Success with CPA

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Welcome
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CPA is Here to Stay
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A Whole Systems Approach
All mental health service users have a range of
needs which no one treatment service or agency
can meet. Having a system which allows a
service user access to the most relevant response
is essential. The principle is getting people to
the right place for the right intervention at the
right time.
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A Whole Systems Approach
This principle is, of course, particularly
important in the case of individuals who need the
support of a number of agencies and services. No
one service or agency is central in such a
system. Service users themselves provide the
focal point for care planning and delivery.
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A Whole Systems Approach
Effective care co-ordination should facilitate
access for individual service users to the full
range of community supports they need in order to
promote their recovery and integration. It is
particularly important to provide assistance with
housing, education, employment and leisure and to
establish appropriate links with criminal justice
agencies and the Benefits Agency.
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Why, What, How
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Effective Care Co-ordination
Why?

• Closure of hospitals / institutions
• Community Care Act
• Serious incidents
• Reports Building Bridges, Still BB
• National Service Framework for MH

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Effective Care Co-ordination
Also now part of the wider agenda

• Patient Centred care
• Choice
• Patient/service user involvement
• Co-ordinated care
• Integrated health and social care

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Effective Care Co-ordination
Why?

• Reports identify recurring themes of
• Poor communication
• Poor co-ordination of care
• Services working in isolation
• Service users losing contact with services

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Care Programme Approach
What?
The framework for the care of working age adults
who use specialist mental health services
Essentially a framework for best practice which
supports a co-ordinated approach to the delivery
of mental health care and aims to more fully meet
the needs of those who use (and those who deliver
mental health services.
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Effective Care Co-ordination
How?
By providing a single programme of planned and
co-ordinated care which spans all agencies and
which most effectively meets an individuals
identified needs
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Effective Care Co-ordination
Aims
To prevent vulnerable people who are experiencing
mental ill-health from falling through the safety
net of care To support the recovery process To
more effectively manage risk To support
communication To support good practice
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Effective Care Co-ordination
Philosophy
The philosophy underpinning the CPA is that care
is planned with the people who use our services.
It is a professional obligation to positively
encourage mental health service users and their
carers to participate in the assessment,
development and review of their care plan.
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Modernising the CPA
Summary of Key Changes

• Integration
• Consistency
• Streamlined Approach
• Risk Management Risk Assessment
• A Proper Focus

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Effective Care Co-ordination in Mental Health
Services
The Process
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Systematic arrangements for assessing the health
and social care needs of people accepted by
specialist mental health services
The formation of a care plan which identifies the
health and social care required from a variety of
providers
The CPA Process has four main elements
A regular review and, where necessary, agreed
changes to the care plan
The appointment of a Care Co-ordinator to keep in
close touch with the service user and to monitor
and co-ordinate care
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Review
These four principles of assessment, care
planning, co-ordination and review are the main
building blocks of effective care co-ordination.
Co-ordination
CarePlanning
Implicit in every process is the involvement of
the service user and, where appropriate, their
carer.
Assessment
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Assessment
Service User
Evaluate Review
Appoint Care Co-ordinator
Care Planning
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The Care Plan
The Care Plan
The Care Plan
Service User
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The CPA Process
The approach applies equally to mentally
disordered offenders, and provides a model that
can be applied to some people with learning
disability living in the community, and to some
children and adolescents and older people.
Effective Care Co-ordination Policy Practice
Guidelines Leeds Mental Health Services
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Levels of Care
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The characteristics for someone on Standard CPA
will include some of the following

• They require the support or intervention of one
  agency or discipline or they require only low key
  support from more than one agency or discipline
• They are more able to self-manage their mental
  health problems

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The characteristics for someone on Standard CPA
will include some of the following (cont)

• They have an active informal support network
• They pose little danger to themselves or others
• They are more likely to maintain appropriate
  contact with services

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People on Enhanced CPA are likely to have the
following characteristics

• They have multiple care needs, including housing,
  employment etc, requiring inter-agency
  co-ordination
• They are only willing to co-operate with one
  professional or agency
• They may be in contact with a number of agencies
  (including the Criminal Justice System)

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People on Enhanced CPA are likely to have the
following characteristics (cont.)

• They are more likely to require more frequent and
  intensive interventions, perhaps with medication
  management
• They are more likely to have mental health
  problems co-existing with other problems such as
  substance misuse

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People on Enhanced CPA are likely to have the
following characteristics (cont.)

