Closer2Home ServiceRecruitment event webinar

Tier 4 CAMHS Provider Collaborative,Wessex and Dorset

Monday 31 August 2021 (6:30pm)

Dilip Chakrabarti, Project Manager, Closer2Home Service

Agenda

Welcome - event outline, Q&A, housekeeping

• 18:30 - Introductions

• 18:35 - Closer2Home Introduction and overview

o Wessex & Dorset Tier 4 Provider Collaborative

o Video – C2H service overview

o Service plans

• 19:05 - Live Q&A - please submit your questions in the chat

• 19:25 - Recruitment process and timelines

• 19:30 - Close

Introductions

• Dilip Chakrabarti - Closer2Home Project Manager

• Rob Guile - Divisional Director of Operations (Specialist Services), Southern Health NHS Foundation Trust

• Richard Brown - Operations Director, Children and Families East, Solent NHS Trust

• Katie Butler - CAMHS Tier 4 Service Manager, Dorset Healthcare University NHS FT

• Richard Sankar - Consultant in Child and Adolescent Mental Health, Clinical Director Wessex and Dorset

Provider Collaborative

Developing C2H - service context

Wessex & Dorset Tier 4 Provider Collaborative

• Greater understanding of the services available across the region

• A more collaborative and joined-up approach to admissions and discharge planning

• A recognition that young people need a safe alternative to admission; based on evidenced and

skills-based treatments, in their homes

• Shared operational and governance structures that also reflect the multi-Trust provider landscape

Consequently;

• The Provider Collaborative clinical strategy is built around the development of an intensive home

treatment service as an alternative to admission; the Closer2Home Team, delivering intensive

mental health treatment to young people requiring urgent care in their homes

C2H Video

Link:

https://www.youtube.com/watch?v=nEpY08EUorM&t=4s

C2H - Aims and objectives

Development of the C2H Team will aim to:

• Reduce the need for psychiatric admission and the risks associated with admission

• Provide assessment and intensive management services for CYP with high levels of risk, who

would ordinarily be admitted

• Support assessments to facilitate admission (where clinically appropriate)

• Provide planned, intensive home or community-based treatment services as an alternative to

admission

• Offer specialist intensive home treatment for CYP whose needs exceed the capacity or skill level

of Tier 3 CAMHS

• Provide supported discharge services (to facilitate timely discharge from an inpatient setting)

• Support the reduction of health inequalities in children and young people mental health pathways.

Provider model and service geographyThe Closer2Home service is provided by a range of the Provider Trusts operating within the Provider Collaborative, each covering a specified geographical area and being the employing organisation for the staff in that area.

Provider Trusts:

• Dorset - Dorset Healthcare University FT

• Mid & North Hampshire -Southern Health NHS Trust

• Southampton & SW Hants -Solent NHS Trust

• Portsmouth & SE Hants -Solent NHS Trust

• IOW - IOW NHS Trust

Service Model - overview

• Operates 365 days a year / 8am-8pm

• 50/50 staff split (clinical / non clinical)

• Contracted 35 WTE’s (plus Consultant, Management, Admin, Peer Support and Trainee Nurse Associate roles)

• Establishment based on caseload of 33 children and young people

o 1/3 of the caseload will be visited 3 x a dayo 1/3 visited 2 x a dayo 1/3 visited 1 x a day

• Three core patient groups

Patient groups and clinical models

Group 1 - Self-harm / suicidal

• The rationale to focus on children and young people who make suicidal gestures or repeatedly harm themselves is based on empirical evidence and clinical observation.

• Widely observed that some young people demonstrate unhealthy care-seeking behaviour which escalates and expands in Tier 4. Clinically, there is iatrogenic harm associated with the psychiatric admission of these young people.

• Clinical model for the Closer2Home team will focus on a high-fidelity intensive offer for young people deemed to be high risk. In practice:

o One 2-hour skills group with young people and carers per week,

o 14-week individual therapy for 1 hour per week,

o Ad hoc phone coaching from 08:00-20:00 for 14 weeks and;

o 1.5 hour of team consultation per week.

• Challenges are:

o Need to consider client mix carefully (high risk young people seem to have more gain whilst low risk young people become riskier) and,

o Logistical issues such as travel and venue for group work.

Patient groups and clinical models

Group 2 - Eating Disorders

• The evidence-base for delivering intensive Closer2Home treatment for young people with complex eating disorders (especially anorexia nervosa) stems from the Treatment Outcomes for Child and Adolescent Anorexia Nervosa (TOuCAN) trial.

