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CBUG REPORT |
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on User Focussed Monitoring of the North Camden Crisis Response and Resolution Service |
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This purpose of this Project was to embark on monitoring The North Camden Crisis Response and Resolution Service. It is hoped that its findings will assist the Camden and Islington Mental Health and Social Care Trust to offer the type of Service that Users would wish to use.
Camden Mental Health Consortium (CMHC) is a membership organisation and the largest user-owned mental health charity in Camden. Qualifications for membership are being a user or one-time user of the Mental Health Services, living or working in Camden. Camden Borough User Group (CBUG) is the working arm of CMHC and undertakes specific tasks in relation to developing, monitoring and evaluating local mental health services. The Crisis Response and Resolution Team is a group of Mental Health Professionals who visit clients at home to carry out assessments and offer a home treatment service where possible in an effort to minimize the number of hospital admissions. The North Camden Service is relatively new (commencing in 2001) and from the outset, the Manager (Alison Greenhalgh) expressed the wish to have some form of CBUG involvement to monitor its activities. CBUG was happy to agree to this, although it took some time for it to be in a position to undertake the work. Camden Social Services made a grant of £5000 to pay for this Study. Academic input was provided by Steve Pilling, Director of The Centre for Outcomes, Research and Effectiveness (CORE) at University College London, and Research Assistants Julia von Hauenschild and Elena Di Lorenzo.
User-Focused Monitoring (UFM) is a generic term used to describe a process where service users are interviewed by other service users. The empathic relationship between interviewer and interviewee is recognised as providing a high quality outcome. (CORE) has developed a form of User Focussed Monitoring using a ‘Your Care and Treatment ‘Questionnaire. This was developed by Webb et al (1998) and has been adopted by CORE for use in Monitoring Mental Health Services in the Camden & Islington Mental Health and Social Care Trust as part of its Clinical Governance protocols. Previous studies have been conducted in In-Patient Units and Community MH Teams. Linda Polan led this project and recruited a team of CBUG members to work with her. CORE provided the templates of the ‘Your Care & Treatment’ questionnaires to be appropriately amended. They also arranged training sessions in UFM for CBUG Members. Only those who completed the training would be eligible to take on the role of interviewers. Seven CBUG members attended this training and five volunteered for the task
The team met regularly with the Project Leader. They altered the CORE Questionnaire Templates making them specific to the Crisis Service. They also conferred with the Crisis Team Manager (Alison Greenhalgh) regarding her Team’s expectations for successful outcomes of their work. The purpose of this service is to offer home treatment. Clients who were hospitalized after a short time with the Crisis Team were not included in included in this Monitoring Project. It was recognised from the outset that it would be difficult to bring together CBUG Members and Clients. Home visits for CBUG would require them to work in pairs, have an extensive knowledge of client records and risk assessments and could well be experienced as intrusive by the Clients. One proposition considered was to bring Clients together in a Group but this was ruled out due to difficult issues of confidentiality which could not be overcome. Two methods of obtaining information were adopted;
As its name suggests, this method relied on clients completing a questionnaire and returning it by post. As an initial step, it was agreed that two weeks prior to discharge, the Crisis Team would give the clients an explanatory leaflet and describe the Monitoring Process. The Project Leader visited the CRISIS office to ensure that the Team were prepared. She composed a script to assist them and stressed that they should not memorize it but impart the information using their own words. When the client was to be discharged, the Team member would present a short reminder leaflet, the Questionnaire for completion, and an SAE for return to CMHC. To ensure that Staff had only a minimal input, all documents were contained in a sealed envelope A CMHC pen was offered to thank clients for their time and assistance. Although this procedure excluded any CBUG/CLIENT connection, it was chosen on the understanding that a more inclusive method would continue to be sought.
