OPEN BOARD OF DIRECTORS 8 June 2016 Open BoD: 08.06.16 Item: 5 TITLE OF PAPER Community Enhanced Recovery Team (CERT) Progress on Development, and the partnership between the Trust and South Yorkshire Housing Association TO BE PRESENTED BY Liz Lightbown Executive Director for Nursing, Professions and Care Standards ACTION REQUIRED Board Members to acknowledge the progress of the development of the Community Enhanced Recovery Team (CERT); and the partnership with South Yorkshire Housing Association OUTCOME Board Members are assured and up-dated on progress TIMETABLE FOR DECISION June 2016 Board LINKS TO OTHER KEY REPORTS/DECISIONS N/A LINKS TO THE NHS CONSTITUTION & OTHER RELEVANT FRAMEWORKS BAF, RISK, OUTCOMES ETC HSE MH Act Equality NHS Constitution: Patients Public Staff IMPLICATIONS FOR SERVICE DELIVERY & FINANCIAL IMPACT Delivery of the Rehabilitation and Recovery Strategy CONSIDERATION OF LEGAL ISSUES N/A Author of Report Lisa Johnson and Debbie King Designation Assistant Service Director and CERT Team Manager Acute and In-patient Directorate Date of Report 25 th May 2016
SUMMARY REPORT Report to: Open Board of Directors Date: 8 th June 2016 Subject: From: Authors: Community Enhanced Recovery Team (CERT) Liz Lightbown, Executive Director for Nursing, Professions and Care Standards Lisa Johnson, Assistant Service Director Debbie King, CERT Team Manager 1. Purpose For Approval For a collective decision To report progress To seek input from For information Other (please state below) To up-date Board Members on the progress of the Community Enhanced Recovery Team (CERT) and the partnership between Sheffield Health and Social Care NHS FT (SHSC) and South Yorkshire Housing Association (SYHA). 2. Summary The attached report has been developed to provide an up-date about the Community Enhanced Recovery Team (CERT). Service users have been returned from expensive out-of-area locked rehabilitation placements as part of the Rehabilitation and Recovery Strategy. There has been a dramatic reduction in bed nights by Community Enhanced Recovery Team (CERT) service users of 97%. The Community Enhanced Recovery Team (CERT) has worked in partnership with South Yorkshire Housing Association and the Living Well project. Feedback from staff, service users and South Yorkshire Housing Association about the Community Enhanced Recovery Team (CERT) model has been very positive. This model of intensive community rehabilitation is innovative and has been part of the transformational change programme in our rehabilitation services. The Community Enhanced Recovery Team (CERT) had a visit from the Positive Practice In Mental Health Collaborative and received very good feedback, resulting in two award nominations being made for the team, one for partnership working, the other for staff well-being and support. 3. Next Steps The Community Enhanced Recovery Team (CERT) will continue to develop and more service users will be returned from out-of-area back to Sheffield. 4. Required Actions Board Members to receive the report for information. 5. Monitoring Arrangements Through the Mental Health Reconfiguration Programme Board, Executive Directors Group and Board of Directors, as required. 6. Contact Details For further information, please contact: Lisa Johnson, Assistant Service Director, 271 8541 Lisa.johnson@shsc.nhs.uk
Community Enhancing Recovery Team (CERT) Progress and Evaluation Authors Dr Mike Hunter, Consultant Psychiatrist Lisa Johnson, Assistant Service Director Debbie King, Team Manager Draft 1 25 th May 2016 5 Open BoD June 16 Community Enhanced Recovery Team (CERT) Service Page 3 of 11
Contents 1. Introduction 2. Background 3. Staff Team 4. Induction and Training 5. Service Users 6. South Yorkshire Housing Association 7. Governance 8. Service User Feedback 9. Innovation 10. Achievements 5 Open BoD June 16 Community Enhanced Recovery Team (CERT) Service Page 4 of 11
1. Introduction The aim of this paper is to present and evaluate the progression and impact of the Community Enhancing Recovery Team (CERT) over the last 23 months. CERT was established in July 2014 with the aim of delivery person centred, recovery focussed care to individuals in their own tenancies as opposed to hospital based care. 2. Background In June 2014 the rehabilitation & recovery provision in Sheffield consisted of two inpatient units: Pine Croft Recovery Ward; a 17 bedded ward with the emphasis on short term (6-18 months) admission to provide rehabilitation & recovery Forest Close; a 44 bedded unit with the emphasis on slow stream rehabilitation & recovery Locked rehabilitation was not a provision within Sheffield Health and Social Care so was therefore commissioned through independent and occasionally NHS facilities outside of the Sheffield area. These hospital placements are very expensive and do not always facilitate timely discharge for service users being placed out of city, also reduces service users opportunities to reengage with their own community, friends and families etc. Placements ranged from 14-120 miles from Sheffield. The rehab strategy has an ongoing commitment to reduce admissions out of city to 0 unless legal frameworks prevent this. This is being achieved by: The expansion of CERT Identifying appropriate care pathways out of hospital through existing social care resource Development of a 30 bed Intensive