Transcript CRISIS MANAGEMENT AT THE MANAGED CLINICAL NETWORK

CRISIS MANAGEMENT
AT THE
MANAGED CLINICAL
NETWORK
Aims
• Outline crisis management ‘framework’ at
MCN
• Highlight contributing factors in developing
a shared understanding
• Outline evaluation project
Service Criteria
Diagnosis of personality disorder or identified personality
difficulties
•
• Multiple ‘complex’ needs
• Significant risk, particularly to self
• Poor response to previous treatment
• Limited social network
• Difficulty maintaining contact with services
• 18 and above
MCN Care Co-ordination
•
Up to 100 weeks clinical case management
• Small case loads
• Assertive approach
• ‘Intensity’ titrated to stage of treatment
• Safety & Containment
• Control & Regulation
(A Simpson, C Miller & L Bowers, Journal of Psychiatric and mental Health Nursing, 2003)
Service User
Involvement
Family
& Carers
3rd Sector
Parties
Individual
Psychology/
Psychotherapy
Group Work
Programmes
Crisis
Resolution
home
treatment
team
Accommodation
Care Co-ordinator
& Service User
Occupational
Therapy
HCSW
Support
Pharmacy
Input
Inpatient
Teams
Key Challenges
• Significant number of inpatient admissions
• Significant degree contact CRHT team & police (S136)
• How to manage ‘splitting’ across services
• How to embed ‘general therapeutic strategies’
• How to balance immediate safety with treatment goals
Crisis Management Framework
Principle: ‘Relief comes from having a connection with someone who understands’
Goals
• Support service user to ‘contain’ distress
• Prevent an escalation
• Support service user to return to the previous level of functioning as quickly as
possible
• Respond in a way informed by a formulation
• Avoid a service response which escalates distress or reinforces maladaptive
behaviours
Therapeutic Stance
• Align with the patient’s distress
‘Containing’ Interventions
• Convey support and understanding
• Establish a connection with the service user
• Focus on affect rather than content
• Use straightforward, concrete statements that reflect an understanding of the
current situation and the patients’ experience
• Reinforce the service users strengths and self-management skills
• Set limits supportively
• Arrange additional support (e.g. MCN team, CRHT)
(Practical Management of Personality Disorder – John Livesley 2003)
Crisis Plan Template
What might be helpful to know about my past?
What is a crisis to me ?
Events that can lead to a crisis / triggers
What can help if I feel like this?
What does not help / makes things worse?
If I need support, how and where do I get it?
Helpful thoughts to keep in mind
How can people help me to use this plan
Who has contributed
Emergency contacts
A Shared Approach, What Helps?
• Crisis plan framework
• Formulation informed crisis plans
• Crisis plan developed with service user and key ‘partners’
• Guidance for admissions incorporated into CPA care plans
• Practice development lead role
• Consultation
• KUF training
• ‘Specialist’ services
• Development of ‘whole systems pathway’
WHOLE SYSTEMS PATHWAY
Service user first point of contact in a
potential crisis:- PDCN, CRHT, DSHT, A&E
Assess risk - Refer to current FACE risk
assessment and CPA
crisis management plan
What does the service user want:
Offer immediate
containing interventions
Risk remains
unacceptably High
Relief from distress
Try other treatment options:
Contact CRHT triage
Initiate joint assessment
whenever possible
Home
treatment
Risk remains
unacceptably high
•Involve family/carers
•Increase visits
•Use alternative community services
– Dial House, Connect etc
ACS
Risk remains unacceptably High
Hospital admission
Ward interventions should provide
safety, structure, consistency and
increased contact/input
Refer to CPA care plan if
appropriate
Clinical reviews with Network
Coordinator should take place
within 48 hours of admission
wherever possible
Discharge planning to involve care
co-ordinator, ward team and service
user
Crisis Plan Evaluation
Project team;
• Mike Pearce, Practice Development Lead
• Vicky Green, Care Co-ordinator
• Vicky Baldwin, Education & Practice Consultant
• Jamie Scott, Clinical Team Manager
Project Aim
To evaluate the impact of the development of collaborative crisis plans between Crisis
Resolution Home Treatment (CRHT) & Personality Disorder Clinical Network (PDCN) staff
and service users currently engaged in care co-ordination at the PDCN.
• change in service user’s self assessed capacity to manage ‘crisis’ effectively
• change in service user’s experience of PDCN & CRHT teams in responding to ‘crisis’
• change in staff’s self –assessed knowledge, attitudes and skills
• change in amount and type of contact with ‘out of hours’ services
Inclusion criteria
• All service users engaged in the care co-ordination intervention (September 2011)
(sample size 20)
Process
Produce Evaluation Report
Collect comparative service
use data (September 2012)
Post crisis plan questionnaire
(September 2012)
Crisis plan review meetings
Crisis plan completed with
care co-ordinator and a
member of the CRHT team
(October 2011)
Pre evaluation
period
questionnaire
(September
2011)
‘When written in Chinese, the word CRISIS composed of two characters, one
represents danger, the other opportunity’
John F Kennedy
• Any Questions?