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Community therapies team (North Kirklees)
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About the service
The North Kirklees community therapy team accepts referrals for assessment, interventions and case management from both Trust services and other organisations.
The service is for people who do not have a diagnosis of psychotic illness, but have (or are likely to have) mental health conditions where there is a significant degree of complexity and disability. Typically this includes people who suffer from depression, anxiety disorders, personality disorders and eating disorders.
We offer a range of medical, nursing, psychological, occupational and social interventions.
Why would someone choose the service?
- Service users can expect an individualised assessment and care package. Over 90% of service users have care plans reviewed at least annually.
- Service users can expect their care to be delivered by appropriate and qualified members of the team.
- Service users and carers can expect to be listened to and treated with dignity and respect.
- The team will communicate clearly and deliver what we say we will.
- Service users and carers can expect to be heard when they have a problem with the service and to have those concerns discussed and acted upon.
- Service users have access to the Trust’s customer services team if required as well as telephone access to an ‘out of hours’ service (Kirklees single point of access) in times of crisis
- The team is able to refer service users to other services and organisations who may be able to help further.
- The team will be working with the Kirklees Recovery College, due to launch in late 2014, which will enable service users to access other educational opportunities to enhance their self-management skills.
Staff you may meet
- Administrative staff provide essential support to doctors, nurses and other healthcare professionals. This can be in a variety of different settings, with administrators working as a receptionist in a clinic or a clerk on a ward. They may also be working closely with a consultant as a medical secretary.
- There are more than 60 different specialities that doctors work within the NHS. Each is unique but there are many characteristics which are common. Roles range from working in a hospital to being based in the community as a GP.
- Domestic staff have a vital role in helping to care for patients. They work in one of three key areas; catering, cleaning or laundry services. All of these services play an important part in aiding an individual’s recovery.
- There are many people who work behind the scenes to keep services running and you may meet them in hospital or community settings. They include porters, cleaners, plumbers, electricians, decorators receptionists and secretaries who all work to make sure healthcare settings are kept clean, tidy and safe.
- Nurses who choose to specialise in the mental health branch of nursing work with GPs, psychiatrists, psychologists, and others, to help care for patients. Increasingly, care is given in the community, with mental health nurses visiting patients and their families at home, in residential centres, in prisons or in specialist clinics or units.
- Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific, purposeful activity to prevent disability and promote independent function in all aspects of daily life.
- Receptionists are the first link for many patients and visitors. They often work on their own or with one or two other receptionists, greeting patients as they arrive and check them in. They might also collect patient notes and ensure that these vital records go to the right healthcare professional. In a clinic, they may make appointments and arrange patient transport.
- Social workers help, support and protect people who are facing difficulties in their lives. They help people to take positive steps to overcome problems and improve their lives. This could involve assessing and reviewing a service user’s situation, building relationships with service users and their families and agreeing what practical support someone needs.
Why a professional should choose the service
- Over 90% of service users have care plans reviewed at least annually.
- The team provides an in-reach service into mental health inpatient services.
- Service users who are discharged from the hospital are contacted again to follow up within 7 days.
- Over 80% of service users referred to the team are assessed within 14 days.
- 100% of staff have annual information governance training.
- 100% of staff have annual fire training.
- A multi-disciplinary team approach to enable a range of mental health issues to be addressed appropriately and timely with a qualified worker.
- Effective working relationships with other professionals internally and externally to provide a seamless service to service users.
- Disabled access to buildings where appointments held.
- Staff will find out how best to meet someone’s needs from gathering information both from the service users, the service user’s family and from finding out the information available on religion or culture.
- All service users have written care plans which include what to do in a crisis or when certain contingencies are required.
- All service users have risk assessments completed that identify areas of concern but also highlight positive risk taking options.
- Annual staff appraisals to ensure mandatory and core training is adhered to and staff are equipped with the necessary skills and knowledge to deliver a high-quality service.
- Consistent positive feedback and praise for the support and learning opportunities available to student nurses who are on placement with the team.
- All staff are trained in safeguarding adults and children and follow Trust and Kirklees Council protocols.
- Incident reporting is recorded on the Datix system. This feeds into the Trust’s risk management system including the investigation of serious incidents and the production and implementation of resulting action plans.
- Information is available on complaints and compliments. There are leaflets and a poster in service user accessible areas. All staff are aware of how to support services users in making a complaint.
- Staff use the RiO electronic care record system to record activity and performance information.
- Managers and staff are able to monitor team and individual performance using reports generated on RiO and also from the Trust performance and information team.
- Dedicated administrative and secretarial support to the team.
Support offered
- Assessment
- Service users will be included in the development of their care plan/care package
- Packages of care that offer a range of support from various organisations
- Interventions that focus on a positive outcome
- Evaluation and review
- Risk assessment and management
- Monitoring of medication concordance (where the service user and a member of staff make decisions together about care)
- Motivational interviewing (a type of counselling)
- Discussions about the impact of treatment on symptoms
- Safeguarding
- Interventions informed by mental health legislation
- The opportunity to make your own choices
- Assessment and access to Self-Directed Support (personalised packages of care)
- Involving and supporting carers
- Support to access community facilities
- Nursing interventions
- Social work interventions
Group work – team members contribute to dialectical behaviour therapy groups (therapy groups designed to help people change behaviours such as self-harming and substance abuse)
Occupational therapists based in the team provide occupational therapy assessment and intervention.
Vocational assessments (used to determine a person’s potential)
Acting as Appropriate Adult (a responsible person aged over 18) for people being interviewed by the police who are on the team’s caseload.
Referrals are made to other parts of the service and other providers during care and at discharge.
Writing reports for Mental Health Act appeal hearings and tribunals.
Outcomes
- Recovery
- Ability to self-care
- Discharge back into the community as soon as possible
- Improved engagement with community services
- Clarification of diagnosis
- Choosing the best and most effective treatment
- Improved physical health
- Improved functional capacity (ability to carry out tasks)
- Preventing a relapse
- Self-management skills
- Limiting the impact of a condition on other individuals and services
Referrals accepted from:
A & E, AHPs, Carers/family, CMHTs, Consultants, Courts, Drug/alcohol agencies, GP staff, GPs, Health visitors, Hospital staff, Housing associations, Local authority staff, Midwives, Other NHS services, Other Trust services, Patients(self-referral), Police, Schools, Voluntary services, Youth Offending Team
Referral criteria:
Inclusion criteria:
- The service mainly works with adults who have (or are likely to have) a diagnosis of a non-psychotic mental health disorder.
- People with co-existing conditions such as substance misuse, acquired brain injury and learning disability (LD) are accepted as long as they are not the primary condition.
- People who have Autistic Spectrum Conditions (ASC) will be accepted as long as there is no primary diagnosis of learning disability.
- Perinatal women who are eligible for support from the service according to the Perinatal Pathway (a care plan which supports pregnant women/women who have just given birth if they are at risk of experiencing mental health conditions) are accepted. Women showing moderate symptoms are also accepted as their pregnancy can often cause further complications.
Exclusion criteria:
- People with a primary diagnosis of psychotic illness.
- People who are assessed as needing treatment from the Improving Access to Psychological Therapies team or other providers. Although they are not eligible for treatment by the community therapies team, the team will provide advice and support around suitable alternative options within the community.