RSS 1.0Coventry and Warwickshire Partnership NHS Trust
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Recent Submissions
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British Thoracic Society quality standards for home oxygen use in adultsIntroduction: The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for home oxygen provision in the UK, together with measurable markers of good practice. Quality statements are based on the British Thoracic Society (BTS) Guideline for Home Oxygen Use in Adults. Methods: Development of BTS Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results: 10 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for home oxygen use, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare. Discussion: BTS Quality Standards for home oxygen use in adults form a key part of the range of supporting materials that the society produces to assist in the dissemination and implementation of a guideline’s recommendations.
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Brief Report: Repetitive Behaviour Profiles in Williams syndrome: Cross Syndrome Comparisons with Prader–Willi and Down syndromesThis study describes the profile of repetitive behaviour in individuals with Williams syndrome, utilising cross-syndrome comparisons with people with Prader–Willi and Down syndromes. The Repetitive Behaviour Questionnaire was administered to caregivers of adults with Williams (n = 96), Prader–Willi (n = 103) and Down (n = 78) syndromes. There were few group differences, although participants with Williams syndrome were more likely to show body stereotypies. Individuals with Williams syndrome also showed more hoarding and less tidying behaviours than those with Down syndrome. IQ and adaptive ability were negatively associated with repetitive questioning in people with Williams syndrome. The profile of repetitive behaviour amongst individuals with Williams syndrome was similar to the comparison syndromes. The cognitive mechanisms underlying these behaviours in genetic syndromes warrant further investigation.
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Assessing the second-hand effects of a new no-smoking policy in an acute mental health trustAims and method To examine whether a new no-smoking policy in an in-patient mental health setting had any effects outside of smoking cessation. Our hypothesis stated that a forced smoking ban for in-patients may result in an increased susceptibility for clinical incidents, aggression and lower admission rates. All patients admitted to adult in-patient mental health services in Coventry and Warwickshire Partnership NHS Trust were included in the analysis. Data 6 months post-implementation of the smoking policy (1 July 2015 to 1 January 2016) were compared with the same period 1 year prior (1 July 2014 to 1 January 2015). Patient demographics, admission rates, ward occupancy, average lengths of stay, numbers of reported incidents and use of the Mental Health Act 1983 (MHA) were compared. Results We analysed 4223 admissions. We found a significantly increased number of admissions under the MHA (P = 0.007), a significantly greater number of reported smoking-related incidents (P < 0.001) and aggression-related incidents in the psychiatric intensive care unit (P < 0.001). However, we found no significant difference in capacity of in-patient wards (P = 0.39), admission length (P = 0.34) or total aggression-related incidents (P = 0.86). Clinical implications Although further comparisons over longer time periods are necessary, our results suggest that enforced smoking cessation on acutely unwell psychiatric patients admitted to the most restricted environments may have some negative effects. Nicotine replacement therapy should be offered to all patients to minimise the risk of clinical incident.
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QI 167 Improve Junior Doctor Induction ProgrammeTo make CWPT Junior Doctor Induction more meaningful. It was felt there was a general dissatisfaction with the Junior Doctor Induction programme among trainees. Data was gathered from surveys of doctors on rotation to gain an understanding of what were the frustrations experienced during their rotation. The information from the surveys was used to identify change ideas to be implemented. A local induction was established led by local junior doctor representatives to include a Q&A session, the handbook was updated to ensure it included relevant information, and an induction pack was created in MS Teams. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf. Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf Project Impact: There was an improvement of 30 % of people who felt they were prepared for their psychiatry rotation and understood their roles and responsibilities following the changes to the Junior Doctor induction.
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QI 73 Reducing Restrictive Practice - November 2018 to April 2020Aim: To reduce the overall use of restrictive practice by 30% by April 2020. This project was run by RCPSYCH and included 40 wards across the country, focussing on Improving Mental Health Safety. Rowans was identified as a target ward to be included and was supported by a QI Coach from the RCPSYCH. We created a Driver Diagram to help focus change ideas into themes Leadership and Learning Culture, Co-Production, Environment, Prevention and Predication and Person Centred Care. We identified how we would collect data and display progress, using a safety cross and incident reporting data, and we used a collaborative approach, including patient involvement, to generate ideas to implement and test using the PDSA cycle. Tools Used: Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf. PDSA Cycle - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf. Statistical Process Control (SPC) chart - www.england.nhs.uk/statistical-process-control-tool. Project Impact: Staff and patients identified communication and trust was improved. The staff team felt more motivated. The team feel less stressed and able to focus on being creative with the client group and developing interpersonal relationships. The patients felt that the interventions have been empowering. Overall data showed a 55% reduction. Physical restraint saw a 57% reduction and rapid tranquilisation became in line with normal variation.