• The Closer2Home team will deliver core components of the (TOuCAN) trial and other specialised programmes, including:

o An initial motivational interview with a named clinician from the locality Eating Disorder Team (EDT)

o An initial nutritional assessment and meal planning session with a dietician from EDT or inpatient services

o Regular (up to three times daily) meal planning, monitored eating and post-prandial supervision, including at sites out of the home (to facilitate school reintegration)

o Measurements (up to three times daily) of biological and physical parameters as advised by EDT or inpatient services

o Collecting multimodal feedback through self-report scales and clinician-rated questionnaires; to be used with young person on a recovery-focused approach to self-management by EDT

o Advice (up to three times daily) to young person and parent on behavioural management of eating disorders

o Interpersonal and parental counselling and teaching

Group 3 - Inpatients (supported discharge)

• The Clinical Activity Panel (CAP) will work with inpatient services to identify young people suitable for the Closer2Home service

• Once someone is deemed to be suitable, the young person and their caregivers will be offered a ‘supported discharge’

• This will be done in consultation with Tiers 3 and 4, as well as relevant community services

• Usual care may continue to be delivered by these services.

• The ‘supported discharge’ function will require elements of assertive community treatment including:o continuity of staffingo full responsibility for treatment serviceso responsibility for hospital discharge planningo a ‘no dropout’ policyo assertive engagement mechanismso work with informal support systems.

Patient groups and clinical models

Referral process

Referrals to the C2H service from the community/CAMHS services will be managed through the same process used for referrals into the Tier 4 services.

Referrals from Tier 4 back to Closer2Home (supported discharges) - to be further developed

Tier 3 services retain care co-ordination role while in Closer2Home(as with Tier 4)

Wider pathway development and integration

• The interface between Closer2Home and wider CAMHS and community mental health services is critical

• Each Hub Locality Group will map Closer2Home alongside current (and developing services)o Crisis teams

o Psychiatric Liaison services

o Community CAMHS Teams

• Aligned and complementary referral criteria

• In / out of hours process (access and support)

• Local Authorities / Children in Care

• Service location / co-location

• Lone working

Staffing

Core skill-sets and roles:

• Experienced and highly trained workforce

• Assess and manage risk of those who would otherwise be in an inpatient environment

• Flexible recruitment approach, balancing skills needed and development opportunities

• Provide a comprehensive training programme that supports appropriate risk management

• Broad and developing skill mix based on learning and feedback

• Support and escalation

• Ensure consistency within Closer2Home across the Provider Collaborative, yet locally implemented

• Support integration through rotations, secondments, and joint working

Staffing model

Provisional establishment

• Service Management / Band 8’s

o 3 WTE Band 8 posts will provide the service management for the Closer2Home teams

o 1x 8B Service Manager

o 2 x 8A Team Managers

o Clinical posts, attracting applications from Nursing, Social Work and Psychologists.

• Consultant Psychiatrist / Clinical Lead

o Up to 1 WTE reflecting the increased complexity and risk of supporting the service and a possibly higher number of referrals / discharges given the average Length of Stay for the service

o Work across all of the Closer2Home Teams, employed by one Trust with contractual agreements with the others to provide clinical input and support to each team

o Aim to attract Junior / Trainee doctors to the service so sufficient time will be required to support these.

Staffing model

Provisional establishment

• Mental Health Practitioners / Band 7

o Higher band than most CAMHS services (6’s) reflects the acuity of the children and young people the service supports

o Service and staff management skills/experience are critical alongside relevant clinical skills

o Multidisciplinary Team approach (Nursing, Social Work, Psychology)

• Community Adolescent Senior Support Worker (CASS) / Band 4

o Diploma or NVQ Level 3 in Care with equivalent skills or have a Care Certificate (or complete this within the first 12 weeks in post)

o Desirable skills Bachelor’s degree in a relevant subject (e.g. psychology, social policy, health sciences) degree in any subject plus additional training and/or experience in health and social care

o Examine use and recruitment of Registered Nurse Associates (as opposed to the Band 4 Support Worker) roles to support career progression for Trainee Nursing Associates

Staffing model

Provisional establishment

• Administration

o Care Programme Approach (CPA) Co-Ordinator (1 WTE)

o Team Administrators (2 WTE)

Future development roles

• Trainee Nurse Assistants / Band 3

• Peer Support Workers / Band 2

o Development and integration of peer and carer peer support reflects the value of peer-delivered self-management intervention, to help bridge the gap between crisis and continuing care

o Build on the experience in Dorset and Sussex Partnership and to ensure advocacy and that the patient voice is heard in every clinical contact

o Build on an initial training programme adapted from an accredited course for CRTs and peer support workers developed by the Nottingham Institute for Mental Health

o Likely to be part-time roles.

