structured clinical management in a nhs trust€¦ · · 2016-04-05structured clinical management...
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Structured Clinical Management in a NHS Trust
Mark Sampson & Emma Hickey
Where and who are we
Why did we need SCM?
• We trained over 1000 staff in personality
disorder awareness training KUF/PDiM/e-
learning.
• Ever expanding need.
• Need to provide cost effective interventions. Promote change recovery versus support and passivity.
• Need socialisation approach for people who
did not engage in MBT/DBT.
What is SCM?
SCM is often argued to be nothing more than:
• Well organised.
• Goal focused.
• Attachment focused.
• Skill building.
• Self management.
• Problem solving.
SCM is more than this
• Provides practitioners with a frame work for
understanding BPD.
• Provides practitioners with a clearer focus on skills set
for BPD e.g.
Effective problem identification and solving.
Framework for providing effective crisis care
including validation.
Provides service users and staff with a clear
rationale for contact with services - an alternative to
previous poor interactions with services.
Why did we need SCM?
Evidence for SCM
Comes from randomised control trials which match
for:
Structure.
Time.
Multimodal.
Clarity/coherency.
Bateman and Fonagy (2008)
Generalist practitioners
Anthony Bateman and Roy Krawitz developed:
• Training manual for generalist mental health practitioners.
• Effective, efficient and evidence based.
SCM and NICE
• Reliable and consistent.
• Active, responsive and curious.
• Realistic expectations.
• Team work and communication.
• Hope and optimism.
• Expect patients to be active in controlling their life.
• Change is expected.
SCM pathway
Planning for
life without
services
Transition
work
Banked
Sessions
Where SCM fits in a Pathway
Our Pathway
C
o
-
m
o
r
b
i
d
i
t
y
Specialist
treatment
Engagement focus
Generic
treatment
Therapy programmes
All therapies:
• Expect learning from service user (active
participation)
• 12 months long.
• Involve group and individual sessions weekly.
• Have banked sessions on discharge.
• Two day (consecutive) training.
• Delivered within organisation.
• Aimed for practitioners (generalist)
Who to contact:
Anna Freud Centre ([email protected])
SCM Training
5bp – SCM training
SCM pre-post training
NB SCM training offered post KUF/PDiM training
SCM -Ward/HTT
12 month audit
12 month audit
Lessons learnt so far….
• Takes time to implement.
• Competing demands for SCM practitioners.
• Positive attitudes towards personality disorder &
recovery.
• Validation is key!
• Valued by the staff and service (enhanced capacity
to manage complexity).
• More wanted…
Successful Implementation
Training alone not enough.
• Clear strategic vision.
• Key people signed up.
• On-going implementation plan/regular reviews.
• Persistence.
• Timing.
• Provide in house on-going training and
supervision.
Implementation Procedure
To conclude
SCM – huge potential benefit:
• Effective, efficient evidence based intervention.
• Can be delivered by generalist practitioners.
• Staff and service users value and are benefitting from SCM.
• N.B. Building good relationships, consistency and explicit structure are key.
Contact Us
Centre Of Expertise in Personality Disorder
COEPD
This is our personality disorder training centre based
on co-production (made up of experts by experience
and experts by occupation).
• [email protected] 01744 626741
• [email protected] 01942 777628