National Audit Office report

Below is an outline of the content for a report commissioned by the National Audit Office. For a full copy of the report, go to www.nao.org.uk.

Are Crisis Resolution & Home Treatment services seeing the patients they are supposed to see?

- A Report of interviews with CRHT and Ward Managers across 25 sites in England, regarding 500 referrals to CRHT teams and 500 admissions to inpatiient wards during Jan-Apr 2007

Steve Morgan
Practice Based Evidence
www.practicebasedevidence.com

on behalf of
THE NATIONAL AUDIT OFFICE

Study Team:
Nick Gauntlett,
Kirt Hunte,
Charlotte McKinley (NAO),
Andrew and Roberta Wetherell
led by Steve Morgan,
under the direction of Jess Hudson (NAO)

Contents

Chapter 1: The project successfully generated reliable evidence from 25 sites operating varying CRHT service models	3
Chapter 2: The Department of Health intends that CRHT teams act as ‘gatekeepers’ to admission, but in fact this function is under-realized	8
Chapter 3: Assessing a mental health crisis is a critical function of CRHT teams, but it must be efficiently organised in order that the home treatment function is not compromised	32
Chapter 4: Home Treatment offers key benefits for patients, but capacity to provide it could be improved with more rigorous implementation of the intended policy	35
Chapter 5: CRHT teams are facilitating earlier discharges where the ward and CRHT team are integrated, but there is room to improve performance in this area	41
Chapter 6: CRHT teams need to be better understood by the teams and services that refer to them in order to ensure they provide the intended functions	47
Chapter 7: Service User/Carer preferences do influence admission decisions, so they need to be fully informed of the range of options	56
Chapter 8: CRHT teams provide acute care, and success will depend on integrating them effectively in the acute care pathway	60
Recommendations	69
Appendix One: The 25 Sites Visited	73

[Go to www.nao.org.uk for the full report and the complete set of National Audit Office reports on this project]

Crisis? Whose Crisis?

First published in Openmind March 2008 and printed here with kind permission

The article below, Whose Crisis?, looks at some of the issues involved in setting up a crisis response and resolution service.

PDF: Whose Crisis? - OpenMind article

To read the report above you will need free software called Adobe Reader. This software can be downloaded here.



Crisis Resolution and Home Treatment Teams: 'Challenges and Pitfalls'

Note: The following is a checklist not a list to be read as an order of priorities

1. Practice Development:
   • Reviewing policies, protocols and team procedures
   • Supporting practitioners in developing their practice
   • Team-based supervision
   • Role of team development facilitation of away-days
   • Examining links with other parts of the service making service integration real
   • On going training needs identified with team
   • Clarifying the meaning of 'fidelity to the model' implementing the 'essential ingredients' for ensuring good practice (not that there is only one way of doing it!)
2. Staff retention & recruitment:
   • Ensuring staff maintain good practice
   • Motivation
   • Supporting staff morale
   • Providing appropriate leadership
   • Good induction & supportive supervision
3. Clarifying the main sources of stress:
   • Volume of workload
   • Interpersonal issues
   • Inter-team issues
   • Conflicting management directives
   • Sustaining the formal & informal support structures to manage the above
4. Time management:
   • A crucial asset that needs to be utilised wisely within the Team/Service
   • On-call activity aware of the potential for 'burn out' (N.B. You cannot become 'burned out' if you were not on fire in the first place)
5. Effective team-working:
   • Good effective communication (room to listen room to talk)
   • Identifying good team players
   • 'Everyone's contribution is valuable'
6. Workload:
   • Volume of referrals and re-referrals
   • Adjusting and adapting to the pace and unpredictability of the volume of work
7. Maintaining flexibility & creativity:
   • The ability to make a rapid response
   • Being consistent through a team approach particularly in response to handling referrals
8. Therapeutic risk-taking:
   • Risk assessment & evaluation
   • Risk management planning
   • Reasoned risk-taking decisions for positive gains
9. Keeping accurate team records & statistics on what you do:
   • A good reminder of all the positive work the team has delivered
   • Keeping accurate local Trust statistics
   • Aware of the statistical requirements of the Department of Health
10. Sustainability:
    • Keeping the momentum making the work interesting and challenging for staff
    • Sustaining the impact
11. Conflict management:
    • Creating a consensus within the team
    • Managing the inter-team difficulties & stereotypes
12. Promoting reflective practice:
    • Making better use of existing team meetings
    • Creating the priority reflecting on practice can enable more effective use of contact time
    • Supervision could support, encourage and enhance such reflection
13. Managing change:
    • Extending the remit when the time is appropriate (e.g. opening up to services for older people, learning difficulties)
    • Embracing positive changes for the service and team
    • Creating the time and space to consolidate or reflect on good practices
14. Forging good relationships with service user groups in the locality
15. Strategies for service development:
    • Overlap with other services (e.g. assertive outreach teams, early intervention service, in-patient services, drug & alcohol services, specialist personality disorder services)
    • Systemic approaches to thinking Trust-wide, looking at forging key linkages with other parts of the service

Kirt Hunte ~ Team Manager
[South Camden Crisis Response & Resolution Team]
July 2006