Our Stockton CMHT has got two streams. Functional team and organic team. The team is based in Lustrum Vale in Stockton Through quality improvement projects, effective leadership and commitment from our staff, the team has consistently delivered effective, timely and efficient services to our service users. The functional service has improved their delivery of care though the purposeful and productive community services initiative, the implementation of the functional pathway, the introduction of the leadership supercell and improving the process by which psychological interventions (formulations and therapy) are facilitated within the team.
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
Our Stockton CMHT has got two streams. Functional team and organic team. The team is based in Lustrum Vale in Stockton Through quality improvement projects, effective leadership and commitment from our staff, the team has consistently delivered effective, timely and efficient services to our service users. The functional service has improved their delivery of care though the purposeful and productive community services initiative, the implementation of the functional pathway, the introduction of the leadership supercell and improving the process by which psychological interventions (formulations and therapy) are facilitated within the team.
What makes your service stand out from others? Please provide an example of this.
The team was the pilot site of a recent quality improvement event that won an award for ‘Outstanding Initiative within Clinical Services’, and addressed issues relating to uptake and use of psychological therapy, e.g. delays in therapy starting, large variation in therapy length and high drop-out rates. Through streamlining the process and involving care coordinators throughout the formulation and therapy journey, this new way of working has minimised waiting times, focused interventions to promote effectiveness, developed care coordinators’ skills in delivering psychologically informed care and promoted therapeutic and working relationships between staff, patients and psychologists. Our award-winning leadership ‘supercell’ includes Dr Mani Krishnan (Winner- Psychiatric Communicator of the year), Dr Ajith Suryadevara (Shortlisted-Staff Grade of the Year), Dr Abi Tarran-Jones (Winner: Outstanding Initiatives within Clinical Services), Sarah Tweddle and Matthew Ford-Huggins. We nurture, confident and skilled workforce that is essential in providing a high quality service.
How do you ensure an effective, safe, compassionate and sustainable workforce?
As part of the Trust-wide Purposeful & Productive Community Services initiative, the team has introduced several new ways of working: • Daily huddles have been embedded to ensure that all service user contacts are discussed and intervention plans are reviewed by the MDT. • Our CPN ‘cell’ lead takes responsibility to chair the huddle meeting, encouraging leadership at all levels within the team. • Our ‘supercell’ leadership team meet once a week, to listen and respond to to staff’s issues, feed and mediate information up to senior management and down to front line staff, and make high level clinical and service delivery decisions. The Functional Pathway ensures the timeliness and effectiveness of service users’ care delivery: • Within morning huddles nurses are leading on developing 5P formulations of all clients referred to the service following initial assessment, to ensure a psychologically informed MDT intervention plan is developed from the start of service users recovery journey. • Nurses and support workers deliver a range of psychological wellbeing interventions to promote and empower service users’ within their recovery. • The locality psychology service facilitated a recent CPD for functional staff in delivering psychological wellbeing interventions (PWB).
The psychologist has developed supervision groups for nurses and support workers respectively, to continue to develop staff confidence and skills in delivering the interventions, utilising a coaching approach. Trauma-informed and Recovery informed care practices: • A recovery and trauma informed initial assessment proforma was developed to enables nurses to facilitate a standardised and therapeutically underpinned assessments. • The psychologist is rolling out trauma-informed care training to ensure that staff feel confident in assessing trauma, handling disclosures and delivering stabilisation interventions. Supervisory practices: • Including the Positive Well Being supervision groups, each member of the supercell offers clinical supervision to staff on a formal and ad hoc basis
Who is in your team?
