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