OPERATIONAL PROCEDURES CRISIS RESOLUTION TEAMS NOVEMBER 2020
OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020
Document title Crisis resolution teams (CRT) Operational Procedures
Document reference CL 100
Document category Operational Procedures
Relevant to All Trust Staff, all stakeholders, all referrers
Date published February 2021
Date last reviewed January 2017
Next review date September 2021
Policy lead & Shilpa Nairi, Operational Service Manager contact details [email protected] ; 07917 559 036 Accountable Adele McKay; Associate Director Director Approved by (committee) Document history Date Version Summary of amendments January 3 • Amendments to sections 2017 12&13 • Response to referrals • Exceptional circumstances • Gate keeping processes • Sourcing beds November 4 Re-write of operational 2020 procedures and introduced interface with MHCAS Membership of Shilpa Nairi, Operational Services Manager policy development/ Debbie May, Senior Service Manager review team Adele McKay, Associate Divisional Director, Acute Division All CRT Managers Consultation All CRT Managers, Acute Division Managers and relevant medical staff
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020
DO NOT AMEND THIS DOCUMENT
Further copies of this document can be found on the Foundation Trust intranet Contents Page 4 1 Introduction 2 Main functions of the service 4 3 Who is the service for? 5 4 Referrals 5 5 Assessment 8 6 Treatment episode 9 7 Interventions 11 8 Did Not Attend procedure 12 9 Outcome measures 13 10 Hours of operations 14 11 Staffing 14 12 Communications 15 13 Gatekeeping 16 14 Interface with Crisis Houses 16 15 Record Keeping 17 16 Complaints 17 17 Evaluating the service 17
18 Handover & Care planning 18 19 Night Time operational procedures 18 20 Operational Practice with MHCAS 19
21 Health & Safety 19 Appendix A Assessment Template 21 Appendix B Camden & Islington GP Practices 22
Appendix C Key Performance Indicators 25 Appendix D Audit List 26
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1. Introduction
1.1 Historical context: In the 1990s, it was widely acknowledged that England’s long- stay mental health hospitals had to be replaced with more effective community- based alternatives. In 1999, the Department of Health published the National Service Framework for Mental Health (NSF–MH), which set a 10-year agenda for improving mental healthcare for working-age adults in England. It named Crisis Resolution Home Treatment Teams (CRHTTs) as the central community-based treatment method. Each CRHTT was assumed to cover a population of 150,000 and have a caseload of 20 to 30 patients at any one time. CRHTTs were to provide intensive home treatment for individuals who experience a mental health crisis that would otherwise require hospitalisation. CRHTTs also acted as “gatekeepers” to acute mental health institutions, rapidly assessing individuals with acute mental health problems and referring them to the most appropriate service. They were to remain involved until the crisis has been resolved and to ensure that links with appropriate ongoing care services have been made. By offering treatment in private homes, CRHTTs allow patients to be discharged earlier from hospital, while still in the acute phase. Key CRHT features include 24-hour availability and intensive contact in the community.
1.2 The Crisis Resolution Team (CRT) is a multi-disciplinary community based mental health team which aims to provide a safe and effective home-based assessment and treatment service as an alternative to in-patient care.
1.3 The service is available 24 hours a day, 365 days of the year for residents of Camden and Islington with mental health difficulties who are in crisis.
1.4 The key features of the service are that it is mobile, provides a rapid response to service users in a mental health crisis and acts a gatekeeping function to inpatient services.
2. Main Functions of the Service
2.1 To provide rapid assessment and treatment to Camden and Islington residents experiencing a mental health crisis as an alternative to hospital admission.
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020 2.2 To provide a timely response to mental health crises 24 hours a day, 365 days of the year.
2.3 To ensure all admissions to acute inpatient beds have been assessed for home treatment “gate kept” by the CRT as per the guidance outlined in the key performance indicator. The current target percentage of service user’s gate kept by the CRT is 95%.
2.4 To facilitate safe early discharge of service users from inpatient wards to a less restrictive environment; this could be a crisis house setting or to their home.