Sarah Tweddle Community team manager FT Dr Mani Santhana Krishnan:Consultant psychiatrist/Senior Clinical Director FT Dr Ajith Suryadevara Acting Consultant psychiatrist FT Dr Thandar Win Speciality doctor PT (4 days) Matthew Ford-Huggins Advance nurse practitioner FT Dr Abigail Tarran-Jones Clinical Psychologist FT Faye Nesbitt Band 6 – Community Nurse PT 3 days Ellen Banks Band 6 – Community Nurse FT Deborah Burnet Band 6 – Community Nurse FT Sheila Redhead Band 6 – Community Nurse PT 2 days Michelle Newton Band 6 – Community Nurse PT 2 days Everlyn Rodriguez Band 5 – Community Nurses FT Angela Lawlor Occupational Therapists FT Jon Munroe Occupational Therapists FT June Paterson Support workers FT Lisa Millward Support workers FT Alison McCabe Support workers FT Janet Martin Support workers FT
How do you work with the wider system?
The team works closely with a range of external agencies, partners and stakeholders to ensure that coordinated care is delivered to our service users. We have a co-located social care service who frequently attend our morning huddles to discuss service users. We work closely with Liaison Psychiatry who work within the acute trust, the Intensive Community Liaison Service who provide intensive support with the aim of preventing hospital admissions, and the Crisis Team who offer out of hours support. In addition, given that our service users often present with comorbid difficulties (physical health, neurological conditions, alcohol difficulties) we frequently request joint visits and interventions with a variety of external agencies including the Stroke Team, Frailty Team, Alcohol Services, GPs etc. Finally, our support workers work closely with community and voluntary organisations to promote service users’ social inclusion and meaningful engagement We work very closely with the functional inpatient service at Sandwell park to enable seamless service to the patients from our locality from admission to discharge and further follow up
Do you use co-production approaches?
The award-winning psychological interventions process promotes co-production at a variety of levels. Intervention plans are developed between psychologist, CPN, service user and family / carer (including professional carers) through psychological formulation meetings. The psychological therapy process also involves the care coordinator and family member at review points throughout therapy, to ensure that they can actively encourage and support service users with the development and consolidation of coping strategies throughout and following the completion of therapy. The psychologist also offers family therapy and separate carer welfare interventions based on carer’s needs. The Functional Pathway promotes co-production of interventions between range of professionals, including interventions that may designed and supervised by psychologist, occupational therapist and psychiatrist and delivered by nurses and support workers. We have had involvement of patients groups to help us in developing the functional pathway.
Do you share your work with others?
The functional pathway has been rolled out across the trust wide MHSOP services The psychologist is submitting the write up of her doctoral thesis regarding service users’ and carers’ experiences of engaging in psychological formulations, for publication in the Clinical Psychology and Psychotherapy journal, the findings of which were used to inform the award winning psychological interventions process
.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
For the last 6 months Stockton CMHT have consistently received the highest response patient and carer feedback. • Overall satisfaction with the service consistently scoring above 96% (Scoring 98% patient and 97% carers) • Quote ‘I was very ill for a long time, now through the support from the mental health team in Stockton, I can now see I have a future and can live well with the support from the fantastic mental health nurses’ • Quote ‘first class service’ • Quote ‘Caring and compassionate. Understood my needs.my care plan completed together which I felt I was in control.’ • The team feel confident to ask for patient feedback to celebrate our excellent practice with positive feedback and to embrace negative feedback as a drive to improve our service. • All staff have access to IIC computer system and use this on a daily basis • Weekly updates from currency and tariff PROMS which manager discusses with staff in management supervision, Using IIC caseload management tool to discuss progress and recovery of patient care.
Has your service been evaluated (by peer or academic review)?
We have excellent track record in recruiting patients for research. Our team manager won the research champion award.
How will you ensure that your service continues to deliver good mental health care?
We aim to deliver safe, timely and effective service with continuous improvement principles Manager has just completed QIS for leaders, staff encouraged to also attend in the future • Talent management in the team – reviewing our workforce
What aspects of your service would you share with people who want to learn from you?
Due to the increasing referral we have now rationalised how they are triaged and allocated for initial assessment to minimise any delays. All our staff are on electronic diary management so that we have allocated slots. This enables the team to slot patients in quickly. This system also helps to respond for emergency by maximising resources and minimising waste The new psychological interventions process is currently being rolled out across the whole of Mental Health Services of Older People and there is increasing interest in rolling it out across the Trust. The publication regarding formulation, includes national guidance on how to make the most of engaging service users’ and carers in the psychological formulation process
How many people do you see?