C2H Consultant Psychiatrist & Clinical Lead – Clinical Oversight of the C2H Teams and CYP caseload

Wessex & Dorset Provider Collaborative

Band 8B Senior Manager (Solent Hubs and C2H Teams)

Closer2Home – Operational Management & Accountability to the Provider Collaborative

The C2H Clinical Lead is employed by the Lead Provider and has honorary contracts with each Trust to provide the necessary support and supervision to deliver the service.

Each Trust has full responsibly for the C2H Team/s it provides and CYP it sees in its own service.

IOW C2H Team(IOW NHS Trust)

Portsmouth / SE Hants C2H Team(Solent Health)

Southampton / SW Hants C2H Team(Solent Health)

North & Mid Hants C2H Team

(Southern Health)

Staff Team Staff Team Staff Team Staff Team

The Provider Collaborative has contractual responsibly for the C2H Service via the sub-contracts between the PC Lead Trust (SPFT) and each Trust.The Provider Collaborative Management Team will oversee the delivery of the C2H service, monitoring clinical quality and governance, manage referral activity and demand into the service and support the Trusts providing the C2H Teams. Referrals to the C2H Service will be managed by the Provider Collaborative Case Managers, the C2H Band 8 A & B Senior Managers and the respective Clinical Leads (via the CAP / F1 process).

B 8A Management(Dorset)

Dorset C2H Team

(DHCU FT)

Staff Team

B 8A Management (Southern Health & Hampshire)

PC Tier 4 Case Managers PC Quality Lead PC Clinical Lead PC Program Director

The Band 8B Senior Manager is employed by Solent and manages the Solent Teams and provides management support & leadership to the wider C2H service (holding honorary contracts with each Trust if necessary).

The Band 8A Managers are employed by DHC and Southern Health and manages the delivery of their respective C2H Teams, and provides support across the wider C2H service as needed.

The Provider Collaborative Partnership Agreement and Sub Contracts between the Lead Provider and each Trust, define the legal roles and responsibilities for the delivery of the C2H service

Training• Co-ordinated and jointly delivered across the Trusts to ensure consistency and economies of scale

• Reflect core Closer2Home skills and local Trust (statutory and mandatory) requirements

Core Closer2Home skills training

• Dialectical Behaviour Therapy (DBT)

o DBT will make up the core training for staff in the Closer2Home team

o Cascade model will be used to provide the necessary skills for the Band 4 staff who will be trained by the Band 7 staff

• Autism Training

• Mindsenseability, (3rd sector organisation who work with young people as part of the Care Education Treatment Review (CETR) framework) will provide Closer2Home staff training in working with young people with autism

• Eating Disorder Training

o Training to develop skills around supporting young people and families to plan meals, monitor compliance and support families manage the young person with eating disorders

o Providing ‘manual input’ into families (x 3 a day)

o Hands-on training will be provided to the Closer2Home team via specialist inpatient eating disorder services

Premises and team locations

• Team locations / bases within each service area will be influenced by:

• Staff travel times in relation to a patient demand / need

• Community based service / home visits

• Access and availability to premises (8am-8pm / 365 days per year) / lone working

• Co-location with other CAMHS / M.H services where possible

• Team development and staff support

• Provisional locations:

• Dorset – Blandford, supported by a range of flexible, hot-desk locations

• Southampton – Adelaide Health Centre

• North Hampshire – Basingstoke area

• Portsmouth – tbc

Live Q&A

Please submit any questions you may have for our panel in the chat.If we can’t get to your question today, we will make sure that it’s answered in

the supplementary information we send out after the event.

Recruitment Process & Timelines

Phase 2: (Closing date 6th Sept 2021)

• Band 7 Mental Health Practitioners (Interviews 13-15 Sept)

• Band 4 Community Adolescent Senior Support Workers (Interviews 13-15 Sept)

• Administration roles (Interviews 13-15 Sept)

Phase 3 (tbc)

• Peer Support Workers

• Trainee Nurse Associates

• Isle of Wight roles

Tips and hints!

The links to all the roles are on the website:

https://www.sussexpartnership.nhs.uk/closer2home

• Read the Job description and Person

Specification, identifying the competencies we

are seeking and how you match these.

• Please read the application questions and match

your skills and experience to them.

• Please submit you application by the deadline!

We look forward to receiving it

Thank you for attending