A digital place for people who access services, carers, staff and partner agencies, to share ideas around care co-ordination & care planning in mental health

Archive for the ‘Care planning & reviews’ Category

What are your top 3 messages for people planning your care?

What are your top 3 ‘makes a difference’ messages you would give to the people planning and providing your care, support and treatment?

I am keen to include the ‘individuals’ voice’ in training. Why? Because what’s the point in providing training if it doesn’t make a difference to the people accessing services. Training can become a standards checklist unless it relates directly to people’s care support and treatment in a meaningful way. The training has to resonate with the participant on some level if it is to have an impact and influence or change practice. The training has to have some value.

listening

In the NHS we are super keen to measure everything, and it’s not that I am against this; it’s just that the measurable bits are often ‘hard’ – concrete and tangible, but it might be that the ‘soft’ bits are where the quality sits. So for example, with Care Programme Approach, one of the standards is that everyone should have a review at least once a year. This is a ‘hard’ standard; it is a distinct event with a time-frame; it is one that is ‘counted’ and reported on. The quality or ‘soft’ aspect in this standard is harder to count but impacts on the persons experience of care support and treatment – the review should include the person’s views, should be held in a way that the person prefers, the review should be held when needed (a year is a long time when you want to be moving forward……) and the review might be a series of discussions and information gathering to inform the care plan rather than a formal, chaired event. It tends to be the ‘hard’ bits that drive practice. My concern here is that practice gets distilled down to the hard bits and the soft bits fall by the wayside. Don’t get me wrong, often it’s the hard bits that get the job done #performance, but is it at the expense of the soft bits #experience? Perhaps a blend of both is best, but have we got the balance right?

So, what are your top 3 ‘makes a difference’ messages you would give to the people planning and providing your care, support and treatment?

Hats off to the care coordinators!

Earlier this year, a chance on-line conversation led to Leeds and York Partnership NHS Foundation Trust becoming involved in the EQUIP study: Enhancing the quality of user involved care planning in mental health services. This presents an opportunity for people who use the service and their carers, and for care coordinators to be  involved in a national research study – you can read more about our involvement with the EQUIP study here. Ultimately this is about increasing people’s involvement in planning their care, an idea that has been around for a lot of years but that remains a challenge to mental health services in delivering consistently.  The good people at EQUIP have published a paper that brings together the current evidence base and identifies barriers and enablers to bringing this level of involvement to practice. It reads well and is available on open access here.

The theme of involvement continues as being ‘involved’ in a national research project brings its own challenges. Theoretically, it is the right thing to do: contributing to the body of evidence; potentially improving people’s experience of mental health services; improving outcomes through collaborative working; challenging stigma and power; developing care coordinator skills…… the benefits go on. Then there is the reality of practice – research activity not always making it to the top of the list of ‘things to do’; perhaps being seen as extra to practice and not part of practice; competing with service user visits/contact. That said, care coordinators have responded positively to the clinical studies officers requests; despite being super busy with clinical work, they screened their caseload in super quick time (hats off  and a big thank you to them!). This bodes well for the next hurdle –  releasing a community team for 2 days of training. Looking forward to experiencing the training and seeing how this can influence practice – and ultimately how people can be actively involved in planning their care. This is where the big win lies in being involved in the EQUIP study.

Oh – and do have chance conversations with people, you never know where it will lead……..

Are you involved in planning your care? Does it make a difference?

Care coordinators – what are the main issues with involving people in planning their care?

Co-production of crisis plans – can you help?

We are setting up the group to improve crisis plans so that service users will be able to say “I am supported to develop a plan for how I wish to be treated if I experience a crisis in the future and there is an agreed strategy for how this will be carried out.”

We talked about this at the York Service User Network on the 25th June and agreed that we needed another meeting so that people could give their views.

I would like to invite you to a meeting on the morning of Thursday 16th July 2015 in York, if you would like to come along, then please contact j.whiley@nhs.net for further details.

If you can’t come to the meeting or prefer to offer your views by email, then please see below; you can leave your responses as comments on the blog or email j.whiley@nhs.net or donna.kemp@nhs.net 

Co-production of Crisis Plans Group

Questions for service users

Please help us understand how to involve you to improve the way that we work with people to co-produce crisis plans.

This work should be Coproduced and Accessible. Please can you help us by answering the questions below?

coproduced accessible

  1. How can we improve or change how we describe what Co-production means?
  1. Who should attend the group?
  1. How should decisions be made in the group?
  1. What else can we do to make the work of the group a Coproduction?
  1. How can we improve or change how we describe what “accessible” means?
  1. How can we make sure the group is accessible?
  1. Are there any rules or standards we should agree to make the group accessible?
  1. Do you have any other comments?

