Sheffield EPIC by pengxiang


									            Sheffield EPIC

            Sheffield Crisis Service
            Dr Simon Mullins
            (Project Lead)

Sheffield EPIC team
 Rashna Hackett, Nurse Consultant
 Jo Nicholson, Clinical Psychologist
 Liz Miller/Sue Bentley, Nurse leads
 Gareth Pritchard/ Lucie Green, STR leads
 Clare Devine, Admin Support
 Sharon Ward, Team manager

Overview of Acute Service in Sheffield

 Sheffield Adult population (18-64),
 Acute Admission Beds
 91 (RCPsych, 84-111)
 ‘Out of Hours Team’, not 24 hours (1997)
 Crisis Service operational (Jan 2005)
 Closure of Acute Day Hospital (2005)

Overview of Crisis Service
 2 CRHT’s (CAHT’s) faithful with PIG template

 Focus on SMI but no diagnostic exclusion criteria

 24/7, MDT

 Gate keeping role

 Provide ‘Home Treatment’ as an alternative to hospital admission and to
 facilitate early discharge from hospital

 1 ‘Crisis Bed’ in Wainwright Crescent (Respite facility within SCT)

 Additional A&E Liaison role

CAHT Referral Routes
 Referral Criteria; (16-65+graduates), Potential
 mental health crisis, Requires 24 hour response,
 Identified increase risks

 Professionals; GPs, CMHT, specialist mental
 health teams, Day Services, A&E

 Clients/carers; NHS Direct

Sheffield’s EPIC Journey
 November 2005
 Original bid proposed Partnership working between
 Crisis Service and Pakistani Muslim Centre

 January 2006
 Steering group agrees a visionary proposal with 12
 Sheffield Care Trust board level involvement in steering group and goals
 are set across other services in the Trust. A city wide network meeting
 inspired by EPIC emerges which reports to South Yorkshire FIS site. EPIC
 project boundaries start to become blurred.

•   A decrease in compulsory detention for the Pakistani community

•   Decreased in Inpatient care for the Pakistani community

•   Increase in early discharge rates (this is to be defined as the average length of stay)
    for the Pakistani community

•   Appropriate percentages of Pakistani people accessing secondary care in non emergency community
    mental health services (consider the local data in the relevant areas and compare the percentage in
•   contact with statutory services).

•   Explorative data regarding the subjective views of PMC users with regards to stigma, suspicion, mistrust,
    capacity, interpreting/translation.

•   The development of advocacy services and representation in Care Trust Council.

•   A focus on economic circumstances of service users within the
    Pakistani Muslim Centre i.e. signposting etc.

•   An improvement in existing collaboration between Sheffield Care Trust
    and the Pakistani Muslim Centre.

•   An improvement in the limited knowledge of the CAHT team on matters
    of ‘Race’ and culture in mental health.

•   An increase in the assessments of social care needs of service users from
    PMC who also use secondary mental health services.

•   An increase in the facilitation of respite care for both service users from
    the Pakistani community and their carers.

•   The emergence of pathways of care that are timely and appropriate
    for the Pakistani community i.e. Early Intervention Services, Psychological Services.

    Sheffield’s EPIC Journey
       February 2006
       Initial positive experience of a few Home Treatment Clients gaining
       access to PMC

       April 2006
       Initial Experience of partnership working could be more systematic
       and more coordinated, however other pathways start to emerge
       through project e.g. EIS

       May 2006
       EPIC Steering group leadership (board level) gains SCT funding for
       a development worker at PMC, 20 hours a week

Sheffield’s EPIC Journey
 September 2006
 CAHT clinical group refocus original clinically based
 EPIC proposal to 2 main pathway interventions plus
 audit of a more culturally appropriate HT Care Package

 September onwards
 Link worker provides opportunity for more coordinated
 partnership working and training.
 CAHT appoint ‘Champions’ within the 2 teams with view
 to ‘re-launch’ EPIC within our clinical service

EPIC Pathway Interventions
    Pakistani Muslim Client referred to CAHT in Crisis

   HOME                          Link     INPATIENT
   TREATMENT                     /CAHT    WARD
             PMC Link Worker/


Pathway Intervention 1
 Nurse ‘Champions’ within team to identify new Pakistani
 clients in ‘Home Treatment’

 PMC Liaison Care-plan for each client

 STR workers to accompany clients to PMC to meet Link
 worker and introduce them to the organization

 PMC Wednesday!

EPIC Pathway Interventions
    Pakistani Muslim Client referred to CAHT in Crisis

   HOME                          Link     INPATIENT
   TREATMENT                     /CAHT    WARD
             PMC Link Worker/


Pathway Intervention 2
 EPIC ‘champions’ to work alongside team
 Early Discharge facilitators to proactively
 identify Pakistani clients on acute wards
 ready for early discharge

 Work alongside PMC Link worker on ward
 to ensure early discharged ‘Home
 Treatment’ clients are introduced to PMC

EPIC Pathway Interventions
   Pakistani Muslim Client referred to CAHT in Crisis

  HOME                          Link     INPATIENT
  TREATMENT                     /CAHT    WARD
            PMC Link Worker/


Further EPIC proposals

     Development of a culturally enhanced
     Integrated Care Pathway within
     ‘Home Treatment’ Care spell

     Training of CAHT staff in culturally
     sensitive mental health issues

EPIC Summary (1)
1.    Facilitate Pakistani Home Treatment
      Clients access to PMC (pathway
      intervention 1)
2.    Facilitate Pakistani Inpatients early
      discharge to ‘Home Treatment’ from
      Inpatient Care (pathway intervention 2)
3.    Audit effectiveness of 1 and 2

EPIC Summary (2)
4.    Development of a more culturally
      appropriate Integrated Care Pathway (an
      enhanced package of ‘Home Treatment’
5.    Team Training by PMC
6.    Audit effectiveness of 5 using ICP as

     What should be the scope of this project?
     What should be the end point of EPIC?
     How can we take further developments
     forward after EPIC?
     How do we make EPIC sustainable?
     How do we manage the momentum?


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