3. Who is the service for?
3.1 The team prioritise the service for people suffering mental illness and who:
• Are in a mental health crisis • Are being considered for admission to hospital • Are already in an inpatient/crisis house facility • Present with a risk to themselves or others • Are resident in the catchment area • Are aged 18 and upwards
3.2 The service provided by the CRT is not primarily targeted at people whose primary need is drug or alcohol dependence, learning disability, brain damage or dementia, unless they would otherwise be admitted to an acute mental health ward.
3.3 The CRT can provide care for those up to the age of 70 presenting with functional illnesses. Refer to SAMH-HTT criteria in 13.4 for exemptions.
4. Referrals
4.1 The CRT accepts direct referrals from various sources including:
• Emergency Departments • London Ambulance Service
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020 • Police • General Practitioners • Service Users • Carers and families of service users • Rehabilitation and Recovery Teams • Community Mental Health Teams • Inpatient Units • Crisis Houses • Primary Care Based Mental Health Teams • Improving Access to Psychological Therapies (IAPT) Services • Adult Social Care • Non-statutory health and mental health organisations
4.2 Referrals to the CRT come via the Crisis-Single Point of Access service (C-SPA).
4.3 All referrals from Camden & Islington GP practices will be accepted and offered an assessment. See appendix for list of GP practices.
4.4 If, at the point of referral from a GP, it becomes clear that the service user requires an alternative CANDI service, then the CRT will take over the responsibility for making this onward referral from the GP i.e. the referral will not be “bounced” back to the GP. For example, if the service user is more appropriate for the Primary Care Mental Health Service, the C-SPA clinician will transfer the call and communicate some preliminary details of the referral.
4.5 All direct requests for informal admissions to an inpatient unit will be referred automatically to the CRT for a face to face assessment.
4.6 On occasion there may be exceptional circumstances whereby the CRT may agree to admission without a full face to face assessment. The definition of exceptional circumstance may be that the crisis is escalating and that there is a significant risk associated with any delay in admission. This would usually be agreed by a senior clinician following discussion around the clinical risks posed. A senior clinician in this context is clinical staff at Band 7 or above grade.
4.7 For those service users that have already been admitted to hospital, referrals are accepted from the in-patient units and crisis houses as part of early discharge procedures. This should reduce the time a service user spends as an inpatient and to plan continuation of acute care in the home environment.
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4.8 All inpatient wards can refer service users to the CRT via C-SPA, or directly with CRT senior clinicians who regularly undertake in-reach work on the inpatient wards.
4.9 There is provision for the Liaison Teams / Mental Health Crisis Assessment Service to decide whether further acute treatment needs to take place at home with CRT follow up. CRT and Liaison Team colleagues should come to an agreement about the care pathway, reducing the need for duplicate assessments taking place.
4.10 All referrals must be assessed by CRT clinicians for both urgency and degree of risk.
4.11 The UK Mental Health Triage Scale tool (See Appendix for Tool) is used by clinicians to assist them with determining the response required for referrals received via C-SPA.
Triage Code Response Type/Time to face to face contact A Immediate Referral Emergency service response B Within 4 Hours Very urgent mental health response C Within 24 Hours Urgent mental health response D Within 72 Hours Semi-urgent mental health response E Within 4 weeks Non-urgent mental health response F Referral or advise to contact alternative provider G Advise or information only / More information needed
4.12 All referrals for Mental Health Act assessments (MHAA) should involve assessment by the CRT.
4.13 All Service Users referred for MHAA must remain open to the CRT pending outcome of the MHAA. The CRT will work collaboratively with other services to support and monitor the service user during this time.
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5. Assessment
5.1 The assessment will take place where the service user is at that time, preferably at home, and will address areas including:
• Circumstances of the presenting problem and potential triggers for crisis • Mental state examination • Symptoms • Current medication and adherence • Family and social network • Social functioning including employment, housing and finances • Physical health & substance misuse • Risks & Safety • Strengths, goals and treatment preferences • Personal & Psychiatric history • Involved carers views • Religious/Spiritual needs
5.2 Family and carers should be notified when a service user has been accepted for treatment and when they are discharged – if the service user disagrees with this action then this must be clearly documented
5.3 Assessments ideally are carried out with two CRT staff and joint assessments with other community staff are actively encouraged. Response time for face to face assessments are key so if paired staff are not available for assessment, assessments may be carried out (taking into account risk and safety issues) by lone staff in line with the Trusts lone working policy.
