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Operational policy update


(At the end there is also a reminder of the structure of the policy and the ... Mark Butler, Louella Bielby, Vicki Sherrington, Meryl Crawford, Amardip Prihar) ... – PowerPoint PPT presentation

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Title: Operational policy update

Operational policy update
  • May 2009

These slides are to let you know about…
  • Changes made recently to the policy
  • Future changes
  • (At the end there is also a reminder of the
    structure of the policy and the process for
    reviewing it)

Changes this month
  • Changes have been made to EIS policy re
  • All new clients to be on full CPA
  • A new consent form
  • Fewer routine assessments for clients accepted by
  • Further clarification of psychiatrists role
  • Accepting referrals to EIS from cmhts and pcmhts

Core module full CPA
  • Under the new CPA arrangements in place from
    2008, some clients of mental health services will
    not be on CPA.
  • However all new EIS clients do need to be placed
    on full CPA.

Core module consent form (1)
  • There is to be a new EIS consent form - the
    content is being finalized and will be circulated
  • This will give clients the options of consenting
    at a single time to a number of things (though
    they can of course withdraw their consent to
    these things at any time)
  • This form will need to be filed at the front of
    the case notes.

Core module consent form (2)
  • Clients will be asked to indicate whether they
  • That they have had explanation of confidentiality
  • For the team to contact school or college
  • For anonymised information from their records to
    be used for research aiming to improve services.
  • For the team to contact a named relative or
    friend to give information about events or
  • To be contacted by telephone for feedback on the
  • For copies of letters to be sent to them at a
    specified address

Core module assessments (1)
  • Following the away day discussions, we have
    greatly reduced the list of structured
    assessments that will be offered routinely to
    clients accepted by EIS.
  • In doing this, we aim to have a list of
    assessments which
  • Is definitely achievable for all clients (ie.
    Realistic for case managers to do
  • Will help us provide good care for individuals
    and understand how the service is performing

Core module assessments (2)
  • From now on, the only structured assessments
    which case managers will be expected to offer all
    clients are these
  • LCFT mandatory assessments
  • (HSCNA, HoNOS, safety profile, carer assessment)
  • PANSS estimation of DUP based on PANSS
  • Timeline and genogram
  • A social inclusion measure
  • (Denver social inclusion scale, plus GAF for the
    time being)
  • LUNSERS (for clients on antipsychotics)
  • EIS feedback questionnaire (for client to

Core module assessments (3)
  • Second line measures
  • Some clients will need additional structured
    assessments eg. for depression, substance misuse,
    personality difficulties, developmental disorders
  • The service will develop a list of recommended
    second line assessments and of indications when
    they should be used.

Core module assessments (4)
  • Importance of the health and social care needs
  • The HSCNA is the starting point for deciding if
    additional assessments are needed.
  • It is crucial that this is a live document which
    is updated as new information becomes available.
  • We are not using a specific assessment for
    assessing trauma history, but it is very
    important to always enquire about this and to
    record on the HSCNA that this has been done, even
    if findings are negative
  • More training will be provided around these

Core module assessments (5)
  • Recording of structured assessments
  • Paper copies should be stored in the assessment
    section of the case notes
  • They should be scanned onto edms when this
    becomes routine practice
  • An entry should be made on ecpa daily record that
    the assessment has been done and filed and
    scanned in.

Core module assessments (6)
  • What about….
  • CAARMS? in future this will only be done in the
    LEAD clinic and in the local assessment clinics
    which will replace the LEAD clinic evenually
  • SCIPANSS? you can continue to use this if you
    like. Or you can score PANSS on the basis of a
    conversation with the client which covers each of
    the PANSS items, but which does not necessarily
    use the SCIPANSS format.
  • Other assessments we use at the moment? eg.
    Beck,Calgary etc.
  • You can continue to use these if you wish where
    you feel it would be helpful with an individual
    client. In time the service will develop some
    recommendations regarding use of other assessment

Organization and processes - psychiatrists roles
  • There are two changes you need to be aware of
    but please re-read the whole section on
    psychiatrist roles to put these in context.

Organization and processes - psychiatrists roles
  • First change
  • A minimum frequency for psychiatrist
  • From now on we will aim to offer appointments
    with a psychiatrist (consultant or other
    psychiatrist) at the very least
  • When a client is first accepted into EIS
  • After a hospital admission, within 4 weeks of
  • At 12 month intervals
  • On discharge from EIS (unless care co-ordinator,
    psychiatrist and client agree this is not needed)
  • Most appointments with psychiatrists will
    continue to be arranged in response to clients
    needs, and will be more frequent than this.

Organization and processes - psychiatrists roles
  • Second change
  • Always having a next psychiatrist appointment
  • After each appointment with a psychiatrist, a
    further appointment will be booked. This will be
    in a maximum of 12 months time, but will often
    be sooner if this is indicated.
  • The secretary booking the appointment will need
    to cancel any psychiatrist appointments already
    in the diary for this client.

Organization and processes - referrals from cmhts
  • A new paragraph added to clarify expectations of
    other teams
  • Referrals to EIS from other teams need to be
    accompanied by a Health and Social Care Needs
    Assessment and safety profile as per CPA policy.
    However if a GP referral appears to have been
    sent in error to another team rather than the
    EIS, then this referral may be accepted by the
    EIS without the other team being asked to see the
    patient first. This will only happen once the
    other team has clarified with the GP that the
    referral was sent in error rather than because a
    same day response was needed.

Possible future changes
  • Please help to improve the policy by sharing your
  • Comments very welcome on
  • The recent changes
  • Anything else you think needs attention
  • In June there will be a major revision to the
    section on referrals, to take account of the new
    assessment clinics which will eventually replace
    the LEAD clinic.

Possible future changes
  • Please pass on your comments by
  • Contacting any of the members of the review group
    (Jeff Warburton, Warren Larkin, Mark Butler,
    Louella Bielby, Vicki Sherrington, Meryl
    Crawford, Amardip Prihar)
  • Coming along in person to an operational policy
    review group meeting if there is something you
    would particularly like to discuss (Next meeting
    September 9th 1.30-3pm)

A reminder of the structure of the policy (1)
  • There are 3 detailed documents for use by EIS
    staff. These are the ones to refer to if you have
    questions about what we are intended to be doing.
    These cover
  • Referrrals
  • Core module
  • Service organization

A reminder of the structure of the policy(2)
  • There is also a summary document is suitable for
    sharing with people outside the service, and as a
    starting point if you are reading the policy for
    the first time.
  • It contains information about the service
    philosophy and structure which arent in the
    other documents. The sections on referrals, core
    module and organization and processes dont
    contain anything that isnt in the other three

And a reminder of how changes get made
  • Anyone can make a suggestion for changes
  • An operational policy review group meets 6
    monthly to discuss suggestions and agree
    proposals for changes
  • The proposed changes are then agreed (or not
    agreed) in the Standards for Better Health
    group, which is the main EIS management group.
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