EQUIP training reflections…….

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

Co-production of crisis plans – involvment opportunity

Leeds and York Partnership Foundation Trust (LYPFT) Involvement Opportunity:

 Co-production of Crisis Plans

We are looking for people to be part of a group focusing on improving the quality of crisis plans.

Click for full flyer

The aim of the group is:

1. To agree what ‘co-production’ means
2. To agree what ‘accessible’ means
3. Understand what the current crisis plans are like
4. To agree what ‘good’ looks like
5. Develop a plan for improvement

Expressions of interest to be part of the group are invited from:

• People who are currently accessing LYPFT mental health or learning disability services and carers
• People who have accessed LYPFT mental health or learning disability services in the last 2 years and carers

The group will be jointly led by service users and will meet monthly to start with.  The group will decide its terms of reference.

If you are interested and want to find out more, please come along to:

York Service User Network Event

Thursday 25^th June 2015

The Library, Friends Meeting House, Friargate, York YO1 9RL

If you want to be involved but can’t make it to the meeting, contact:

Jeff Whiley, Locality Manager  j.whiley@nhs.net 07852538247 or 01904294687

or Donna Kemp CPA Development Manager donna.kemp@nhs.net 07985 259082

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.

So 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

Safety Planning – a risky business?

Lynne Maskill is LYPFT’s CPA and Risk Trainer, as an occupational therapist with a clinical background in Mental Health, Lynne talks about safety and risk and poses some pertinent questions about current challenges…..

Understanding someone’s risk and helping people keep safe is a key part of working with people in mental health services. Developing and agreeing a risk management plan with the person, and where possible with carers is central, not forgetting, who is responsible for what, what helps and what does not.  So, all straight forward in terms of good practice and sounding like a risk trainer?

But actually to what extent are practitioners actually sharing the plans with people they are about?  How do risk management plans connect with care plans and crisis plans? Some practitioners have said to me that a risk management plan tends to be more service focused, letting staff know what they need to do to prevent or minimise harm, whereas a well-developed crisis plan is a way of helping the person using services manage their distress or increase in symptoms. Is this also not about safety, reduction in harm, risks in relapse?  Furthermore how do crisis plans fit with wellness and recovery action plans?  … and advance statements?

I could go on but  the point I am getting to is, are we making things too complicated? How do we plan and document how we are working with people around safety in a way which is meaningful and as inclusive as possible to the person , supports recovery, lets staff know what they need to do and how best to help  ……….and if possible reduce time at a computer?

 

Planning Care Checklist

Join the conversation here.

Planning Care in Assertive Outreach

I was fortunate enough to spend some time with Leeds Assertive Outreach Team (AOT) this week.  Assertive Outreach teams have been around for some time and are intended to support people with severe mental health difficulties who find it difficult to work with traditional services. You can read more about AOT’s in this Rethink information leaflet.

I initially met with AOT late last year to hear about how they were using Care Programme Approach (CPA) to co-ordinate, plan and review care. There were 3 questions considered:

1. How does CPA works within Assertive Outreach?

Around care plans it was identified that most people did not want a copy of their care plan; that reviews held varied interest to the service user – from ‘something to be endured’ to ‘very keen’.  In response to this the coordinators use a number of flexible methods to complete the review.  Where the person is in hospital the coordinators take the opportunity to spend time with the person developing the care plan for when they are discharged; it was acknowledged that the in-patient CPA review was not always conducive to agreeing goals and detailed plans following discharge. There was some variation in the way the CPA documentation was completed.

2. Why does CPA works within Assertive Outreach?

The team reflected that their ability to be flexible contributed to CPA working well within the team, factors impacting this were their level of experience, good understanding of care management/planning and proactive engagement with people using the service and partner agencies.  Capacity was also identified as a factor, that coordinators have around 12 people on their caseload.

3. What could be better?

• Inpatient reviews being held more flexibly
• Summary – a one page summary would be useful alongside the full care plan; it would also capture initial plans.
• Documentation – The running order of the CPA Care Plan could be improved; the language could be simpler; the review questions should be revised.

The full report is available here.

Having met with AOT again this week, it is apparent that they continue to use CPA well to provide co-ordination, care planning and reviews.  The coordinators find a way to involve the person in planning their care despite on the face of it the person not necessarily wanting to be involved.  The involvement comes through negotiation, flexibility, working with the persons priorities first and through getting to know the person, and their carer(s)/networks/supporters well.