 

Write your own care plan

Guest Post by Maria

I was recently at a SUN meeting where I was fortunate to hear a lady speak about writing her own care plan; I found this heartening and was delighted when our paths crossed again thanks to social media. Maria agreed to write about her experience of writing her care plan and the effects it has had. She is keen to share her experience and hopes it will help other people……..

How did it come about?

Maria loneliness

By Maria

I had just come out of a really dark and difficult period and was trying to move forward the best I could. My CPN (community psychiatric nurse) and I were talking about my care plan and how ineffective it had been through this time. I expressed my frustration and annoyance at past care plans and how I’d never found them helpful as they were often filled with others perceptions of me, their interpretation of what my life needed, what my goals should be and their beliefs in what would be helpful in my  crisis. Non of them were true reflections of me or what I’d find helpful.

So my CPN handed me a template care plan and said I could read it through and write as much as I’d like, the things I feel should be or want to be mentioned and what I felt would benefit me in crisis. We agreed I would do what I could and she would edit, add to and finish off.

After reading through I found myself excited at the prospect of answering the questions posed. With only recently coming out of a crisis I was able to draw on that experience and what I’d found useful/helpful.

I soon found myself writing each section, my history, my aims, goals long and short term, a true description of myself and my life. What I believed to be my difficulties and how best to deal with them.

I wrote my crisis plan like never before with real difficulties and a realistic approach for all.

To my astonishment my CPN read it and didn’t change a thing.

What difference has it made?

It gave me a massive sense of control and the strength I needed to stand up and say “I can do this, it’s in my hands.”  It was a significant turning point for me were I realised my recovery was up to me and no one else. That services were there to support me whilst I worked on making changes to improve my life and manage myself.

Writing my care plan challenged me to really look inwards and think about myself. To really think about what I found difficult and what I think will help. It also made me think of the things I would like to happen and goals I could obtain. It gave me a glimmer of hope that recovery was a possibility.

My Care plan was now something that gave me an aim, a clear focus on the areas I needed to work on to achieve the things I wanted for myself.  It also made me more aware of the  behaviours and patterns I’d established that were unhelpful and the things I could do to help me manage my day to day life.

The most significant  area I’ve truly benefited from is my crisis plan which is more fitting to my personal needs and how i react in crisis. I wrote it stage by stage and what to do to help me depending on the depths of my despair. I believe it was most helpful to myself because in crisis I’m no longer “rational” me and I find it incredibly difficult to trust anyone, therefore I could read it and trust what it said as it was my rational self who’d written it. This made it easier to accept and follow making the really difficult times shorter in length and better managed.

What key message would you give to other people about writing care plans?

Maria quote 1Service users have to be involved in their care plan. A CPN and service user need to work together  to collaborate a care plan that’s a true reflection of the service user with realistic  goals, expectations and what’s effective short and long term, crisis or not.

Services need to trust and understand that we know ourselves better than anyone, therefore ask us what’s helpful and unhelpful. Ask us what we want to change, ask us what our recovery looks like because we know better than anyone.

Service users need to take charge of their recovery and accept the professionals role. Services are there to help, support and understand as much as possible but can not nor will not make you better. Only you can can make recovery happen with the right support, so let your care plan be the start.

 

 

My Wellbeing and Recovery Plan

My Wellbeing and Recovery Plan

This is the new name for the CPA Care Plan as chosen by you (you can read more about Care Programme Approach here). It is due for launch on the 8th of June 2015 but what does this mean for people accessing services and for people working in mental health? Changing the name on the tin doesn’t mean the contents will taste any better, so here is an outline of what the new care plan is intended to bring (Ellie Apple is fictitious):