5.4 All risk assessments will be updated at the point of assessment and as risk changes. All risk incidents must be documented and be a part of this update.
5.5 Following assessment all demographic and social information is recorded on the electronic patients records in the appropriate fields.
5.6 All service users taken on by the CRT for a treatment episode will be allocated a cluster as part of the Mental Health Tariff at the point of the initial assessment
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020 5.7 The referrer should receive feedback within 24 hours of assessment
5.8 Outcome from the CRT assessment will include the following:
• Taken on for home treatment • Not taken on for treatment / referred to referrer with advice • Admit to crisis house • Admit to inpatient bed • Refer for mental health act assessment • Referred for physical investigations
6. Treatment Episode
6.1 After having undertaken a comprehensive assessment, the treatment episode will include the team visiting frequently, supporting the social network and staying involved until the crisis is resolved, at which point the service user may be handed over to on-going care if appropriate.
6.2 A safe and effective care plan will be developed in collaboration with the service user in line with the needs identified; this will be documented within the progress notes and updated following each visit.
6.3 Collateral information from all relevant involved services and historical case notes should be gathered.
6.4 A copy of their current medication should be obtained from their GP.
6.5 Service users taken on for treatment will receive a diagnostic coding.
6.6 The CRT will consider the physical health and substance misuse needs of the service users in conjunction with our primary care partners.
6.7 For all service users that are in treatment with the CRT, the following will be monitored and reviewed daily: • Risk • Mental State • Collaborative care planning with service user and carers • Response to medication & side effects of treatment
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020 • Physical Health • Capacity & Consent • Living environment • Suitability for discharge from the service
6.8 Service users are reviewed in multidisciplinary meetings weekly attended by the medical team where the need for a psychiatric review by the team psychiatrist including medication management is considered.
6.9 Service users who may be under the care of another team, or step-down from inpatient unit to crisis house where there is a known diagnosis and clear treatment plan in place, are not routinely offered a review with the CRT psychiatrist.
6.10 If a service user is considered significantly high risk or engages in significant risk activity whilst on the caseload, the CRT Consultant Psychiatrist or other available specialty grade or higher trainee must be involved in a face to face review.
6.11 Where indicated the CRT can arrange for the service user to have an activity of daily living (ADL) assessment of needs.
6.12 Where indicated, the CRT will be able to carry out capacity assessments.
6.13 The CRT will make use of all community resources; including the service user’s own social network in any intervention.
6.14 Clear information about services available will be provided in order to promote choice.
6.15 All essential inputs will be recorded in the service user’s electronic patient record (EPR) system.
6.16 The Service will operate to the principles set out in Safeguarding policies.
7. Interventions
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020 7.1 The model used by the CRT is a bio-psychosocial one with an emphasis on involvement of the social network of the service user to resolve the crisis. This requires a shift in perspective from the individual, to the system of which the individual is a part.
7.2 The main tenets of this approach are to gather information about the person’s social context; to elicit causes in their social world for the presentation; and through a process of group/family work, generate solutions.
7.3 As far as possible treatment will be provided in the person’s own environment with as little disruption to their normal routines as can be managed.
7.4 Examples of interventions: Biological • Prescribing of and administering treatment with medicines • Monitoring levels of medicines and side effects • Medicine reconciliation • Phlebotomy • Referral for routine and specialised blood screen tests • Electrocardiogram • Physical and wellbeing monitoring -BP/Weight/Nutrition/Smoking cessation • Referrals to substance misuse services • Clozapine initiation & monitoring • Referral for ECT • Referral for additional tests –EEG/ MRI/CT/Hormone profile etc
7.5 Example of interventions: Psychological • Supportive counselling • Solution focused interventions • Review with Clinical psychologist • Distress tolerance group work • Cognitive Behavioural Therapeutic based interventions • Motivational interviewing • Peer led coaching • Family psychoeducation • Neuro psychometric tests as required • Relapse prevention / crisis planning • Medication management and adherence
7.6 Examples of Interventions: Social • Social systems interventions • Open Dialogue • Benefits and employment advice and support
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020 • Carers assessment support • Care Act assessment • Housing advice • Referral for occupational therapy activity of daily living assessment • Practical support with daily living activities
8. Did not attend procedure (DNA)
8.1 All service users must be seen face to face within 48 hours of initial assessment.
8.2 All service users must be seen face to face at time of discharge apart from in extenuating circumstances which have been discussed and planned as a team.