Inpatient Service, enabled by the merge of current inpatient service (Pine Croft & Forest Close) 3. Staff Team A phased approach to recruitment has enabled the team to expand to meet the needs of increasing service users. The team is divided into 3 mini teams to ensure that service users don t have to build relationships with the full staff compliment. The table below details the staff provision to achieve that aim Role Band Number WTE Team Manager 8a 1 1.0 Assistant Team Manager 7 1 1.0 Consultant Psychiatrist N/A 1 1.0 Principal Clinical Psychologist 8b 1 0.8 Clinical Psychologist 7 1 1.0 Assistant Psychologist 4 1 1.0 Occupational Therapist 6 1 1.0 Team Administrators 3 2 1.5 Care Coordinators 6 6 6.0 Recovery Coordinators 4 3 3.0 Recovery Workers 3 41 40.8 Apprentices N/A 3 3.0 5 Open BoD June 16 Community Enhanced Recovery Team (CERT) Service Page 5 of 11
Staff are recruited using value based approaches with a significant service user involvement. At the most recent Recovery Worker Interviews 60% of CERT service users participated in the recruitment process. CERT co-presented their experience of value based recruitment with Human Resources at the Compassionate Care Workshop held in July 2015 and at the Implementing Recovery through Organisational Change (ImROC) learning set in November 2015. Case formulation is embedded in the teams routine practice and links to care planning, identifying staff training and support needs, governance and by inviting colleagues from across the Trust who are involved with the service users care, it places the teams within the wider context of services. A team formulation should therefore be more reliable than individual formulation by a single clinician. By placing an emphasis on everyone inputting, everyone sharing, the whole of the clinical team are encouraged to share their experiences and knowledge. The aim is to build and maintain a team dynamic that is valuing, respectful and empowering for all, throughout highly challenging situations that can illicit strong emotional responses. Case formulation is designed to bring the team back to our core values and allows the team members to maintain a validating work environment and relationships with service users Through understanding the meaning in behaviour, and understanding staff members own responses, the staff members receive support and learn to recognise and understand the desperation behind the behaviour, where it was developed and why (Isabel Clarke) Weekly reflective practice groups provide an opportunity for staff to reflect on their work in a safe space. It can provide an outlet for anxieties and frustrations generated by their work and help staff to hold a compassionate view of the service user. It can help staff to maintain a shared perspective of service users whom they have previously found upsetting, or difficult or hard to help and this opens minds to other possibilities, and day to day management and help staff to keep empathy with the service users difficulties. The reflective practice group provide support and improves communication within the team and helps to promote a shared view and can improve job satisfaction. Some examples of feedback provided by staff: Because Service Users are behaving in ways that elicits a response from you but when you have got that diagram you can see other avenues and you can see why Having the team formulation and having like a diagram that explains your own responses so you know that sometimes the feelings that you are feeling are natural you know where it s coming from It helps because you feel like you have understood the problem a bit more..that gives us confidence in what we are doing..its easier to give our Service Users confidence Case formulation makes us look at the bigger picture. maybe you re dealing with a crisis where someone is being verbally abusive you ve got in the back of your mind all these discussions that you ve had as a group about maybe why they are in that place right now, that it is not personal, its not because of you this has happened, and triggered loads of other feelings. 5 Open BoD June 16 Community Enhanced Recovery Team (CERT) Service Page 6 of 11
It keeps it in the back of your head so that you are never kind of feeling animosity towards the service user for being aggressive because you ve got a further understanding of what they re going through Despite the intensity of the work that staff deal with on a daily basis, the sickness rate was 2.9% for 2015/16. This is testimony to the staff support systems in place. 4. Induction and Training Recovery Workers are given a two week induction focussing on trust, directorate and team specific requirements, following which they spend a further two weeks shadowing peers and developing relationships with service users. Recovery Workers are now expected to complete the Cavendish Care Certificate within their first 12 weeks of employment and are supported by a number of assessors in the team. CERT works closely with the Recovery Education Department and have staff currently undertaking a variety of training courses including Recovery from Psychosis (Family Interventions) Recovery and Value Based Practise Recovery in Mental Health Online Introduction Post Graduate Diploma Recovery in Mental Health Other training opportunities have included: BA (Hons) Leadership and Management for Health and Social Care The Mary Seacole Programme There is an effective system in place for monitoring compliance with mandatory training. 