LIVERPOOL ASSERTIVE OUTREACH TEAM

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LIVERPOOLASSERTIVE OUTREACH TEAM

• VINNIE FARRELL
• TEAM MANAGER
• ROBERT HIGGO
• CONSULTANT PSYCHIATRIST

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POPULATION

• Inner City Liverpool
• Drifting Population
• Unstable Accommodation
• BEM Mix
• Dual Diagnosis
• Offending/Risk Behaviours
• Sounds familiar !

3
ESTABLISHMENT

• Formed 2000 135 Caseload
• 1 Manager
• 1 Deputy Manager
• 12.5 Care Co-Coordinators
• 1 Assistant Nurse Practitioner
• 5 STR Workers
• .4 Psychologist
• 1 Consultant Psychiatrist
• 1 SpR / 1ST3

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CASE MANAGEMENT

• Engagement is.
• Trust
• Relationships (Carers/Service Users)
• Face to face contact
• Consistency in contact
• Monitoring of treatment plans
• Assessing risks
• Negotiation/Collaborative approach

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DOWNSIDE

• Information shared ineffectively
• Less flexibility/team response
• Protecting caseloads
• Over Dependence
• Prevents Recovery
• Reduces Throughput

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PREVENT AGAINST THIS BY

• Team Ownership
• Team Responsibility
• Communication is key
• Share knowledge
• Team Meetings
• Case Reviews / Presentations
• Use CPA effectively

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PLAN What are we doing ?

• Challenge What / Why
• Test out
• Encourage innovative
• approaches
• Supervision
• Dont do more of the same!

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CARE OF IN-PATIENTS

• Some figures
• Admissions/year 53 44 36 30 29
• gt50 come in informal and stay informal
• Maximum number gt20
• For last 2 years lt10
• Vast majority admitted directly by AOT

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WE MANAGE OUR OWN IN-PATIENTS

• Continuity
• Engagement
• Risk Management
• Discharge Planning
• Active in-reach

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SOME NEGATIVE CONSEQUENCES

• Not the fashion (in-patient consultants)
• Some longer admissions
• Activity figures
• Consultant case load numbers

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HOW

• Nothing radical !
• Care Co-Ordinator in-reach
• Escorted leave
• Home visits
• Team discussion (Tuesday)
• Ward MDT (Thursday)

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WELL PERSON CLINIC

• Why
• Worse physical health
• Die early
• Co morbidity
• Little preventative health care
• Poor help seeking
• Medication effects

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WELL PERSON CLINIC

• What
• Started with monitoring Clozapine, Lithium etc.
• Now, offered full screen
• Trainee Psychiatrist
• Assistant Practitioner (champion)

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WELL PERSON CLINIC

• Benefits
• A very thorough check
• Generally preferred by SU
• Engagement

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WELL PERSON CLINIC

• Downside
• Social inclusion
• Skills/limits
• Time costs
• Using Trainee

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WELL PERSON CLINIC

• Future
• GP session ?
• Audit