81, Lowther Streetcriteria & Protocol

81, LOWTHER STREETCRITERIA & PROTOCOL

Introduction:

The Croftlands Trust Crisis Service, based at 81 Lowther Street, is a six bed Registered Care Home. It provides a 24 hour acute/crisis residential service for up to six people experiencing severe and enduring mental health problems 81, Lowther Street is the only, Community Crisis House in Cumbria. The service was established to provide a unique alternative to psychiatric hospital admission. The Project opened on 4 February 2002 and provides a residential service for up to 6 people who are experiencing a mental health crisis and find themselves in need of short term 24 hour staffed supported accommodation. The project delivers a holistic package of support in a safe, comfortable and supportive environment without the stigmatizing effects and restrictions of hospital admission. The project can also facilitate an extended stay for further intervention/treatment for individuals with a diagnosis or suspected diagnosis of Personality Disorder and support the avoidance/relocation of out of county placements.

There is a minimum of 2 staff on duty 24 hrs a day, there is a Registered Mental Nurse on call at all times to provide clinical advice and support. The project also has an Occupational Therapist as part of the team who can provide daily living assessments.

Who is the service for?

81, Lowther Street is a county wide service for adults throughout Cumbria who find themselves in need of short-term 24 hour staffed support, but do not require nursing intervention or observation.

Have been admitted to an inpatient bed and no longer require nursing or medical interventions but will benefit from 24 hour support. The risk has been re-assessed and there are sound therapeutic reasons for a referral to81 Lowther Street to take place.

Criteria for referral:

Crisis prevention:

The Care Co-ordinator and/or the Crisis Resolution Home Treatment team has identified with the service user that there are relapse indicators, which may trigger a mental health crisis. A period of support at 81 Lowther Street is considered to be the least restrictive and most suitable environment.

Onset of mental health crisis:

The Care Co-ordinator and/or the Crisis Resolution Home Treatment team has identified that the service user is experiencing the onset of a mental health crisis and a period of 24 hour support is required away from the home environment.81 Lowther Street is considered to be the least restrictive and most suitable environment.

Move on from Inpatient services:

On assessment theservice user was deemed unsuitable for Lowther Street and was admitted to inpatient services. Howeverfollowing a review of care it is felt that a transfer to 81, Lowther Street is appropriate. The transfer must have sound therapeutic aims as identified in the individual’scontingency care plan/CPA arrangements and Lowther Street has been identified in the discharge planning process on hospital admission

Personality Disorder:

It was felt that a service user would benefit from an extended period in Lowther street following the crisis period for further assessment or/and treatment. This would need to be agreed with the Care coordinator and service user and will be determined on level of motivation and outcomes required. The approach used is an eclectic approach that combines interventions from different therapeutic models. Interventions usedare based onSchema Therapy, Motivational Interviewing and Solution Focused Therapy. Alongside this framework the project offers askills training programme incorporating 32 Cognitive Behavioural Therapy (CBT) and Dialectical Behavioural Therapy (DBT) skills. The project is based on a T.C model and provides a more appropriate setting than inpatient services.

Referral process:

A referral is made by Cumbria Partnership Foundation NHS Trust staff by contacting the project by telephone. 81 Lowther Street staff will conduct a telephone referral. (appendix 1) This will elicit the relevant information for the referral to be considered. The verbal referral will be accompanied with the GRIST Risk Assessment, and Contingency/Recovery CarePlan.Staff will then consider the appropriateness of the referral with the information received and completion of the Project TAG risk assessment. Referrals will normally come from CRHTT, CMHT, AOT and EIP teams No referral will be considered without the appropriate paperwork, i.e. referral details, risk assessment, current Contingency Care Plan and when appropriate recent history notes. Decisions re admission will be made as speedily as is possible, normally the same day. Admissions can take place from 8.00am to 8.00pm

Discharge planning:

It is required that the care co-ordinator and/or the Crisis Resolution Home Treatment Team will maintain contact with the service user and communicate with the project team. Direct contact is expected to be a minimum of 1 visit weekly. In the absence of the care coordinator, it is expected that the duty worker will take up this role. There will be a discharge planning meeting before the service user leaves the project as per care co-ordination policy.

Accessing In patient beds:

If it is felt that a service user may need a mental health assessment or admission to the acute ward setting, the project staff will be able to access this by liaising with the CRHT.

Communication of information:

It is required that any changes to CPA or risk assessment will be communicated to the project immediately. Any changes to risk whilst residing at 81 Lowther Street will be reported to the CRHTT using the Threshold Assessment Grid.

Please Note:

81 Lowther Street is a Registered Care Home in its own right. Whilst Croftlands Trust wants to work in close partnership with the Cumbria Partnership Foundation NHS Trust we must also uphold the legislation that governs our operation and service delivery under the Care Quality Commission. In order to maintain ongoing provider compliance with the CQC outcomes and project statement of purpose the final decision to refuse an admission to 81 Lowther Street rests with the Registered Manager (John Dryden) and the senior worker (Sharon Grisdale)

Model used:

Outcomes

81 Lowther Street works to the Recovery Star System model. This tool enables care to be planned around user defined goals and quality of life outcomes. With professional support, service users are able to use the star to self assess their recovery journey and identify where they need the most support.This means that the support required may include advice on healthy eating and exercise or encouraging social contact and engaging in daily household chores, as well as more traditional interventions. This is all undertaken in a comfortable and non-institutional environment that promotes the involvement of the individual. The project also utilises other outcome/rating scales (appendix2)

Over the first 72 hours following admission, the team conducts a needs assessment, Recovery star and care plan with service users, this helps to develop an holistic support package that considers 10 life domains. Care plans are formulated with direct involvement from service users. The team offers a range of therapeutic, educational and recreational activities to meet the needs of service users. With regular 1/1 based on, Cognitive Behavioral Therapy, Brief Solution Focused,Motivational Interviewing and Anxiety management interventions.

The Project has 6 bedrooms, all with lockable doors, 5 bathrooms, 4 kitchens 2 communal lounges, a resource room with online CBT, internet access and Bibliotherapy, a cardiovascular fitness room, relaxation/activity room and a rear enclosed garden. Resident meetings are held every week to facilitate group discussions, raise resident/staff issues and to plan weekly activities and menus. Evening meals are an integral part of the therapeutic milieu, with staff and residents dining together, and residents being encouraged to assist in food preparation.

Revised May 2012: Due to be reviewed May 2013

Appendix 1

81 LOWTHER STREET PROJECT

REFERRAL FORM

SignedDate

Appendix 2

Lowther street Outcome Tools

Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)

Mobility Inventory (MI)

Internal State Scale (ISS)

Centre for Epidemiological Studies Depression Scale (CES-D)

Becks Depression Inventory (BDI)

Eating Disorder Examination (EDE-Q)

Personality Disorder Questionnaire (PDQ-4)

Young Schema Questionnaires (YSQ)

Borderline Evaluation of Severity over Time (BEST)

PennState Worry Questionnaire (PSWQ)

Obsessive Compulsive Inventory (OCI)

Panic Rating Scale (PRS)

Psychotic Symptom Rating Scales (PSYRATS)

Impact of Events Scale revised (IES-R)

Mini mental State Examination (MMSE)

Glasgow Anti psychotic Side effects Scale (GASS)

Liebowitz Social Anxiety Scale (L.S.A.S)

Mental Health Recovery star (MHRS)

Clinical Outcomes in Routine Evaluation (CORE)