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QI 86 Timely Health and Safety/RIDDOR Reporting - February to March 2019Aim: To review and revise the process of Health and Safety (H&S) investigation, RIDDOR identification and reporting to the Health and Safety Executive (HSE) to meet the legal requirements. On 30 January 2019 the HSE formally contacted the Head of H&S to raise concerns over the timeliness of RIDDOR reporting. The RIDDOR regulation requires that work related ‘specified’ injuries are reported in 10 calendar days and work related injuries that result in an over 7 day absence are reported in 15 calendar days. HSE communication initiated a focussed review of the H&S investigation process and RIDDOR reporting arrangements. Facilitated process mapping session identified: • delays in receiving incident reports as these were only sent following manager sign off • delays in incident reports being reviewed as this task was the responsibility of the most agile staff • delays in investigation as securing sick notes were not easily available • PDSA principles were used to quickly introduce changes Tools Used: Process Mapping which is usually undertaken with a range of people involved in the process, and enables you to create a visual picture of how the pathway currently works, capturing the reality of the process, exposing areas of duplication, waste, unhelpful variation and unnecessary steps - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf. Statistical Process Control (SPC) chart, which is an analytical tool that plots data over time, showing the impact on data when changes are implemented - https://www.england.nhs.uk/statistical-process-control-tool/. Value Stream Mapping is a more detailed process map. It helps staff to understand the steps in a patient journey and the patient experience of the journey. It is used to improve their journey / pathway by eliminating steps that do not add value for them. Patients should be involved in value stream mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-value-stream-mapping.pdf. Lean Transformation (Ohio’s eight wastes) approach is used to help teams examine their own workplace and eliminate activities that do not add value. This can improve patient experience and release time for frontline staff to reinvest in service provision / care giving - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-lean-ohnos-eight-wastes.pdf. Project Impact: Timely reporting of RIDDOR incidents has reduced the risk to the organisation of HSE intervention, improved the grip of H&S related incidents and investigation workflow, created a timely response to incidents which will improve staff experience of H&S investigations and created a timely identification of H&S risks and resultant actions to prevent reoccurrence.
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QI 137 Standardised PreceptorshipAim: To standardise and establish preceptorship across Coventry and Warwickshire Partnership NHS Trust (CWPT) for all newly qualified staff. To begin with what was currently on offer across the Trust was reviewed and then found out what colleagues would like to see within the preceptorship programme. This was compared to other NHS Trusts preceptorship programmes and national guidance to develop our programme. The right stakeholders where involved throughout the project and the sustainability of the project was assessed as the project progressed. The completed Preceptorship study programme launched June 2022 and has evolved using Plan Do Study Act (PDSA) cycles. Tools Used: Project Charter - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-define-your-project-charter.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; Action Tracker - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-develop-your-action-plan.pdf; Stakeholder Analysis - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-stakeholder-analysis.pdf; Sustainability Tool - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-sustainability-model.pdf; PDSA Cycle - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf. Project Impact: The trust now offers 12 study days for newly qualified nurses, nursing associates and AHP's through a blended approach of face-to-face and virtual sessions. Preceptees are provided with a portfolio/framework for their preceptorship journey. Signposting to resources in CWPT Support provided for all newly qualified professionals Peer-to-peer support A point of contact for new starters outside the work place.
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QI 145 Reducing Length of Wait for Assessment For Children's Speech and Language TherapyAim: To reduce length of wait to achieve 92% of children being assessed within 18 weeks of referral by June 2024 This project was carried out to address the waiting time for initial assessment in Children’s SLT. Prior to May 2021 the 18 week RTT target (92%) was achieved, but due to a COVID backlog, reduced capacity and increased referrals, children were waiting considerably longer from May 2021, with a low point of 41% in June 2023. A number of change ideas were tested but most had little impact on the waiting times. Therefore additional investment was supported by CWPT executives for a Patient Flow Coordinator to assist with addressing waits for Children’s SLT. The target has been temporarily amended from 92% to 80%, to have the least impact on the waiting times for follow ups and intervention (balancing RTT:ATT). Tools Used: Process Mapping; Driver Diagram; Theoretical Capacity; PDSA. Project Impact: 89% of children are seen within 18 weeks of referral.
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QI 146 Creating a Long COVID Pathway Through Integrated WorkingAim: To establish a Long COVID pathway across UHCW & CWPT. The project sought to establish an integrated pathway across 2 health trusts which use separate staffing teams, IT, operational, & clinical systems. This was achieved through collaborative working across both trusts to establish: • Referral pathway and GP training • Community rehab arm inc. Vocational rehab • Review of MDT attendance Joint Trust MDT meeting, DPAs and DPIAs completed for data sharing • Psychology rehab criteria • Assessment paperwork, • Cross ICB recovery group-face to face and virtual offer Tools Used: Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; SPC Charts - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; PDSA Cycle - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf. Project Impact: This project has increased networking across local Trusts, as well as regional and national bodies. It is continuously contributing to evidence base for this new disease through practise-based research. It has been presented and discussed nationally at events such as RCOT, Adapt Framework, Listen Project and FFT thematic analysis. It has also garnered continuous positive patient feedback which helps shape the continued Long COVID Service. Next steps are; 1. Pro-active case finding work; including a Long COVID workshop. 2. Co-production to develop the cross ICB psychology offer; including rehabilitation intervention. 3. Increase capacity of psychology offer (through group development & recruitment). 4. Develop a recovery group to help patients convalesce. 5. Scope peer support groups in collaboration with the voluntary sector.