8.3 Standard Operating procedure for unanswered telephone calls
• If a service user does not respond to a planned telephone call, leave a clear answer phone message if facility is available and/or text message if possible. Message should detail who is calling and leave a number on which the service user can contact the team.
• If not able to leave a message, set a time during the next shift to attempt contact again. If contact is still not made, consider an unannounced call at the services users address.
8.5 Standard Operating Procedure for “Did Not Attend” appointment home visits.
• If a service does not attend a planned appointment at the CRT premises, call them on available telephone numbers and rearrange. If no response, follow procedure above.
• If service user is not at home when attending a planned home visit, discretely leave a note on CRT headed paper to state the date and time attended and ask service user to contact team within a certain time frame.
• Should the service user not respond within a stated time period, attempt telephone call and follow procedures detailed previously.
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020 • Staff should aim to ensure the referrer and other involved agencies remain updated and involved.
• Consideration must be given to contacting members of the service users’ social system including their Next of Kin.
• In all cases a team discussion should take place taking into consideration risk factors and / need for a police welfare check if appropriate.
• If the decision has been reached that the risk is sufficient that there are concerns for the welfare of the service user, staff will summon police assistance. When confirmation of police undertaking a welfare check have been received in the form of a CAD number, this will be documented in the service users progress notes and a time agreed of six hours after which if no contact has been received back from police, then CRT staff must follow this up with the police.
9. Outcome Measures
9.1 After the service user has been assessed, the CRT will contact the referrer and GP to inform them of the outcome of the referral and further plans. A copy of the complete assessment will be sent by email or posted to the referrer within 24 hours and be available on the EPR.
9.2 With service users under the care of a community team the care co-ordinator and team will be notified by email of the outcome of the assessment within 24 hours.
9.3 A shared crisis and safety care plan is agreed at the start and updated regularly throughout the treatment episode by service user and team which includes responses to identified relapse signatures.
9.4 Discharge notifications should be sent to the GP, service user and any other referrer within 24 hours of discharge.
9.5 All service users are requested to complete a feedback questionnaire for each treatment episode.
10. Hours of Operation
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10.1 The team provide a service 24 hours per day, 7 days a week, 365 days a year. A two-shift system operates in the day time from 08.00 to 16.00 hours and from 13.00 to 21.00 hours
10.2 Between 20.45 and 08.15 hours three staff operate the night service and can respond accordingly to calls from service users and other callers making urgent referrals through the Crisis-Single Point of Access service.
11. Staffing
11.1 A key element of any team is skills and competencies. A multidisciplinary team allows for a variety of approaches and interventions. The CRT includes the following professional disciplines:
• Team Leaders from any registered professional background • Senior Clinicians • Social Workers • Mental Health Nurses • Clinical Practitioners • Assistant Practitioners • Peer Support Workers • Psychiatrists • Psychologists • Pharmacy technicians • Administrative staff
11.3 The current standard of staffing on either Camden or Islington CRT on a shift by shift basis is that six clinical staff work per shift, with at least two of whom should be a registered nurse or social worker (Band 5 or 6).
11.4 All clinical staff of all disciplines will have a common orientation and generic role with the service and will be interchangeable in tasks performed.
11.5 Responsibility for the allocation of resources and duties in the team will lie with the team leader and these will be congruent with the skills and abilities of the staff on the team.
11.6 All CRTs aim to have a gender balance on each shift in order to provide choice to male and female service users in terms of carrying out assessments, home visits
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020 and other interventions. Managers are expected to take the gender balance of shifts into account when planning rotas. If it is known that there will only be one gender on shift and there are service users who are known to find this difficult, they can be contacted the previous shift to inform them of this and to reach agreement in making alternative arrangements or staff from other teams in community acute should be requested to offer support.
11.7 The CRT administrators play an integral role both in terms of supporting the clinical staff and data collection. Core tasks include populating data forms on EPR, which are used to provide data for both internal and external reporting; ensuring essential information is completed on the EPR e.g risk assessments and closing community episodes. The administrators ensure the CRT’s have easy access to stationery, clinical supplies, and forms/information leaflets for service users.
