Carers Self-Assessments on the team and try to improve our communication and support of carers by utilising the Triangle of Care. We offer individual appointments for Carers when providing home treatment.
Looking Back/Challenges Faced
The team have faced staffing pressures, that could have potentially impacted patient care, but have rallied together, doing overtime, supporting the wards when they have been struggling, implementing changes to benefit the service users and being incredibly supportive of each other. The team were 6 members of staff short for a number of months, currently we are 3 members of staff short but will have 2 of them in post in June.
Throughout this time the staff Friends and Family feedback has also improved in quality showing that the staff are incredibly focused on good quality patient care but also love their jobs.
At Christmas the team also underwent a change in management but at team and locality level and they have dealt with and managed this change exceptionally well.
Sustainability
Training events have taken place so staff feel confident with the changes made so far. The team is well supported but are encouraged to be forward thinking and embrace change, they are incredibly adaptable and rise to any challenge. There has been a lot of collaborative working and some changes have come from the teams suggestions.
Kaizen events have been completed for the changes with policies and procedures being written with clear guidance.
Evaluation (Peer or Academic)
Feedback from the All Age Pilot showed that the staff felt they were able to provide a more quality assessment, the environment was calmer, due to there being a dedicated telephone triage team, service users were seen in a more timely manner, other services fed back a more quality referral was taken and the signposting was made in agreement. this was all whilst the referrals tripled for that month.
Staff have fed back they are happy with the work towards a reduction in section 136’s as this can be very distressing for the service user and our partners have already felt an improvement from the commencement of work on the repeat attenders – there is not any hard date available for this as yet, but we hope to see an improvement of attendances with services.
Outcomes
The hope for my team is that we see services users get the right care, at the right time, from the right person.
That we improve service user outcomes and reduce long term risk by providing a consistent service from all services involved.
That we reduce the need of people being placed on a section 136 and the distress of having to wait for long periods to be assessed by offering an out of hours Voluntary Assessments as an alternative.
Sharing
Yes. We work closely with the other Crisis Teams in North Yorkshire and the rest of the Trust. We share ideas as Crisis Team/Urgent Care forums and visit other areas to see what is working there.
We invited different stakeholders and services to our pilot feedback and asked for their feedback on what we presented. I have agreed to be part of a larger Yorkshire and Humber Network, again to share good practice.
Is there any other information you would like to add?
I feel that the North Yorkshire Locality is innovative and inspiring, they listen to views of staff, carers and service users alike. My currently line management offer support and guidance when needed and have supported me in this new role. The staff within my team are the most supportive in any team I have worked in. They are kind, caring, humble, will share the more difficult tasks and check each other are OK at all times. This then feeds into the excellent service they provide in very challenging high pressured circumstances. Feedback from service users and carers always mention the compassionate care and advice given. I feel the trust are very lucky to have a team like this one.
