Last week I was fortunate enough receive training delivered as part of the EQUIP trial – EQUIP stands for Enhancing the Quality of User Involved Care Planning in Mental Health Services, you can read more about it here. Anyway, I was a bit of a cuckoo in the community teams’ nest and I have to say they were very welcoming (I know it can be disconcerting to have a non-team member present at a team event!).
Having been involved in bringing the trial to the attention of Leeds and York Partnerships NHS Foundation Trust (LYPFT) I was curious as to what the training content would be – and anxious that it was on similar lines to the existing training provided within the LYPFT. I don’t want to blog the entirety of the training but I am happy to share some key reflections:
- Training was delivered by Lauren, Lindsey and Karina – experts by experience of using services, being a carer and an academic. This worked very well and brought the theoretical points to life, making the learning ‘real’; so helpful in understanding the impact that professionals way of being, interventions and ‘rules’ have on people.
- Role play can work – the trainers pushed some difficult conversations that served to highlight some of the stickier areas that we work within – confidentiality, information sharing, truth-telling versus saying a lot of words but saying nothing.
- People can’t be involved in shared decision-making if they don’t have the information upon which to make the decision.
- There is disconnection between what the research found to be important to service users and carers (engagement and delivery of the care plan) and what the professional found to be important (production of care plan, targets met). Noted that there are professional and organisational drivers, but to provide care support and treatment that is going to make a difference, we have to prioritise the person’s goals.
- Aspirational goals are the future – we can ditch SMART (hurrah, permission granted!). People’s goals are not always SMART and they don’t have to be. They need to be heard, understood and drive the care plan.
- Care plans are an output of working together with people to agree a plan but the journey to get to this point is where the value lies – involving the person, understanding priorities and being prepared to hear them even if they are in conflict to professional/organisational priorities, being flexible and responding to changing needs. It’s the process not the product.
- The role that an organisation takes in setting local ‘targets’ can work against improving quality of involvement and inhibit shared decision
- The trainers mentioned that they found the Trusts care plan to be the most service user focused amongst the Trusts they have worked with; that they found working with LYPFT to be a positive experience, that the staff have been positive, motivated and caring. Lindsey said that it gave her hope that care coordinators can and do support people very well in the community.
Delighted to have had the opportunity to participate, looking forward to thinking about what this learning means for LYPFT, community teams and most importantly for the difference this makes to people and carers.
Donna Kemp | Care Programme Approach Development Manager
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?
EQUIP: Enhancing the quality of user involved care planning in mental health services
LYPFT are pleased to be involved in the EQUIP trial, involving service users, carers and clinical teams in research. Here is an outline of the project and what it entails for participants.
- The EQUIP project is funded by the National Institute for Health Research’s Programme Grants for Applied Research Programme.
- A joint project between University of Manchester; Manchester Mental Health and Social Care NHS Trust; University of Nottingham; and Nottinghamshire Healthcare NHS Trust.
- 5 year programme
- Aim: to develop, evaluate, implement and disseminate a user/carer led training package for mental health professionals to improve user/carer involvement in care planning
Service user and carer participation:
- Researchers and Trust clinical studies officers assess eligibility of service users for participation in the trial
- Service users are written to, inviting expressions of interest to participate
- Face to face informed consent is sought
- Service user is asked to identify an involved carer, friend, family member
- Care coordinator asked to complete a brief risk assessment
- Baseline questionnaire data is gathered prior to team training
- Questionnaires are repeated 6 months after team training
Clinical team participation:
- There are 3 pairs of community teams identified across Leeds and York
- Teams are randomly assigned to control and experiment groups
- All Mental Health professionals and Allied Health Professional’s will be asked to participate in the training (80%+ participation required)
- The training package – co-produced and co-delivered with users and carers – is delivered over 2 days (October/ November 2015)
- Team clinical supervision is offered post training (6 hours)
- At the end of the trial, training will also be offered to the control groups
There is opportunity for service users, carers and Mental Health professionals to participate in interviews to explore the impact of the training after the event.
If you have any questions or comments, then please do not hesitate to contact firstname.lastname@example.org