• They are more likely to be at risk of harming
  themselves or others
• They are more likely to disengage with services

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The Role of the Care Co-ordinator
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Role of the Care Co-ordinator
The role of the care co-ordinator should
usually be taken by the person who is best
placed to oversee care planning and resource
allocation
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Role of the Care Co-ordinator
Both health and social care managers should
ensure that the care co-ordinator can combine the
CPA care co-ordinator and care management roles
by having

• Competence in delivering mental health care
  (including an understanding of mental illness)
• Knowledge of service user/family (including
  awareness of race, culture and gender issues

(slide 1 of 2)
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Role of the Care Co-ordinator
Both health and social care managers should
ensure that the care co-ordinator can combine the
CPA care co-ordinator and care management roles
by having

• Knowledge of community services and the role of
  other agencies
• Co-ordination skills and
• Access to resources

(slide 2 of 2)
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Responsibilities of the Care Co-ordinator

• Explain the process
• Carry out assessment
• Identify carers
• Develop care plan
• Develop Crisis and Contingency Plan
• Involve Service User
• Involve carers and other agencies
• Ensure service user knows who to contact

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Responsibilities of the Care Co-ordinator

• Have regular contact with the Service User
• Record interventions
• Ensure reviews are carried out
• Assume the role of chair person at the review(
  unless independent chair invited)
• Advise of advocacy
• Involve GP

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Responsibilities of the Care Co-ordinator

• The care co-ordinator must have the authority to
• Co-ordinate the delivery of care
• Monitor the care plan provided
• Call a review
• Access resources
• Directly access other members of the team

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Potential Care Co-ordinators

• Medical staff (not enhanced)
• Clinical psychologists
• Psychotherapists
• Mental health/learning disability nurses

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Potential Care Co-ordinators

• Occupational therapists
• Social workers
• Any suitably experienced mental health / learning
  disability worker statutory and non statutory

For a service user with standard needs in
contact with only one professional, this person
will be the care co-ordinator
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Potential Care Co-ordinators
It should be noted that responsibility for care
co-ordination for mental health service users on
enhanced CPA should not be given to unqualified
staff grades in community settings. In
residential and day services suitably qualified
staff may be considered for the role of care
co-ordinator
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Care Planning
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Care Planning

• Summarises identified needs and how they are to
  be met
• Description of process
• Formal record, setting out what is to be done,
  why, when and by whom

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Care Planning - Principles

• Should always be written in a jargon free way and
  not using abbreviations
• Care plans should be based around the service
  user needs and not the ability of the service to
  provide
• The process and all aspects of the care plan
  should be fully explained to the service user and
  carer (s)

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Care Planning - Principles

• Is a multi-agency endeavour
• Is co-ordinated by the care co-ordinator
• Is based on thorough assessment of needs
• Should recognise the priorities of the service
  user
• Must take into account any risk to the person,
  their carer, any worker involved in delivering
  the plan, and the wider community.

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Care Planning - Content

• Identify the interventions and anticipated
  outcomes
• Include the reasons in the event of disagreement
• Give estimated time scale by which outcomes or
  goals achieved
• Have the date of the next planned review

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Care Planning - Content

• Those on enhanced CPA - crisis and contingency
  plans
• SMI or risk of suicide specific follow up within
  7 days of discharge
• Care plan reviewed within 4 weeks
• More intensive provision first 3 months after in
  - patient stay

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Care Planning - Crisis
As a minimum crisis plans should include the
following

• Who the individual responds to best
• How to contact that person
• Interventions that have been successful in the
  past
• Be creative - Dont limit to above. NHD not AnE

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Care Planning - Crisis

• The Mental Health National Service Framework
  requires that care plans should specify the
  action to be taken in a crisis for all people on
  enhanced CPA.
• Crisis plans should set out the action to be
  taken based on previous experience if the user
  becomes very ill or their mental health is
  rapidly deteriorating.

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Care Planning - Contingency

• Contingency planning prevents crises developing
  by detailing the arrangements to be used where,
  at short notice, either the care co-ordinator is
  not available, or part of the care plan cannot be
  provided.
• This could be, for example, the sudden absence of
  the family member who oversees medication, or the
  absence of a staff member through sickness.

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Care Planning - Contingency

• The contingency plan should include the
  information necessary to continue implementing
  the care plan in the interim, for example,
  telephone numbers of service providers and the
  name and contact details of substitutes who have
  agreed to provide interim support.