5. Service Users Between July 2014 and July 2015; 12 service users moved either from out of city locked rehabilitation services or from SHSC Inpatient provision, to enable transfer from out of city locked rehabilitation services, to CERT. The subsequent year has focussed upon increasing the number of service users to 24 and the team are working with an additional 4 service users who will be discharged from hospital during 2016. Though the team is needs led, the service users have complex needs associated with severe psychotic illnesses and/or personality disorder with co-morbid learning disability or substance use. They have had frequent and lengthy admissions to hospitals including secure, locked rehabilitation and acute facilities. CERT enables people to make the transition from locked rehabilitation by providing intensive support at least initially and then reducing care packages over time, the chart below demonstrates for the first 12 service users; how care packages have reduced. For this group of people, contact hours have reduced from 649 to 344. 5 Open BoD June 16 Community Enhanced Recovery Team (CERT) Service Page 7 of 11
Where service users require additional support at times of crisis CERT is able to increase support up to 24 hours a day for a short periods or where admission is indicated; alternatives are considered such as the crisis house or the Short Term Care Bed. At times when admission is unavoidable the team works closely with Inpatient services to ensure a timely discharge. As of the 1 st May 2016: 24 Service users in CERT 7722 total nights 8 service users have had admission to hospital Total acute bed nights 229 (3%) 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 Crisis house/stcb Acut e admission 0 20 40 60 80 100 Bed nights This is a dramatic reduction in bed use, from 100% down to 3%. 5 Open BoD June 16 Community Enhanced Recovery Team (CERT) Service Page 8 of 11
6. South Yorkshire Housing Association Sheffield Health and Social Care NHS FT (SHSC) has established a partnership with South Yorkshire Housing Association to provide tenancies for Service Users. Individuals are supported to view a variety of properties, decorate and furnish their property. Ongoing tenancy support, to enable people to maintain their homes and pay bills is also provided. South Yorkshire Housing Association works in partnership with the Community Enhancing Recovery Team. They currently provide tenancy to 22 service users currently under the care of Community Enhancing Recovery Team. This partnership is working very effectively to support service users to live as independently as possible. The following quotes are from Natalie Newman, Area Lead for care, health and wellbeing at South Yorkshire Housing Association: The collaboration between SYHA and SHSCT has been an insight into the future of mental health services, where health, housing and care work together as equally invaluable partners working with people to improve their lives The partnership has been an opportunity for two directional learning and improvement, where housing and health have seen and benefited from the exceptional skills and resources in each sector, bringing them together to a life-changing and sector-changing collaboration An example of this partnership is service user A. Service user A had 10 admissions to hospital between 2004 and August 2015 this included a period of admission lasting 4 years between acute and rehabilitation wards. Service user A had an 8 month period in locked rehabilitation, out of area. They had previously had attempts living in the community with supported living which had failed as a consequence of unsocial behaviour and rent arrears. As a result, housing providers reused to house this service user. Once CERT was set up and the partnership with SYHA was established we were able to identify and secure a property. SYHA Living Well project engages with service users alongside CERT during the in reach process to identify that persons needs and wishes in order to find the right property in the right area with the right specification. This permanent tenancy continues to be successful. Service user A has had 2 short admissions to acute hospital totalling 18 days but has continued to maintain their property throughout. Another example of this is: Service User B has had 15 admissions to Acute Care/PICU since 2006 totaling 1810 days and a further 265 days in locked rehabilitation. Since 2007 the longest period they lived in the community was 5 months. CERT began working with Service User B in December 2014, despite being 40 miles away they gradually built up relationships with some of the team and were supported to visit Sheffield to view properties and choose furnishings, they opted to do a large part of the decorating themselves. Service User B was discharged from locked rehab on the 30 th March 2015. In July 2015 Service User B was admitted to an acute ward for 3 nights before moving to the crisis house for a further 6 nights. She has remained living in her own home with support from CERT. Her care package has reduced from 96 hours during April 2015 to 16 hours in April 2016. 5 Open BoD June 16 Community Enhanced Recovery Team (CERT) Service Page 9 of 11