Of the CPA documentation, there are changes planned following a review of what we have and feedback from service users, carers and clinicians.  You can read about the changes in full here; but the headlines are:

• CPA Care Plan name changing to My Wellbeing & Recovery Plan
• Change in wording used for the care plan headings – to be straightforward, plain English
• Goal setting and care planning section made simpler
• Additionally,  a ‘one page care plan’ to be included within the Integrated Care Pathway trial

How does CPA work in your team?

What would make CPA better?

If you access services or are a carer: What is your experience of  being involved in developing your care plan and in your review?

If you have recently had a review, then you should receive a brief questionnaire through the post, alternatively, you can complete this online here.

 

 

 

 

 

Pathways to Recovery: Service User & Carer led research, a carers view

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Service User Led Research ‘Is there a pathway to recovery through care coordination?’ was presented at a recent CPAA event  – click here to read more about this event. This emancipatory research was designed and conducted by people with lived experience of mental health difficulties and carers.

This research supports recovery in a number of ways – for example, personal recovery and wellbeing; hope, inspiration and aspiration for others; contributing to the evidence base for recovery. This is a positive story that should be shared…… Caroline Kemp (no relation 🙂 ) agreed to write about her experience as a carer & researcher; and shares a poem about coding…….

Pathways to Recovery..how and why I got involved..

The last few years have been very rewarding for me…the path has been very stimulating and has been a big learning curve.

My background has been in mental health as I have cared for my daughter for over 16 years. She has enduring and severe mental health problems..her path has been very tough and witnessing this battle is also equally as tough..too much anxiety and panic. .and also the fact that no meds seemed to be of any help..just lots of dreadful side effects…as a mum and a Carer you expect or try to fix things..I always thought things would be better if only we could find the right meds…I tried to read as much as I could so I could help..I thought in the early days I would fix it..and my daughter would not suffer needlessly for years…

When I first heard of the research into pathways to recovery through care coordination I felt strongly I wanted to be a part in it..( I had had plenty of experience of Care Coordination..not all positive ) The reasons were mixed..on one hand they were purely selfish..if there was any hope of finding recovery I had to know it.. I wanted to have some hope…the other reason was to make things better for everyone in anguish and torment..I think this is also why people do research in the first place..to make things better.. I had seen too many people abandoned on the acute wards without a single visitor.  Also our research group were chosen because of their expertise and life experience..there was no formal academic requirement..another strength was we were a mix of service users, Carers and professionals.  We had multiple perspectives and this made out research even better science. Also I knew from the way this research was done we would play a full part in doing it..at all levels ..it would not be a tick box exercise.

At Northumbria we were given excellent training on research up to PhD level ..so this gave our group the confidence to do all the interviews..Carers  interviewing Carers and S U interviewing S U…in all the interviews this has made a difference to our data as people related to us and disclosed more of their true feelings..perhaps this was because we had shared journeys and paths. We developed questionnaires, piloted them, and refined them.

After hearing all these stories I cannot help being amazed at human resilience in the face of terrible tough times and challenges..

Not only did we interview but we also did data analysis ..I never thought I would be able to do this but after all our training I had the confidence to sign up for it..it certainly sharpened our interviewing skills and kept us on task on answering the research project question..not just collecting hours of data. I also learned a whole new vocabulary …Nvivo and nodes…parent ones too..

I have been part of this research for over three years now and I have had many highlights..

What I loved was meeting every Wednesday and analysing the data; keeping a reflective diary and writing poems around recovery..I have been published in an American journal; doing many Carer interviews and sharing people’s life stories; being asked to present at conferences, INVOLVE and to the Trust; talking to students at Northumbria on our research; I also did a short video diary for NIHR ( National Institute of Health Research ) this has been used to train students too; and have been interviewed twice on the radio! At the INVOLVE conference our group was selected to be in a film also. It has been very exciting. We have been brave enough to step outside of our comfort zone.. And it has been well worth it. It has been part of our recovery too..that is being engaged in something meaningful and the added bonus of being for the benefit of others.

Presenting at St James

At the moment we are preparing our next three conferences on the findings to the trust and developing a toolkit. Also we have been asked to write about our journey and how we did it..not only academic papers but also a book..so we have a lot to do.

But this is how I like it and I think I speak for others in the group too..we will be sad when it ends..however I think when you do become involved it always leads to many other things..jobs for some, enhanced skills..now we are a trained group of researchers and can offer our own training and experience to others…

I am glad I have been valued as a Carer and service users in the group are also glad that their mental health experiences have been recognised and valued and able to be of benefit to others on the pathway to recovery.