12 Communications
12.1 The CRT will provide additional written information for service users, outlining the services provided by the team and how to contact them.
12.2 After the service user has been assessed, the CRT will contact the referrer and GP to inform them of the outcome of the referral and any further plans. A copy of the complete assessment will be sent by email or posted to the referrer within 24 hours.
12.3 If the referrer is Trust staff then they will be informed of the outcome of the assessment and directed to view the full assessment on the EPR system.
12.4 CRT staff will carry Trust mobile phones whilst on duty to enhance both safety and efficiency.
12.5 Service users under the CRT case load can make contact with the CRT via the Crisis-Single Point of Access where calls are answered directly by a CRT clinician.
12.6 The Crisis-Single Point of Access free phone number will also have a voicemail option function which invite callers to leave their name, a contact number and a brief message for a C-SPA clinician to return their call within an hour.
12.7 All information regarding service users is entered on the EPR. The assessment and risk assessment should be recorded on the EPR within 24 hours of the assessment taking place.
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13. Gatekeeping
13.1 The “gatekeeping” function of the CRT is essential – The CRT should assess if home treatment can be offered as an alternative to hospital admission. All adult admissions to an acute in -patient setting must be authorised by the service.
13.2 Any patient meeting the Services for Ageing and Mental Health Home Treatment Team (SAMH HTT) criteria and referred to a Trust inpatient unit should be gatekept by the SAMH HTT prior to admission.
13.3 Outside of the SAMH HTT operating hours, the CRT will gatekeep the admission. SAMH HTT operate from 08.00 – 19.00 Weekdays and 08.00 to 16.00 Weekends.
13.4 The SAMH HTT criteria includes working with: • People with dementia of any age • Any person over the age of 70 with an acute mental illness • People under the age of 70 with acute mental health crisis who have significant frailty associated with ageing that contributes to or complicates the management of their mental health problems. • People with psychological or social difficulties related to the ageing process or end of life issues or if they feel their needs are best met for services of older people.
13.3 A Mental Health Act assessment should not be requested before the patient has been assessed by the SAMH HTT. In the event of an emergency and an MHA has been arranged prior to the patient having been seen by the SAMH HTT, the team should be part of the MHA assessment.
14 Interface with Crisis Houses
14.1 There are 3 Trust crisis houses that the CRT can refer service users to and can receive referrals from:
• North Camden Crisis House (Based at 3 Daleham Gardens) • The Rivers Crisis House (Based at St Pancras Hospital) • Drayton Park Women’s Crisis House (Based at 32 Drayton Park) 14.2 Islington Crisis House is a crisis house based at 18 Highbury Grove provided by Lookahead Care. Services users admitted here for short term residential stays experiencing a mental health crisis are offered input from the CRT and will remain on the CRT caseload for the duration of their stay.
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14.3 If a service user is transferred from a Trust inpatient ward to a crisis house as a long stay patient stepped down from the ward, the CRT does not need to additionally provide input to this group of service users.
14.4 The CRT may be requested to offer input to a service user who is transferred or provided with a short stay at the Quality Hotel which is based in North Camden.
15. Record Keeping
15.1 The CRT will keep records of every contact made with clients, their families/carers and other service providers, which must be entered onto the electronic patient record system.
16. Complaints
16.1 Complaints will be dealt with according to the Trust Complaints Policy and allocated to an appropriate manager or senior clinician to investigate. Managers and senior clinicians when appropriate should attempt to resolve complaints informally, whilst still informing the Trust Complaints department.
17. Evaluating the service
17.1 The service will be evaluated in the following ways:
• Twice daily handover meetings at which all service will be discussed. • On-going Service user and carer satisfaction and feedback and at point of discharge • Key performance indicators • Clinical audit • Clinical risk management • Continuing professional development of all staff • Clinical and Managerial supervision • Participation in the Home Treatment Accreditation Scheme (HTAS) • Reference to CORE Study (UCL). The crisis resolution team optimisation and relapse prevention (CORE) study group developed a best practice model of CRHT care and a fidelity scale to measure adherence to this best practice model.