  • wellbeing report front pgA renewed focus on people’s wellbeing and recovery –  This is a shift away from focusing on ‘clinical recovery’; this is  about seeing people as individuals within their own life context. Supporting people to build satisfying, fulfilling and enjoyable lives  with  positive states of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment.
  •  Co-production – Service users, carer’s, supporters and care coordinators working together to develop the care plan. In days past, the care plan was a document that was written by the health care professional, filed in the persons notes and read by staff – the actual person it concerned often had no idea what was in it! The Wellbeing and Recovery Plan is intended to be developed with the person – even better if the person writes their own care plan.
  • wellbeing report pg2Working towards the persons goals – This sets a direction of travel with the destination defined by the person it concerns, not the service.  Getting to know a person is a good way to find out what the persons goals are; talking about goals and getting a clear understanding of them is a recovery tool in itself. The Wellbeing and Recovery Plan is a place to record the goals and the plan to work towards achieving them. People’s goals don’t stop when their time with mental health services ends, indeed, people will likely only be with mental health services when their needs are greatest. Linking in with local community based support networks –  family, supporters, voluntary organisations, volunteering, working, hobbies, interests etc can be vital to the person in reaching their goals and enjoying wellbeing and recovery.
  • People having a copy of their care plan – Having worked together to develop the goals, the care plan and the crisis plan, the person should receive a copy of their care plan. This seems straightforward but people have said that they don’t have a copy of their care plan, so what gets in the way of this? I have a few thoughts about this here but feel free to add your own views/comments…….. Care coordinators will now be required to record the date that they shared the care plan with the person – this may be face to face (ideal!) but might be posted out and I look forward to when care plans can be shared digitally……….

The changes are supported by the use of ‘plain English’; people are encouraged to write their own care plans; to say what’s important to them and to have open discussions about their care, support and treatment. Want to make a start at your own care plan? – you can find the template for it here.

As ever, your comments/views/opinions are welcomed……..

 

Service User Experience of CPA Reviews – final report

People receiving care, support and treatment from Leeds and York Partnerships Foundation Trust (LYPFT) should have a care plan and this should be reviewed regularly. Care may be arranged through ‘Care Programme Approach (CPA)’  or through ‘Standard Care Plan’ if needs are more straightforward.

LYPFT sent out a brief questionnaire to people on CPA to find out what their experience of their review was; you can read a bit more about the questionnaire here.

The results from the questionnaire, the full report can be found here:final report

  • People being offered or given a copy of their care plan was 54.5%.
  • Understanding what is in the care plan, being involved in agreeing the goals and being aware that other people could be involved in the review are areas identified for improvement.
  • Areas where the results should be celebrated are that people are aware of who their care coordinator is, that they were asked how they were feeling, that they had their say and that they found the review overall helpful.
  • Results from 2013 to 2014 are overall improving.
  •  The response rate to the questionnaire was lower than anticipated at just over 7%.

In response to the questionnaire results LYPFT are focusing training on improving service user involvement in planning care. There are monthly awareness sessions across Leeds and York – dates for these are available here; they are open to people accessing services and carers as well as members of staff across LYPFT and partner organisations. The Planning Care Workplan Implementation Group are tasked with overseeing LYPFT activity in relation to planning care – you can find out more about this group here.

Many thanks to those of you who participated in completing the questionnaires.

Donna Kemp | CPA Development Manager

 

Are you involved in your own care?

According to a number of sources, including NICE and Department of Health, people should be involved in planning their care; care plans should be developed jointly and people should be given a copy of their care plan. The care plan should be reviewed at an appropriate time (but no less than annually). The care coordinator or lead professional writes up the agreed care plan (the individual can write it if they want to) and this sits on the electronic patient record called PARIS in Leeds and York Partnership Foundation Trust. The clinician then prints this out to share with the service user for accuracy and then shares with the agreed people, including the service user as a final record.

Should we develop the care plan with the individual? Short answer is yes. Involving the person adds to the sense of empowerment and self determination; is respectful; increases the likelihood of engagement with the plan and therefore improves health outcomes; contributes to the therapeutic relationship and works towards the person’s recovery and wellbeing on their terms. #whywedontengage emerged via Twitter recently; click here to read what people using services said about why they don’t engage – it’s (brutally) honest and not censored by services.

nursing_informatSo who does the care plan actually belong to? My answer would be that it belongs to the individual concerned yet responses from the National Service User Survey and local audits suggest that people are not always being given a copy of their care plan and therefore the owner of the care plan becomes PARIS.

If the care coordinator or lead professional has worked collaboratively with the individual to negotiate and agree the plan of care – the goals, who is going to do what and when, then does it matter if the person has a copy of this written down in a care plan or not? As a pedant, I would say that yes, it matters – why go to the trouble of working closely with someone to then not bother capturing it in a personalised care plan. Professionally, clinical staff have to write a care plan anyway so it may as well be done in a way to reflect the involvement that the individual had in agreeing the plan. I would also add that the care plan should be presented in the format that the person prefers, taking into account their communication requirements. You might consider different font size, paper colour, audio tape, language, Braille etc – all depending upon the need of the person. Click here for information leaflets and more about Care Programme Approach.

I have had my say about the questions posed but what is your view? Post on the blog or email lypftplanningcare@nhs.net

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