It gave me hope things could be different and I would encourage everyone to become involved in research ..you do not have to have a degree..just valuable life experience. And empathy ..and a willingness to work and share together and learn from each other. It was great being part of a team.

Caroline Kemp

Choice & how people want to be treated: key messages from SUN

At the March Service User Network (SUN) meeting there was a discussion carried forward from the previous meeting. The SUN members wanted to explore areas that they would like choice in. The following two questions were addressed at tabletop discussions, and the responses are condensed:

1. What would you like choice in?

• Which service I am involved with
• Choice of worker and who I work with – gender, CPN/Support worker/care coordinator, access to different professions, seeing the same worker
• Appointments – flexibility in where we meet
• Involvement in planning care – reviews: how often, who attends, what is discussed; involved in agreeing care plans;
• Medication – the different options, including not taking any medication, easy access to a second opinion
• Treatment and therapy options – CBT, DBT, TC; what we do not want and what we do want, including ECT; access to complementary therapies; mindfulness
• Access to peer support – including courses (Mind), easy access
• Personal independence budgets
• Where I live and the things I do – like cooking, what I eat, and watching sport
• To have the right to make my own choices

2. How would you like to be treated as an individual within Mental Health and Learning Disability services?

• Treated as a person, not an illness
• As an equal – regardless of my characteristics
• Non-judgementally – with respect, compassion and understanding
• As an intelligent person – just because I have a mental health problem doesn’t mean I’m stupid – people can talk down to you!
• As an expert in my own issues and life
• As a customer – eye contact, honesty, humane, respect my sense of urgency in crisis
• To be talked to, listened to and liked – to be seen as worth getting to know and be with
• That my feedback is accepted – that what I say has value

These points will be discussed at the April SUN meeting and next steps in moving this forward decided. How would you like to see this – as a charter? a ‘best practice’ support? All ideas welcomed!

What is your view from a mental health professional, carer or partner agency  perpective? Feel free to comment…..

Please leave a comment if you have anything to add to these suggestions…….

The next SUN meeting is on Wednesday 2^nd April at St Chad’s Community Hall in Headingley; the guest speaker will be Dr Jim Isherwood, LYPFT’s Medical Director – click here to see the flyer. All are welcome to attend, but if you can’t get there, please feel free to post any comments or questions you may have for him here or email donna.kemp@nhs.net

Carers Resource Folder – feedback request

Hi, my name is Steve Taylor and I manage of the carers team in Leeds at Leeds and York Partnership NHS Foundation Trust.

I am in the process of developing a ‘Carers Resource Folder’ and am keen to get your views and feedback on it.

The folder comprises of a series of fact Sheets that carers can pick up as they go through their own  ‘journey’ of mental health services.

There will be a core number of sheet (information that is relevant) to all Mental Health carers and others that are service specific.

By introducing the information as a series of ‘fact sheets’ means that it keeps cost low and information would be able to be updated easier.

Click here to view the Resource Pack 

All ‘fact sheets would be available to download or view from LYPFT external website.

Please consider:

• The overall presentation
• The wording – is it understandable? is it in plain English?
• The layout
• The content – is it enough information, too much?

Can you please post your comments here or feel free to email them to me stephen.taylor3@nhs.net  by 14th April 2014

Many thanks

Steve

 

Using data to improve care – a participation event

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LYPFT Planning Care Network – our first event of 2014!

You are invited to join us in a participation event that brings together service users, carers, health and social care practitioners alongside developers, designers and coders to explore using data to improve care.

Click here for full details of the event and the issues we are hoping to explore.

The event will take place on Friday 11 April 2014 between 10.00 – 16.00.

Time: 10am until 4pm
Location: Arthington House (part of Leeds Federated Housing),
30 Westfield Road, Leeds, LS3 1DE

We will provide lunch and refreshments during the course of the day.

To book your place and let us know if you have any specific requirements please contact Susan Portland by 31 March 2014: Email: s.portland@nhs.net or telephone: 0113 30 55972

Please note: for those eligible, reimbursement of travel expenses will be made on the day (receipt needed). If you have any questions or comments please contact donna.kemp@nhs.net

Exit comfort zone stage left…….