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020 18. Handover & Care Planning
18.1 Handover takes place three times daily at the beginning of each shift- Early shift 08.00, Late Shift 14.00 and Night Shift 20.45.
18.2 The shift lead or delegated person chairs the handover / care planning meeting to ensure it is run on time and all staff are involved in discussions.
18.3 Care Plan Review meetings are extended weekly multidisciplinary meetings to review each patient in more detail and share in collaborative decision making about treatment and risk with the Consultant Psychiatrist present.
18.4 Staff should come prepared to care planning MDT and between the staff present on duty be able to present a brief synopsis and update of the service users on the caseload and contribute effectively to decision making and planning of care.
18.5 Discussions and actions must be entered onto the EPR system during handover. Two members of staff are to utilise the EPR system simultaneously to ensure notes are entered in a timely manner during the handover and are contemporaneous. Staff must entitle the top of the note: “Care Plan Review”
18.6 Staff must ensure a note is made of whether the Psychiatrist is present. If the Psychiatrist is present then wherever possible, the Psychiatrist enters any relevant notes under their own name.
18.7 Any cases which are considered complex are to be escalated immediately to medical staff. The Consultant Psychiatrist, together with the clinical team hold any risk, with final decision-making around care being planned by the Consultant or their clinical delegate if they are unavailable at the time.
19. Night-Time Operational Procedures
19.1 The Night service is staffed with three staff (with at least one Band 6 staff on duty, but ideally two) who are based in the C-SPA. One staff will be identified as the shift lead.
19.2 The night service provides:
• Telephone support for Camden & Islington service users and their carers in mental health crisis.
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020 • Face to Face CRT assessment of service users that may be indicated for informal inpatient admission.
• Assistance and back up to the Mental Health Crisis Assessment Service (MHCAS). Whenever feasible, service users should receive joint assessment / care planning from MHCAS and CRT.
19.3 The CRT night staff will undertake face to face visits either at the service user’s home or at a Trust base if it is required to prevent the persons crisis escalating to needing the input of emergency services.
20. Operational Practice with Mental Health Crisis Assessment Service (MHCAS)
20.1 The CRT and MHCAS work closely to assist service users at the point of crisis / emergency entry to the Trust. In order to ensure the interface is effective the following must apply:
• CRT and MHLT staff to ensure all communication is clearly documented in the EPR system.
• When any CRT service users are admitted to the Royal Free, UCLH, or Whittington Hospital, staff should notify MHCAS.
• If the CRT service user requires medical admission for whatever reason, the CRT must ensure they remain on their caseload for a minimum period of 24 hours before decision is made to discharge from the CRT. The service user and any carer/ family must be notified of this decision.
21. Health and Safety
21.1 Staff will be based at one of three sites:
• The Highgate Mental Health Centre (Islington CRT & C-SPA) • St Pancras Hospital (South Camden CRT) • 3 Daleham Gardens (North Camden CRT) 21.2 Staff will operate within guidance set out in the Trust procedural documents including the Lone Working Policy.
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21.3 At night, staff members that do not drive can book a taxi to take them to Emergency Departments which are not in their immediate vicinity by booking with the Transport department at St Pancras Hospital and quoting the relevant booking code (TASC number) for each team. Night staff from the transport department will organise the transport.
