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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