We have a trust target to see patients within 28 days of referral received. Within our functional team if the referral is urgent we will see patients within the same day/24hours. Non-urgent referrals are seen within 7-14 days. • Within a 1 year period from May 2017 and May 2018 – We had 1193 patients referred to the CMHT Stockton – 193 patients were functional patients. Functional team We average 15 referral per month, Nov 2018 we had 20 referral and May 2018 we had 23. In may we seen patients within an average of 7.4 days. We run recovery groups regularly
How do people access the service?
Referral from GP Patients who have had previous involvement can self-refer themselves back to our team. At the time of discharge we provide a comprehensive contingency plans with relevant number to all the patients. Team have a robust system of triaging referrals immediately rather than batching. We have clearly marked diary slots for assessments which are managed with electronic diary management. We are able to respond to urgent referrals depending on the level to severity on the same day or within 24 hours
How long do people wait to start receiving care?
We have a trust target to see patients within 28 days of referral received. Within our functional team if the referral is urgent we will see patients within the same day/24hours. Non-urgent referrals are seen within 7-14 days. • Within a 1 year period from May 2017 and May 2018 – We had 1193 patients referred to the CMHT Stockton – 193 patients were functional patients. Functional team We average 15 referral per month, Nov 2018 we had 20 referral and May 2018 we had 23. In may we seen patients within an average of 7.4 days.
How do you ensure you provide timely access?
From referral received our admin processes the referral, which is given to our triage nurse. We have a standard operating process of how to triage assessments. Nurses provide admin with a time scale of when the patient needs to be seen. The admin contacts the patients within 2-4 hours of referral received and offers an appointment. If patient is unavailable my phone a letter is sent. • Staff have a job plan which we ensure in the functional team that each team member has one assessment slot each week which is protected. This allows patient choice of appointment, patients to be seen in a timely manner, urgent patients can be seen quickly. • Within Stockton we have 2 full time band 6’s, 1 part time band 6 and 1 full time band 5
What is your service doing to identify mental health inequalities that exist in your local area?
We do have close working with BAME communities, we have been attending a local community centre for women which we were invited to attend once a month. If patients and carers are concerned about any mental health issues the leader of group asks our team to see the patient/carer. Although we are services for older people, we are happy to see any person of any age. We advise of what service the person may need, we can carry out initial assessments for patients for our service. It has taken over a year for the group to accept our service into the group however, feedback from the group that this has been positive to the group to know if any mental health issues arise that the person doesn’t need to go to a mental health department, it’s in a familiar environment. We have an average of 3 patients/ carers each month. We have now been invited to attend the male group each month. We feel that we started to break barriers and stigma of mental health
How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?
Our assessment and interventions are all standardised with evidence based pathway. The functional pathways provide resources of evidence based tools for assessment of Depression, anxiety, and also antipsychotic monitoring tools
What support do you offer families and carers? (where family/carers are not the service users)
We provide comprehensive information at every step of the patients journey. We offer carers assessment. We also have close links with several organisations to whom we can signpost for support. Social prescribing is regularly considered for our patients and carers to enable the recovery
Further information
With increasing demands and limited resources Stockton CMHT functional team has worked collaboratively to continuously deliver high quality safe and effective care of Older Adults suffering from functional illness. We have used quality improvement methadology to eliminate waste and improve flow of patients. Our functional care pathway has clearly helped us to deliver standardised, patient centred and evidence based treatment using pharmacological, psychological and social intervention We are a cohesive hard working team and take pride in what we do
Hours the service operates *
9-5 PM(5 Days a week) with support from intensive community liaison team 8am-8pm 7 days a week
Population details
Brief description of population (e.g. urban, age, socioeconomic status):
Semi-Urban and Rural population (Stockton on Tees and local areas)
Size of population and localities covered:
Overall Stockton population 194,803.
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
Stockton Borough Council Hartlepool and Stockton CCG
Provided by (e.g. name of NHS trust) or your organisation: *