Appendix A
ASSESSMENT TEMPLATE
REFERRAL DETAILS:
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TIME SEEN: BY WHOM: LOCATION: IF KNOWN TO COMMUNITY TEAM / CC DETAILS:
CIRCUMSTANCES OF PRESENTING SITUATION & TRIGGERS MENTAL STATE EXAMINATION APPEARANCE & BEHAVIOUR: SPEECH: MOOD & AFFECT: THOUGHTS: PERCEPTIONS: COGNITION: APPETITE: INSIGHT: CAPACITY: PSYCHIATRIC HISTORY: MEDICATION & ADHERANCE:
PERSONAL HISTORY: FAMILY AND SOCIAL NETWORK: SOCIAL FUNCTIONING (EMLPOYMENT, HOUSING, FINANCES): RELIGIOUS / SPIRITUAL NEEDS:
PHYSICAL HEALTH: ALLERGIES: SUBSTANCE MISUSE: RISKS & SAFETY: (CURRENT & HISTORICAL) OWN HEALTH & SAFETY: TO OTHERS: FORENSIC HISTORY: SAFEGUARDING:
PATIENT’S STRENGTHS, GOALS AND TREATMENT PREFERENCES: CARERS VIEWS:
IMPRESSION: OUTCOME OF ASSESSMENT /PLAN: FEEDBACK TO GP: FEEDBACK TO REFERRER:
Appendix B
Camden GP practices
1 South Ampthill Medical Centre 219 Eversholt street NW1 1DE
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2 South Bedford Square Medical Centre 60 Bloomsbury Street WC1E 6BN
3 South The Bloomsbury Medical Centre 1 Handel Street NW5 1ER
4 South Brunswick Medical Centre 39 Brunswick Centre WC1N 1AF
5 South Camden Road Surgery 142 Camden Road NW1 9HR
6 South Covent Garden Medical Centre 47 Shorts Gardens WC2H 9AA
7 South Fitzrovia Medical Centre 31 Fitzroy Square W1T 6EU
8 South Gower Place Practice 3 Gower Place WC1E 6BN
9 South Gower Street Practice 20 Gower Street WC1E 6DP
10 South Holborn Medical Centre 64-66, Lambs Conduit Street WC1N 3NA
11 South Grays Inn Road Medical Centre 77 Grays Inn Road WC1X 8TT
12 South James Wigg Practice 2 Bartholomew Road, NW5 2BX
13 South Kings Cross Road Surgery 215 Kings Cross Road WC1X 9DN
14 South Primrose Hill Surgery 99 Regents Park Road NW1 8UR
15 South Regents Park Practice Cumberland Market NW1 3RH
16 South Somers Town Medical Centre 77-83, Chalton Street NW1 1HY
17 South Museum Practice 58 Great Russell Street WC1B 3BA
18 North Abby Medical Centre 87-89 Abbey Road NW9 0AG
19 North Adelaide Medical Centre 111 Adelaide Road, NW3 3RY
20 North Belsize Priory Health Centre 208 Belsize road NW6 4DX
21 North Brondesbury Medical Centre 279 Kilburn High Road NW6 7JQ
22 North Brookfield park surgery 2 Brookfield Park NW5 1ER
23 North Caversham Group Practice 4 Peckwater Street NW5 2UP
24 North Cholmley Gardens Surgery 4 Peckwater Street NW5 2UP
25 North Daleham Gardens Health Centre 5 Daleham Gardens, NW3 5BY
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26 North Dartmouth park practice 18 Dartmouth Park Hill NW51HL
27 North Fortune Green Road Surgery 80 Fortune Green Road NW6 1DS
28 North Four Trees Surgery 118 Malden Road NW5 4BY
29 North Gospel Oak Health Centre 5 Lismore Circus NW5 4QF
30 North Grasse Surgery 125 West End Lane NW6 2PB
31 North Hampstead Group Practice 75 Fleet Road NW3 2QU
32 North Keates Group Practice 1 B Downshire Hill NW3 1NR
33 North Matthewman General Practice ? 87-89 Prince of Wales Road NW5 3NT
34 North Parliament Hill Surgery 113-117 Highgate Road NW5 1TR
35 North Park End Surgery 3 Park End, NW3 2SE
36 North Prince of Wales Surgery 52 Prince of Wales Road, NW5 3LN
37 North Queens Crescent Surgery 76 Queens Crescent NW5 4Eb
38 North Rosslyn Hill Surgery 20 Rosslyn Hill NW3 3PN
39 North Swiss Cottage Surgery 2 Winchester Mews NW3 3NP
40 North Turvill General Practice 76 Queens Crescent NW5 4EB
41 North Westfield Medical Centre 543 Finchley Road NW3 7BJ
42 North West Hampstead Medical Centre 9 Solent Road NW6 1TP
43 North Windmill Medical Practice 65 Shoot-Up-Hill NW2
Islington GP Practices
1 South Ritchie Street Group Practice 34 Ritchie Street N1 0DG
2 South St. Peter's Street Medical Practice 16 1/2 St. Peter's Street N1 8JG
3 South Dr Bunt RJ & Partners River Place Health Centre River Place Essex Road N1 2DE
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4 South New North Health Centre 287-293 New North Road N1 7AA
