liverpool assertive outreach team vinnie farrell team manager robert higgo consultant psychiatrist
TRANSCRIPT
LIVERPOOLASSERTIVE OUTREACH TEAM
VINNIE FARRELLTEAM MANAGER
ROBERT HIGGOCONSULTANT PSYCHIATRIST
POPULATION
Inner City LiverpoolDrifting PopulationUnstable AccommodationBEM Mix Dual DiagnosisOffending/Risk Behaviours
Sounds familiar !
ESTABLISHMENT
Formed 2000 135 Caseload
1 Manager1 Deputy Manager
12.5 Care Co-Coordinators1 Assistant Nurse Practitioner
5 STR Workers.4 Psychologist
1 Consultant Psychiatrist1 SpR / 1ST3
CASE MANAGEMENT
Engagement is…….
TrustRelationships (Carers/Service Users)Face to face contact Consistency in contactMonitoring of treatment plansAssessing risksNegotiation/Collaborative approach
DOWNSIDE
Information shared ineffectivelyLess flexibility/team responseProtecting caseloadsOver DependencePrevents RecoveryReduces Throughput
PREVENT AGAINST THIS BY :
Team OwnershipTeam ResponsibilityCommunication is key :Share knowledgeTeam MeetingsCase Reviews / PresentationsUse CPA effectively
PLAN – What are we doing ?Challenge – What / Why
– Test out – Encourage innovative approaches – Supervision
Don’t do more of the same!
CARE OF IN-PATIENTS
Some figures :
Admissions/year – 53 – 44 – 36 – 30 – 29>50% come in informal and stay informalMaximum number >20For last 2 years <10Vast majority admitted directly by AOT
WE MANAGE OUR OWN IN-PATIENTS :
ContinuityEngagementRisk ManagementDischarge PlanningActive in-reach
SOME NEGATIVE CONSEQUENCES :
Not the fashion (in-patient consultants)
Some longer admissionsActivity figuresConsultant case load numbers
HOW :
Nothing radical !Care Co-Ordinator in-reachEscorted leaveHome visitsTeam discussion (Tuesday)Ward MDT (Thursday)
WELL PERSON CLINIC
Why :
Worse physical healthDie earlyCo morbidityLittle preventative health carePoor help seekingMedication effects
WELL PERSON CLINIC
What :
Started with monitoring – Clozapine, Lithium etc.Now, offered full screenTrainee PsychiatristAssistant Practitioner (champion)
WELL PERSON CLINIC
Benefits :
A very thorough checkGenerally preferred by SUEngagement
WELL PERSON CLINIC
Downside :
Social inclusionSkills/limitsTime costsUsing Trainee
WELL PERSON CLINIC
Future :
GP session ?Audit