Poster sw ei survey amsterdam 2010(2)

Survey of Early Intervention in Psychosis Services in the South West of England Frank R Burbach & Louise Glover - Somerset Partnership NHS Foundation Trust A detailed audit questionnaire was designed as part of a Peer Review of Early Intervention (EI) Services in the South West (SW) of England, which was commissioned by the SW Strategic Health Authority (SHA). The nine Durham fidelity criteria formed the basis of this audit and provided the structure for this poster. The questionnaire was based on the NIMHE National EI audit of February 2005 (Pinfold, V., Smith, J. & Shiers, D., 2007). At a meeting of EI lead clinicians, the basic methodology for this audit was agreed. The questionnaire was finalised by Kate Schneider, Yvette Denham, Martin Hember and Frank Burbach. Each EI team within the SW (N=15) was sent a questionnaire on 30/04/09 and asked to reply by 31/05/09. Results were compiled by Sonia Bues and reported to a SW EI network meeting on 23.09.09. Some inconsistency in the data were noted and so teams were asked to provide further information on a second questionnaire by the end of August. The final report was compiled by Louise Glover and Frank Burbach and disseminated to aid the peer audit process. South West Early Intervention (EI) Teams EI Teams Involved: Somerset Devon & Torbay East Dorset North Devon Gloucestershire Exeter, E & M Dev N & W Dorset Cornwall Plymouth Avon & Wiltshire Partnership Trust: A – South Gloucester B – Bristol C – North Somerset D – Bath & North East Somerset E – Wiltshire F – Swindon Most teams had been established for 3-4 years (range 2-8 years) prior to the review and many were still under development. The Durham Fidelity Criteria specifies that EI teams should: 1 Have the capacity to intervene over a period of 3 years with first episode psychosis (FEP) cases. All 15 teams reported having the capacity to intervene over a period of 3 years for all first episode psychosis (FEP) cases. This was an improvement on the National Mapping Highlights figures in February 2005 indicating that three quarters of services had this capacity. 2 Be accessible to the full age ranges from 14 to 35 years (acknowledging that services to under 18s may be provided from a separate CAMHS EI team). In February 2005 only 80% of services reported being accessible to the full age range, whereas in this survey 100% reported fidelity to this aspect of the Durham criteria. This figure was corroborated by the responses provided to more specific questioning. 3 Have systems in place to cover out-of-hours (OOH) and weekends. All services reported having systems in place to cover OOH, compared to the 48% of services in 2005. This mostly involves using the crisis resolution and home treatment team. 4 Offer active monitoring of individuals who are considered at high risk of psychosis or with suspected FEP for a minimum of 6 months EI services are expected to work with people who are assessed as being at high risk of developing psychosis. These cases are monitored and, although they may be provided with some EI team input, they do not form part of the active caseload. Most teams reported actively monitoring such cases for a minimum of 6 months. In the 2005 National Survey only 58% of services monitored high risk cases. 5 Have caseloads of no more than 15 FEP cases per case manager When asked whether they had caseloads of no more than 15 cases per case manager, 8 teams replied ‘yes’ and 7 replied ‘no’. However, when asked about average caseload sizes (see above), and from calculations of capacity based on care coordinators and team caseload, it became clear that only 5 services appeared to consistency have caseloads of below 15. 6 Have a strategy for early detection and engagement of high risk and suspected FEP cases Half of the teams surveyed reported that they had a strategy but relatively few had a formal strategy that had successfully been implemented. 7 Monitor DUP and collect data to demonstrate its effectiveness in relation to key outcomes including engagement rates, relapse rates, hospital readmission, suicide and Para suicide, education and employment functioning. Teams reported that they were collecting a range of information, although many of these data gathering systems were still under development. It was hoped that through the peer review process it would be determined how effectively, routinely and in how much depth this took place. Mean DUP for each area (using the medication end point criteria) provided by each EI team for 2008/09 The mean DUP was provided by 7 teams. The mean was 216 days (range 49 – 402 days). There was wide variation in the number of people readmitted. Teams reported considerable variation in numbers of hospital readmissions (average 7.3 per team). This would equate with a relapse rate of 7%, although this figure does not include relapses resulting in crisis/ home treatment team (C/HTT) involvement only: this data was not available for many of the teams. Four teams reported an average of 29% of their clients had C/HTT involvement, suggesting that the true relapse rate in the SW could have been up to 36%. Education and employment were not sufficiently clearly defined but there was considerable variability in these outcomes. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Whether each EI team reported monitoring certain types of information Reference: Pinfold, V., Smith, J. & Shiers, D. (2007). Audit of early intervention in psychosis service development in England in 2005. Psychiatric Bulletin, 31, 7-10. Team DUP (days) A 402 B 210 D 192 F 251 H 84 J 49 K 118 O 75 Total Average 216 Type of monitoring DUP Engage-ment rates Relapse Para-suicide Re-admissions Employ-ment Education Number of teams (out of 15) that monitored 12 12 9 9 15 13 13

Poster sw ei survey amsterdam 2010(2)

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