The OSCA Crisis team offer a service that is recognised nationally as innovative, creative and highly effective. They have achieved successfully to offer wrap around care 24hrs a day to reduce the numbers of young people admitted to hospitals and support families to provide safe care at home. They also promote and support early/prompt discharge from hospital by offering wrap around care out of hours so young people do not have to stay in hospital too long.
Joint Winners - National CYPMH Awards 2019
Co-Production
From start: Yes
During process: Yes
In evaluation: Yes
Evaluation
Peer: No
Academic: Yes
PP Collaborative: Yes
Find out more
Andrea Shand - Head Of Service Oxon CAMHS - Oxford Health NHS Foundation Trust
The OSCA Crisis team offer a service that is recognised nationally as innovative, creative and highly effective. They have achieved successfully to offer wrap around care 24hrs a day to reduce the numbers of young people admitted to hospitals and support families to provide safe care at home. They also promote and support early/prompt discharge from hospital by offering wrap around care out of hours so young people do not have to stay in hospital too long. The level of professionals offered by the staff is exceptional and their compassion, knowledge and skills are exceptional. We also have staff who work as temporary staff, in order to support a staffing vacancy, but who also offer the same level of care and commitment to the service that the permanent team offer. This is greatly valued by us all and by the young people who benefit directly. In the assertive outreach team, the staff have developed a unique way of delivering DBT to young people.
It has allowed young people who have been long term service users, and failed to manage to make an improvement throughout a long period of treatment, the opportunity to work in a very challenging and different way through and evidence based approach that is not offered anywhere else in the Country to this level of success (as far as I am aware) and has been nominated for a specialist piece of research as a result. The outcomes from these groups (DBT) for parents and young people are exceptional, and the feedback is often shared more widely as it is so inspiring. The full group is a complex approach for those highly committed and in great need, and needs to be supported by their parents/carers, but we do also offer DBT informed work more widely. The work of the team has continued to make positive difference to the experience of our service users and their families due to the dedication of the team.
Wider Active Support
The work of the team has continued to make positive difference to the experience of our service users and their families due to the dedication of the team. The team have run a summer project for our most high risk and most difficult to engage young people to prevent hospital admissions and shorten admissions for young people which they were successful in. This was often for long hours and being out all day increasing the pressure on them for their existing caseloads, The team have all picked up extra shifts, on-calls and cases on their caseload so every young person has access to the right treatment at the right time. All staff in the team has worked well above and beyond to ensure all young people receive an outstanding and safe service. Despite the challenges faced by the team they have continued working together, supporting each other and ensuring excellent communication within our team and with external teams both within and external to the trust. Staff have shown their on-going commitment in their willingness to be flexible in the way they work whilst ensuring all elements of their roles are completed to a high standard. Several complex cases have recently come through the Crisis caseload requiring multi-agency working, swift responses and care planning and risk management to allow young people to move into appropriate social care placements.
Co-Production
Patients have, quite literally in my view, had their lives saved by this team. They have been supported by them as they have come into the service, being offered immediate assessment and ongoing visits as needed, or being part of the ongoing treatment plans when other attempts have not succeeded. They work very closely with other services and agencies such as inpatient units, social care, the police, EDPS, Schools, families, specialist services, the wider service at other hospitals etc. They have embraced a new research post within their team to further look at the option to support young people who are in crisis out of hours and in hours, but whose need is not at the level of admission for mental health/illness treatment. They are excited by this prospect and working as a wider team to find ways to be creative and make this role make a difference for this vulnerable group of young people. Families are able to get direct support from them in and out of hours, and these are people who often do need immediate access to support as they are so unwell. They always work well, in a coordinated way, so that this can be successfully delivered. They reflect on and review the ways they work to ensure that they can make improvements when needed, and share practice that works well, and they have developed a summer programme that has run for the last few years and is exceptionally successful giving a specific benefit to a group of very vulnerable young people. It is a fantastic innovation directly benefiting young people and families.
Looking Back/Challenges Faced
My team have worked exceptionally well together over the last 12months despite numerous challenges. We had exceptionally high staff turnover. At one time there were only 3 band 7 clinicians out of 15 staff members left in the team to carry out all of its functions. The work of the team has continued to make positive difference to the experience of our service users and their families due to the dedication of the team. The team have run a summer project for our most high risk and most difficult to engage young people to prevent hospital admissions and shorten admissions for young people which they were successful in. The team have all picked up extra shifts, on-calls and cases on their caseload so every young person has access to the right treatment at the right time. All staff in the team has worked well above and beyond to ensure all young people receive an outstanding and safe service. Despite the challenges faced by the team they have continued working together, supporting each other and ensuring excellent communication within our team and with external teams both within and external to the trust. Staff have shown their on-going commitment in their willingness to be flexible in the way they work whilst ensuring all elements of their roles are completed to a high standard. Several complex cases have recently come through the Crisis caseload requiring multi-agency working, swift responses and care planning and risk management to allow young people to move into appropriate social care placements. Our “ I want great care” feedback has also been very positive.