The clients were invited to attend at the CMHC office where a CBUG Member would assist them in completing the Questionnaire. Their name and contact number would be given to CBUG and within a week of discharge, they would be telephoned to arrange an appointment. Alternatively, Clients could call us to make an appointment. This method would be adopted unless Clients refused to be involved. Assisted Interviews proved even less successful than the postal questionnaires. Four Clients telephoned, three agreed to attend and one eventually arrived. The first Questionnaire packs (Appendix 1) were delivered to the Crisis Team on 11/10/2003 and by 28/01/2004 sixteen had been returned. CBUG were disheartened by this result; not only were they excluded from the project but the return rate was less than expected. It is important to note that Postal Surveys tend to yield low response rates and take a long time. CBUG decided to continue only with postal replies until either 28th May 2004 or a total of 50 were received, the minimum number of responses required for a meaningful return. By 16th May 44 had been completed and returned; by 28th May we received 50
The questionnaire has 31 questions under 5 headings: REFERRAL and ASSESSMENT (03 items) TREATMENT and CARE (11 items) THE TEAM (11 items) DISCHARGE (02 items) GENERAL (04 items) It also includes age, gender and ethnic origin (self defined) and two blank pages; one for clients to make any points they felt were not covered in the questions or to add anything they had missed out. This would prove useful should we decide to include anonymous testimonies in the final report. The other page was for CBUG to note anything about the clients or what they had said that might lead to greater understanding.
DESCRIPTIVE STATISTICS
Age
31 of the 50 participants recorded their age. The mean age of those 31 participants was 42.16 years, the minimum age being 19 years and the maximum 75 years.
Gender 38 of the 50 participants recorded their gender. Of those 38, 27 were female and 11 were male. Ethnicity Ethnicity was self-defined. 28 participants recorded their ethnicity however due to small sample size, low response rate and the self-defining nature of the question it is not possible to conduct a valid ethnicity analysis.
QUESTIONNAIRE STATISTICS
The Crisis Service was well liked by the majority of the respondents. More than 60% were satisfied with their treatment (Q. 4,7,9,12). They particularly appreciated the opportunity for friends and family to become involved (Q. 4.9.) There were similar responses to being offered Care & Treatment other than medication (Q. 9) and to Having the chance to discuss the type and dose of anything prescribed (Q. 12). 80% of Respondents preferred the Crisis Team to hospital and would choose it in other similar circumstances (Q. 30) 100% would recommend it to others (Q. 31). “Recovery in Hospital had taken up to three months; the Crisis Team reduced this to eight weeks” “The Team provided me with support until I could be assessed/admitted to a Day Centre; an arrangement which they successfully co-ordinated” “They were more like friends and speeded up my recovery” However, it can be seen in the testimonies below, which are no less valuable, that there were Clients who felt there were some gaps in the service: 1) More information about the drugs prescribed and their side effects would have been helpful 2) The sudden arrival of the Crisis Team, without warning was distressing for some people. “I was not happy at the way they arrived on my doorstep; it was a total surprise to me. I would prefer to have notice of such a visit – a phone call would have done…..” “Team told me what to do – no discussion allowed……” “No one described the side effects of my medication which altered my libido and made me impotent. Initially, I became more depressed because of this” The failure of the Assisted Interview method means that no further information is available on any of these specific points. However, this omission in no way reduces their significance. The lack of CBUG input could account for the number of positive results. Monitors can clarify the questions if necessary and Questionnaires contain a page for CBUG comments on the Clients. The content of “Is there Anything Else you’d Like to Tell Us About this Service?” page is always much more complete when a CBUG is present. They remind Clients of previous responses and always write in the Client’s own words. At the end they read it back to them for confirmation. Should a follow-up Audit of this Service be put in place, we suggest that a way must be found for Monitors and Clients to meet on a one-to-one basis. It is clear that the general level of satisfaction was very high and the Team can take a pride in many of the results. It should be borne in mind however, that a large number of positive outcomes in such a low response may mean that only the satisfied respondents participated. We would recommend that the Crisis Team examine any areas where clients expressed dissatisfaction and try to rectify any deficiencies.
Our thanks go to CBUG members who assisted in devising the questionnaire Martin Elman Noel Walker Cathleen Mainds David Hayes Katrina Anderson who commissioned the project on behalf of Camden Social Services Colin Plant Director of Mental Health Services for Camden and Roger Evans Service Manager for advice and support Steven Pilling (Director of CORE) Research Assistants: Elena Di Lorenzo Julia von Hauenschild For their academic input and advice
For their assistance in disseminating information we thank Alison Greenhalgh (Team Manager) CRISIS Team Members and for her unflagging administrative support we thank Rena Toufexis
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