5 South Islington Central Medical Practice 28 Laycock Street N1 1SW
6 South Elizabeth Avenue Group Practice 2 Elizabeth Avenue N1 3BS
7 South Amwell Group Practice 4 Naoroji Street WC1X 0GB
8 South Killick Street Health Centre 75 Killick Street N1 9RH
9 South Dr T Haffiz 8 Bingfield Street N1 0AL
10 South Bingfield Surgery Bingfield Primary Care Centre 8 Bingfield Street N1 0AL 11 South Dr Bowry & Partners The Family Practice 117 Holloway Road N7 8LT 12 South Dr Segarajasinghe The Pine Street Medical Centre 17 Pine Street EC1R 0JH 13 South Clerkenwell Medical Practice Pine Street Finsbury Health Centre EC1R 0LP 14 South City Road Medical Centre City Approach 190-196 City Road EC1V 2QH 15 South Dr B Shah Roman Way Medical Centre 58 Roman Way N7 8XF 16 South Mitchison Road Surgery 2 Mitchison Road N1 3NG
17 South Highbury Grange Medical Centre 1-5 Highbury Grange N5 2QB
18 South The Miller Practice 49 Highbury New Park N5 2ET
19 South Dr CM Woolf 94-96 Holloway Road N7 8JG
20 South Mildmay Medical Practice 2a Green Lanes N16 9NF
21 North Andover Medical Centre 270-282 Hornsey Road N7 7QZ
22 North Archway Medical Centre 652 Holloway Road N19 3NU
23 North Dartmouth Park Practice 18 Dartmouth Park Hill NW5 1HL
24 North Dr H Hussain 5 Wedmore Gardens N19 4DL
25 North Junction Medical Practice 244 Tufnell Park Road N19 5EW
26 North Dr S Edoman 140 Holloway Road N7 8DD
27 North Dr VK Gupta 272 Holloway Road N7 6NE
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020
28 North Hanley Primary Care Centre 51 Hanley Road N4 3DU
29 North Partnership Primary Care Centre 331 Camden Road N7 0SL
30 North St John's Way Medical Centre 96 St John's Way N19 3RN
31 North Stroud Green Medical Clinic 181 Stroud Green Road Finsbury Park N4 3PZ 32 North The Beaumont Practice Hornsey Rise Health Centre Hornsey Rise N19 3YU 33 North The Goodinge Group Practice Goodinge Health Centre 20 North Road N7 9EW 34 North The Northern Medical Centre 580 Holloway Road N7 6LB
35 North The Rise Group Practice Hornsey Rise N19 3YU
36 North The Village Practice 115 Isledon Road N7 7JJ
Appendix C
KEY PERFORMANCE INDICATORS
Elements to be monitored Target Offer of assessment to service users within 4 hours of referral N/A Offer of assessment of service users within 24 hours of 95% referral. Face to Face gatekeeping by CRT of inpatient admission 95% referrals Face to Face review by CRT of informal admitted patients 80% C-SPA call handling response rate NA C-SPA blue light response rate NA
Appendix D
AUDIT LIST
TASK FREQUENCY RESPONSIBILITIES
Medication audit Weekly Checking audits are completed, taking a lead in liaising with pharmacy about monitoring medications.
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OPERATIONAL PROCEDURES- CRISIS RESOLUTION TEAM JULY 2020
Physical health audit Weekly Taking a lead in working with Kat Johnson and completing physical health audit
Infection Control- Weekly Ensure staff are maintaining Hand washing correct hand hygiene techniques.
Infection Control Weekly Ensuring all medical devices are Checklist – medical cleaned + disinfected weekly devices
Care Plan Audit Weekly Encouraging the completion of care plans Making sure the care plan audits are completed and of a good quality Medication cupboard Weekly Check stock of prepacks in medication cabinet against signing in book / weekly prepack order
Car checks and clean Weekly Log books are up to date MOT Oil changes/repairs Ensuring staff are allocated to take cars to the car wash
Environment Checks Weekly Ensuring the office environment is maintained to a safe standard.
Reporting any health and safety issues that may arise.
PULSE reliance Weekly Ensuring staff are using devices at every contact when lone working. Fire Audit/Checklist Monthly Kept in H&S folder in managers office.
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