Presentation on theme: "L Letting Go of Families Steve Kingsbury and Ann York."— Presentation transcript:
L Letting Go of Families Steve Kingsbury and Ann York
Letting Go of Families Part of the ELF Tends to be one of the Habits we do least well Helps with E: Extend capacity F: Flow management
Habit Handle Demand Extend capacity. Let go of families. Process map and redesign. Flow management. Use Care Bundles. Look after staff. Average 43% 40% 30% 38% 8% 68% Data from 100 teams in 2005 Average total score 38% (42/111)
Letting Go of Families Links to 10 High Impact Changes numbers 3, 5 and 7: 3 (manage variation in service user discharge processes) 5 (Avoid unnecessary contact for service users and provide necessary contact in the right care setting) 7 (apply a systematic approach to enable the recovery of people with long-term conditions)
L et go of families Keeping families is like driving another junction on the motorway because you aren't sure you are at the right exit Letting go is Planning your route Clinical Only follow-up for a reason Use Care Plans and review them Have a systematic approach to long-term problems
Variation Natural variation Users are different We are different Artificial variation How we do things (structures and processes) Research shows that artificial variation affects services most!
L and Artificial variation in CAMHS We tend to have well thought through standard processes to get into the service But how do you get out?
How you get out… DNA! Say you don’t need to come any more Planned ending 95% of DNAs in CAMHS NHS are for follow up appointments Question: How often is your last contact a DNA?
Table discussion A: Think of families or times when it was easiest to close? Why? Use table sheet Choose your “top 3” and write them on post its…
Working towards ending What is your prevailing team value system? Long term support of vulnerable families to promote development Quick crisis resolution and close What is yours?
Our guesses… Closing tends to be easier when End point is clear e.g. menstruation returns in anorexia nervosa Psychosis resolves You are leaving! End point is clear- you won’t be there! Families don’t want to start again Limited session models Endpoint is clear- used up the sessions But the work may not be done The family / young person have made the changes they wanted (CHOICE!)
And… …You have time to close Admin/liaison time in job plan Review times with families Multidisciplinary discussion and supervision
Recap: Always work towards ending Ensure it is in your literature Remind users at all stages Remind referrers! Remind yourself! Have standard processes to help you
Use Care Plans Because they allow you to work towards the ending… Written Agreed Background and Formulation Key worker, co-workers and network Interventions and who does them- including family Goals Outcome measures Review date
The End Point rule! Make it clear- goals Get a baseline measure if behavioural Agree end point Monitor progress regularly Plan for relapse Anticipate worsening symptoms coming up to ending
Care plan tips Plain english User and clinician to sign Copy to network Reviews to be with network Reviews to be at regular intervals e.g every 6 sessions; every 6 months Team audit annually
Only follow up for a reason… Are you clear why you are seeing them again? Are they? Could someone else do it? Could you do it another way? Plan the purpose of next meeting…
Table exercise B In your service, having considered what works, what are the obstacles to Letting Go? What is having the greatest effect?