Operational policy update

1
Operational policy update

• May 2009

2
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)

3
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
  EIS
• Further clarification of psychiatrists role
• Accepting referrals to EIS from cmhts and pcmhts

4
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.

5
Core module consent form (1)

• There is to be a new EIS consent form - the
  content is being finalized and will be circulated
  soon.
• 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.

6
Core module consent form (2)

• Clients will be asked to indicate whether they
  agree
• That they have had explanation of confidentiality
  policy
• 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
  opportunities
• To be contacted by telephone for feedback on the
  service.
• For copies of letters to be sent to them at a
  specified address

7
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

8
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
  interview
• 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
  complete)

9
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.

10
Core module assessments (4)

• Importance of the health and social care needs
  assessment
• 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
  issues.

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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.

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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
  instruments.

13
Organization and processes - psychiatrists roles
(1)

• 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.
•  

14
Organization and processes - psychiatrists roles
(2)

• First change
• A minimum frequency for psychiatrist
  appointments.
• 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
  discharge
• 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.
•  

15
Organization and processes - psychiatrists roles
(3)

• Second change
• Always having a next psychiatrist appointment
  booked.
• 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.

16
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.

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Possible future changes

• Please help to improve the policy by sharing your
  ideas
• 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.

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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)

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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

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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
  documents.

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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.