That is how it felt when the plan for CPA – making a difference  got the green light and was signed off. The plan focuses on listening. Listening to what people say about Planning Care – from people’s personal experience of accessing care, support and treatment across LYPFT services  to hearing how people would like services designed and delivered. Listening to what staff say about what they need to provide the best care, support and treatment and listening to what our partner agencies, statutory and third sector, say about what its like being alongside LYPFT.

Listening is a key element of communication, the listening part is key to understanding different viewpoints and identifying people’s priorities; and it is around here that I start to leave my comfort zone. The tension emerges when there are differences between what people want – from differences between individuals to differences between different groups or ‘stakeholders’.  Difference is good, it would be rather dull if everyone wanted the same thing but how to reach consensus fairly? The end result will be some folk are delighted, some are dismayed. My challenge is to remain neutral enough to ensure that people can freely express their views but to provide enough information for people to consider their views upon.  At times there can be different priorities between people who access our services, the professionals delivering the service and the organisation itself; final decisions are often made at quite a distance from where the original discussions took place, it takes courage to shout up for other people’s views and it requires committment and believe  to progress what can initially appear as disparate agendas (though they often are not).

So why am I sharing this? Well, hearing people’s views and making shared decisions is what we all do.  Discussions with staff across the organisation be it face to face, via email or social media constantly reminds me that we are all working in a similar way. I wanted to acknowledge this and share a bit about how this shift has changed the way I work and some of the challenges this has brought along the way.

If you are still reading, then you will be aware that I didn’t manage to squeeze in competence and compassion – oh look, I have now! So what’s all this about? Well, it’s about building Compassion in Practice;  you can read more about this, along with examples of how this is working locally here,  you can also read here about how Towngate House Rehabilitation and Recovery Team are building a culture of compassion.  So how are you building compassion in  your practice?  If  you access services or are a carer, how do you experience compassion in care – is this something that can be felt/experienced? How does it make a difference?

So whats the link between The 6Cs, Planning Care and exiting comfort zone stage left? Well if we apply the culture of compassionate care to the way that we work with people in planning care then the benefits to people who access our services and their carers should be evident. I came across The 6C’s on Twitter. Yes Twitter. Something very new to me and a steep learning curve in many respects. I had not underestimated the value of twitter in relation to connecting with people professionally, with the public and people in other organisations, fact is I had not estimated it at all. But that’s a whole other subject…….

Thanks for reading – Donna Kemp

Involving people in Care Coordination training

‘The Care Coordination process and practice’ training is currently available to all LYPFT staff members who are involved in supporting the delivery of Care Programme Approach (CPA); it runs 1-2 times each month and is available in Leeds and York venues.

The training explores best practice in applying the CPA process and meeting individuals needs and includes:-

• When to use CPA
• Transfers and Transitions
• Roles within CPA
• Review Processes
• Goal Setting and care planning with service users
• Crisis planning
• Carers

To further develop the training we are looking to involve people who use the service and carers/supporters in the training; this promotes the recovery and wellbeing ethos. So, to move this forward, there are a few points I would like you to consider from your perspective and to share via ‘comments’ please:

• What methods of involvement could be used/would work well?
• How can we ensure that people have an equal chance of being involved in the training?
• Do you have experience of involving people in training?, if so, can you please share the good practice

Also, if you (using the service or carer/supporter) or someone you know would be interested in participating in the training, please let me know via email donna.kemp@nhs.net and you can be involved as this progresses.

Update

Meeting held on 15th Jan 2014; ideas were shared as to how we can ensure that service users have the opportunity to be involved in co-facilitating the training and that service user experience is conveyed throughout the training.

Ideas to achieve this were to take the 2 approaches together; this blend would ensure some certainty on content at each session and provide opportunity for people to get involved in co-facilitation:

1. Co-facilitation of the training, either in half days or full days
2. Video/vimeo of people responding to specific questions eg. how were you involved in planning your care?

The video/clip/vimeo might be of the person sharing their responses to questions or, if the person prefers to be anonymous, to utilise animation. Here is an example of how this worked in relation to Lived Experience in the Workforce

It was acknowledged that the opportunity to get involved in either aspect of the training should be available to all; and that all groups of people should be represented including people living with dementia; younger people; people with learning disability; adults and older adults.

Question – How do we access people from different backgrounds and ensure all ‘groups’ are represented?

If you (or someone you know) are accessing mental health services  or are caring/supporting someone who is, and might be interested in helping to co-facilitate training or be willing to answer some specific questions about your experiences of care, support and treatment or of caring/supporting someone, then please contact donna.kemp@nhs.net