l letting go of families steve kingsbury and ann york
TRANSCRIPT
LLetting Go of Families
Steve Kingsbury and Ann York
Letting Go of Families
Part of the ELF Tends to be one of the Habits we do least
well
Helps with
E: Extend capacity
F: Flow management
Habit
Handle Demand
Extend capacity.
Let go of families.
Process map and redesign.
Flow management.
Use Care Bundles.
Look after staff.
Average
43%
40%
30%
30%
38%
8%
68%
Data from 100 teams in 2005 Average total score 38% (42/111)
Letting Go of Families
Links to 10 High Impact Changes numbers 3, 5 and 7:
3 (manage variation in service user discharge processes)
5 (Avoid unnecessary contact for service users and provide necessary contact in the right care setting)
7 (apply a systematic approach to enable the recovery of people with long-term conditions)
Let go of families
Keeping families is like driving another junction on the motorway
because you aren't sure you are at the right exit Letting go is
Planning your route Clinical
Only follow-up for a reason Use Care Plans and review them Have a systematic approach to long-term
problems
Variation
Natural variation Users are different We are different
Artificial variation How we do things (structures and processes)
Research shows that artificialvariation affects services most!
L and Artificial variation in CAMHS
We tend to have well thought through standard processes to get into the service
But how do you get out?
How you get out…
DNA! Say you don’t need to come any more Planned ending
95% of DNAs in CAMHS NHS are for follow up appointments
Question: How often is your last contact a DNA?
Table discussion A:
Think of families or times when it was easiest to close?
Why? Use table sheet Choose your “top 3” and write them on
post its…
Working towards ending
What is your prevailing team value system?
Long term support of vulnerable families to promote development
Quick crisis resolution and close
What is yours?
Our guesses…
Closing tends to be easier when End point is clear e.g.
menstruation returns in anorexia nervosa Psychosis resolves
You are leaving! End point is clear- you won’t be there! Families
don’t want to start again Limited session models
Endpoint is clear- used up the sessions But the work may not be done
The family / young person have made the changes they wanted (CHOICE!)
And…
…You have time to close
Admin/liaison time in job plan Review times with families Multidisciplinary discussion and
supervision
Recap:
Always work towards ending Ensure it is in your literature Remind users at all stages Remind referrers! Remind yourself!
Have standard processes to help you
Use Care Plans
Because they allow you to work towards the ending…
Written Agreed Background and Formulation Key worker, co-workers and network Interventions and who does them-
including family Goals Outcome measures Review date
The End Point rule!
Make it clear- goals Get a baseline measure if behavioural Agree end point Monitor progress regularly Plan for relapse Anticipate worsening symptoms coming
up to ending
Care plan tips
Plain english User and clinician to sign Copy to network Reviews to be with network Reviews to be at regular intervals e.g
every 6 sessions; every 6 months Team audit annually
Only follow up for a reason…
Are you clear why you are seeing them again?
Are they? Could someone else do it? Could you do it another way? Plan the purpose of next meeting…
Table exercise B
In your service, having considered what works, what are the obstacles to Letting Go?
What is having the greatest effect?