The team have not only managed to maintain the on-going safer care work, but continued to provide a high level out of hours on call, DBT on call, and Crisis safer care board. Our hospital admission rates remain low and length of stay reduced for those who are admitted. All members of the team have continued to push their own CPD for the benefit of our client group. We have for the 1st time had 3 newly qualified members of staff (nurse/OT/and Social worker) who have all excelled in their new roles and are striving to match the dedication and commitment of my existing staff. The team have recently started an integrative approach reflective practice group and rotating CPD slots to include safeguarding supervision, group supervision and in house training. PAF statistics around performance targets have evidenced the maintenance and improved performance despite resource and staff turnover challenges. (These can be provided if required). The team have also expressed interest to take part in a national research project and have been approached by NHS England to have the Crisis part of the service written up as a case study due to the excellent work and outcomes the team are achieving. I could not be prouder of my team
Sustainability
The teams continually shares knowledge, skills and experiences with one another. For example the DBT Lead runs many DBT Skills training groups through the year and all OSCA workers are expected to attend, widening their skills and allowing for progression of individuals. There is peer support available between the different counties for the OSCA Teams. We have recently introduced restorative supervision to the OSCA team, which allows for safe reflection as a team, this is facilitated by a lead clinician from an alternative area. We have developed some band 5 developments roles, to address recruitment concerns but allows for experience to grown and competencies to be met for career progression.
Evaluation (Peer or Academic)
The service is currently part of the evaluation being conducted by Oxfordshire University Psychiatry and Research department, this is a two year evaluation and we are currently nearing the end of the first year.
Outcomes
We recently asked for feedback from our service users and family to present at a local conference and this is what they said for the Outreach part of our service: “The Outreach team are great. When I started with them I wouldn’t even leave my house. Now I go to school all the time and love their summer project it’s so much fun,” 15 yp. “When I got put in care I hated everyone. Emma and her team kept coming even when I was rude and refused to see them. They kept coming even when no-one else did. They help me feel stronger even when it’s hard”,16 yp. “The Summer project is AMAZING!!!! Normally my mum says I can’t spend all day outside as I get too tired and it’s not safe. My worker convinced her to let me come to prove I could manage. It was amazing. I learnt I can do anything with help, “13 yp The team are always accessible and support not only the young people but our staff. They work with our young people who struggle in clinical settings.
The differences we see in our young people is great. Maltfield House Social care Girls residential Home They never give up. Even when I had they kept coming. Parents of X, “Whilst I didn’t always like to hear what they had to say and they couldn’t fix what I wanted them to, they did help think about things in a different way to be a family again.” Parent of X And our Crisis part of the service families and young people said: “The Crisis team are really kind. They know just what to say to help me stay safe.” 12 yp “The Crisis team teach me different ways of helping myself stay calm and in control.” 16 yp “It is so reassuring to know support is a call away.” “The team not only give my child time but us as parents too. They helped L stay out of hospital.” Parents of X “the Crisis team supported us through the most difficult time. They helped us put our family back together. Thank you.” Parents of X
Sharing
The level of development of this service is to such a high level that people come from other parts of the country to see how it works and if they can replicate it. Staff have been invited to speak at conferences, and recently they were invited to be part of a national piece of research for the DBT approach used. The level of impact that the staff have day to day on some of our most vulnerable young people is immense, and they literally support people through some of the most difficult crises they have encountered (individually and as a family). It can be an exhausting and demanding area of work, but the team have such collegiality and professionalism that this is never what others see. They can always help, always give advice, always support training and they are always smiling. They use their immense skills and professionalism to bring about change in extreme situations and to give hope where others may feel there is none to be seen. This is most definitely over and above their role, and they always work and offer to work extra shifts if there is a sudden need (given the crisis nature of the service this can happen a lot). They actively seek feedback from and engagement with young people and parents to ensure the service is the best it can be and as effective as possible.
Can you please tell us who your service is commissioned by and provided by?
Commissioned by Oxfordshire Clinical Commissioning Group (CCG) and provided by Oxford Health NHS Foundation Trust