7. Governance A whole team approach is used to plan and deliver effective care. With a heavy emphasis on recovery the team works with service users to develop collaborative goals to increase confidence and independence to live in the community. Weekly protected time enables each staff member to attend Case Formulation and Reflective Practice both of which are essential to ensuring consistent and meaningful intervention based on psychological understanding of a person s experience. Case formulation enables the whole team to contribute to and share ideas to support people with their goals and maintain compassion at difficult times. Reflective Practice provides a space for sharing experiences, both positive and negative and support for each other. 8. Service User feedback These are some of the comments that CERT have received from service users: It is equipping me with the skills to live in the most independent way I love it. I will always take my meds and work with CERT as a team CERT has done a remarkable job of enabling me to live in society and the community, rehabilitising my mental health and myself as a person I believed I would stay in different places on the wards and rehabs, I had no hope, suddenly the CERT team came with the offer of a home in the community again, they always go the extra mile, I love them Without constant support from CERT this probably would not have been possible Just a little note to say, thanks for all you do for me and I am happy that CERT opened cause it s a fantastic service run by all parties Thank you for not giving up on me, I know it s been hard but I m grateful to have a team like you all at CERT Thank you for helping me fit into my new flat, because of your help it is now my home Below is a quote from a carer: To celebrate service user X s first year living on his own in the community. He couldn t have managed without you and we do appreciate your support and commitment to him, many thanks to all involved Carer CERT has worked with SUEMU to develop a service specific version of the quality and dignity questionnaire. There are plans for this to be completed on an ongoing basis. Living Well regularly hold events for service users, to involve and provide opportunity to provide feedback these sessions are called Over To You. At one of these sessions the Key Performance Indicators for the Livingwell project were defined by service users: Every customer has the opportunity to take up the offer of attending a benefits information session, either a group or individually This will enable the customer to find out what benefits they are entitled to and facilitate their access. 5 Open BoD June 16 Community Enhanced Recovery Team (CERT) Service Page 10 of 11
We will support all our customers with their move on from Livingwell customers will receive follow up visits from their Living well worker, at a frequency and time that suits the need of each individual. I don t want to be left to start again with no faces I kno w All Livingwell customers will have consistent support with a named keyworker; all customers will have a named deputy keyworker, who they can get to know. Customers want to be able to build a supportive relationship, trust and a rapport with their key workers; customers want to know who they will be working with if their named worker can t make it. We will support Livingwell customers to improve tenancy and life management skills, for e.g. making telephone calls. No Livingwell customer will leave our service feeling unprepared to settle in their o wn tenancy. All Livingwell customers will have a matching meeting with their potential keyworkers at the start of service. Customers will have a choice of who they work with. I want to choose who I work with; I don t get on with everybody All Livingwell customers will receive personalised support to improve their wellbeing. We will use established qualitative and quantitative measures to record this. Key measurable themes reported by customers were: building confidence, meeting new people, being involved in the community, pursuing hobbies, volunteering. We will offer events that give our customers opportunities to build relationships with the wider community. Key support: particularly concerning events where customers can socialise and reintegrate into the community customers mentioned wanting to make friends with a diverse range of people; not just those with health and social care needs. This is an example of service users being fully involved in the design and delivery of care. 9. Innovation CERT has worked closely with the IT department to pilot mobile working with the use of tablets to record daily notes, access data-store and other applications and create collaborative care plans. CERT have begun using a Microsystems approach to quality improvement involving a range of team members. 10. Achievements CERT was presented with the Chair s award at the Annual Member s Meeting and Staff Awards in September 2015. CERT hosted a visit from the Positive Practice in Mental Health Collaborative on Friday 20 th May 2016 and received very positive feedback from this. Two nominations have been submitted for an award to the collaborative, one for partnership working with SYHA and another for staff support and well-being. 5 Open BoD June 16 Community Enhanced Recovery Team (CERT) Service Page 11 of 11