'Practice Based Evidence' - South Camden Report (October 2001 - March 2004)

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Evaluation of a 'Practice Development Approach' for Community Mental Health Teams

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Introduction

This specific 'practice development' initiative has been engaged by Camden & Islington Mental Health and Social Care Trust to focus on the support and development of the community mental health teams in South Camden, with an intention to disseminate the approach subsequently to other sectors of the Trust. It is an approach originated by Steve Morgan (Practice Based Evidence) through work with assertive/active outreach teams, and the creative input of David Juriansz for its adaptation to community mental health teams. It follows an identified process:

• Engage the trust and respect of team members
• Interview each team member regarding strengths of the team, and potential areas for changing practice
• Compile a 'team' report of interviews
• Implementation of ideas/change:
  • 1st team development away-day
  • Working alongside the team
  • 2nd team development away-day
  • etc.
• Evaluation of the process/changes

Programme of 'Activity' in CMHT's:

Connections across wider local systems

In addition to the focus on the community mental health teams, a limited amount of work is also engaged with other community services working closely with the CMHT's. The aim is to avoid the potential for seeing one part of the broader mental health service in isolation from its other component parts. Resources and priorities dictate that the following teams receive only 'away-day facilitation' out of the process of practice development identified above.

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CMHT 'Practice Development' Evaluations

Anecdotally, many of the practitioners across the community mental health teams have engaged positively with the 'practice development' initiative. Verbal feedback has generally highlighted the focus on:

In addition to positive feedback from individuals, David Juriansz and Steve Morgan developed a 'Creative Capability 2' tool for baseline measures and measurement of change. These are made up of 15 positive statements of 'team practice and functioning', and capture an amalgamation of how the whole team rates itself at each point in time. The summary findings from administering this tool across the 4 community mental health teams in South Camden are captured on the following page. Generally, the figures across the teams identify a similar positive trend of team development across relatively short periods of time.

Baseline Point 1 (Dec. 01) - Point 2 (July 02)

• Gains made in all 15 items.
• Strong gains made in some items (+3% to +46%).

Point 2 (July 02) - Point 3 (Feb. 03)

• Most areas sustained i.e. within +/-10%
• Some areas with marked variation:
• Efficient systems of administration and documentation (-18%)
• Team decision processes work well (-17%)
• Responding to service user needs and wants (+13%)

Baseline Point 1 (Dec. 01) - Point 3 (Feb. 03)

• Gains are sustained in all 15 items (+12% to +50%)
• Referral and allocation processes work well (+48%)
• Contingencies to cover team functions (+43%)
• Team decision processes work well (+42%)

Baseline Point 1 (Feb. 02) - Point 2 (Oct. 02)

• Gains made in all 15 items
• Positive opinion shifts ranging from +5% to +36%

Point 2 (Oct. 02) - Point 3 (June 03)

• 9 items recorded as continuing improvements (+1% to +21%)
• Efficient systems of administration and documentation (+21%)
• Promoting use of ordinary community resources (+13%)
• Managing a broad range of risks effectively (+9%)
• Links with other parts of the system (+7%)
• 1 item showing no change (Current knowledge equips me to the job)
• 5 items recording a reverse on the initial gains (-2% to -11%)
• Referral and allocation processes work well (-11%)
• Team decision processes work well (-7%)
• Using a broad range of interventions (-7%)

Baseline Point 1 (Feb. 02) - Point 3 (June 03)

• Gains are made in all 15 items (+5% to +50%)
• Efficient systems of administration and documentation (+50%)
• Promoting use of ordinary community resources (+35%)
• Team decision-making processes work well (+29%)
• Links with other parts of the system (+26%)

Baseline Point 1 (April 02) - Point 2 (Oct. 02)

• Gains made in all 15 items
• Positive opinion shifts ranging from +1% to +19%

Point 2 (Oct. 02) - Point 3 (May 03)

• 4 items recorded as continuing improvements (+2% to +14%)
• Implementing CPA (+2%)
• Service users determining priorities in care plan (+8%)
• Broad range of interventions (+10%)
• Referral and allocation processes (+14%)
• 2 items showing no change
• 9 items recording a reverse on the initial gains (-1% to -15%)
• Links with other parts of the system (-15%)
• Systems of administration and documentation (-10%)
• Identifying service users strengths (-10%)
• Creative approaches to engagement (-7%)

Baseline Point 1 (April 02) - Point 3 (May 03)

• 12 items recorded as continuing improvements (+4% to +25%)
• Referral and allocation processes (+25%)
• Utilising knowledge and experience within the team (17%)
• Broad range of interventions (15%)
• Team decision-making processes (14%)
• 3 items recording a reverse on the initial gains (-1% to -11%)
• Links with other parts of the system (-11%)
• Identifying service user strengths (-3%)
• Using ordinary community resources (-1%)

Baseline Point 1 (Oct. 02) - Point 2 (June 03)

• Gains made in 12 out of the 15 items
• Positive opinion shifts ranging from +1% to +24%
• Team decision-making processes work well (+24%)
• Utilising knowledge and experience within the team (+21%)
• Referral and allocation processes work well (+18%)
• Negative shifts recorded in 3 items:
• Efficient systems of administration and documentation (-1%)
• Managing a broad range of risks effectively (-3%)
• Promoting use of ordinary community resources (-9%)

Point 2 (June 03) - Point 3 (Mar. 04)

• 11 items recorded as continuing improvements (+3% to +26%)
• Efficient systems of administration and documentation (+26%)
• Clarity about the priority functions of the team (+9%)
• Service users determine the priorities in the care plan (+8%)
• 1 item showing no change (Team decision processes work well)
• 3 items recording a reverse on the initial gains (-3% to -5%)
• Utilising the knowledge and experience within the team (-3%)
• Current knowledge adequately equips me to do my job (-3%)
• Effective links with other parts of the system (-5%)

B>Baseline Point 1 (Oct. 02) - Point 3 (Mar. 04)

• Gains are made in 14 of the 15 items (+4% to +26%)
• Referral and allocation processes work well (+26%)
• Efficient systems of administration and documentation (+25%)
• Team decision-making processes work well (+24%)
• Only 1 item recorded a negative shift across this time period:
• Promoting use of ordinary community resources (-5%)

For pictorial representation of the above 4 sets of data see the separate files entitled 'CC Charts'

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Summary of findings

A consistent theme of the initiative's results, as evaluated by the practitioners themselves, is its ability to attend to essential aspects of good team functioning: team decision-making processes, systems of administration & documentation, and referral & allocation processes are consistently seen to improve. Broadly speaking, these are areas of functioning that no other training or development input help to address.

Essentially, the level of knowledge and expertise within teams is high, but their opportunities and encouragement to exercise their creativity and initiative appears low. A 'practice development' approach within teams has helped to raise the issue of better sharing of knowledge and experience within teams, rather than assuming teams need constant bombarding with Trust-wide training initiatives. There is a strong argument for encouraging a true bottom-up approach to developing a Trust training strategy, based in the annual development of 'team training plans'.

The focus of 'practice development' projects within and between the teams was many and varied, ranging from brief team-based discussions to deeper developments involving changes in practice. These initiatives are captured in the following list:

The simple but important messages are:

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Potential Future Directions

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Within Teams:

Across the Trust:

Beyond the Trust:

• Practice Based Evidence
• Consultancy Services
• Practice Development in Mental Health
• Personalisation
• A Strengths Approach
• Community Mental Health Teams
• The South Camden Report
• Assertive Outreach Teams
• Crisis Resolution & Home Treatment Teams
• Positive Risk Taking
• Working with Service Users & Carers
• Care Programme Approach