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QI 148 Improving Patient Flow Across Urgent and Reablement TherapyAim: 90% of Reablement patients to be seen within 48 hours of receiving the referral (Monday – Friday) 100% Urgent Community Response (UCR) Therapy patients to be seen with in 48 hours of receiving the referral (Monday-Sunday). Following the publication of Urgent Community Response (UCR) guidance by NHSE in July 2021 CWPT has responded with the development of their own UCR team. This in turn was predicted to change the utilisation of therapy within the urgent offer. Patients need to be seen within the timescale specified by triage which can be 4-6 hours / 24 hours / 48 hours. The therapy team that responds to the urgent referrals also provides the on-going up to 6 weeks Reablement service. Any changes to the urgent response roster will have a knock-on effect on the reablement offer. Therefore, we needed to explore how to maximise capacity to fulfil the requirements of both Urgent and Reablement Therapy using QI. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf. Project Impact: Waiting times for Reablement patients January 2022 = 3 weeks. Patient facing activity time during every working shift varied across the team from 42% to 99% against a target of 67%. Developed a way of measuring waiting times for UCR patients Next Steps: Daily monitoring of: Waiting list /Capacity and demand / Patient flow. Scoping what capacity can be released from both clinical / non clinical perspective to support service improvements and patient flow, followed by, scoping funding for Patient Flow Coordinator to release further clinical capacity. Preparing for AHP job planning. Equitable workload across the services. Plan for future workload for the service e.g., trajectory of wait lists being cleared.
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QI 140 To reduce the length of stay within the Crisis Home Treatment Team (CRHT) for Older AdultsAim: To reduce the length of stay within the Crisis Home Treatment Team (CRHT) to 42 days for 60% of Older Adults by September 2021. The age integrated CRHT caters for people aged 18 years and over. Clinical reviews within the team indicated inadequate risk assessments leading to ineffective management plans when dealing with older adult referrals. Informal discussion with staff revealed lack of experience and confidence leading to poor service delivery and impact on length of stay with the team. Key areas of focus 1.Recruit skilled professionals within Triage and Assessment. Team with older adult experience. 2. Develop older adult champions. 3. Develop link workers within IPUs who can work alongside the champions for seamless transfer of patients. Tools Used: Plan, Do, Study, Act (PDSA) Cycle which is a framework that helps you to test small changes. This is part of the Model for Improvement framework, which helps you to test out small changes and build on the learning from each cycle - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram which is a tool designed to show 'cause and effect' and can help you plan your improvement project - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf. Project Impact: Training : Feedback before and after related to confidence in dealing with older adult referrals. Overall, very positive feedback and request for more online resources related to social care and voluntary sector –which were sent to attendees. Referrals: There was a very marked reduction in the number of referrals received between the 2020 period and the 2021 period. Reduction occurred in referrals which then resulted in relatively short lengths of stay. 30.8% of the overall reduction of 318 referrals was in referrals that were discharged on the same day, and 84.3% of the reduction comes from referrals discharged within four days. The number of referrals discharged on the same day fell from 110 in 2020 to just 12 in 2021.
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QI 144 Improving Upper Limb Splinting for Young People in CoventryAim: To reduce the waiting time for splints for young people in Coventry from a maximum of 174 days to a maximum of 7 days by June 2022. Children and young people were assessed once a year in the Hand Splinting Clinic and were issued with prefabricated splints. Delays of up to 174 days were caused if the required splints were not in stock due to splints being ordered from overseas. The cost of these splints and staffing was around £105.00 per splint. The delays resulted in some splints not fitting the children by the time they had arrived due to growth, leading to excess stock and reordering. This improvement project aimed to reduce waiting times and costs. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf. Project Impact: We achieved a reduction in waiting times from up to 174 days to 0 days leading to better patient experience. The average cost of fitting a splint reduced from £105 to £80. Fabricated splints cost less. We saved approximately £6000 over the last financial year.
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QI 149 Increasing Referrals to the Children’s Cerebral Palsy Strengthening GroupAim: Increase the referral rate for the Cerebral Palsy strengthening group from 0% in March 2022 to 80% by September 2023. A virtual group was set up in 2021 for children and young people with Cerebral Palsy. As Covid restrictions reduced there was a noted decrease in referrals and an increase in requests from parents to move the group from virtual to face to face. The project was initially set up in March 2022 to scope the barriers to referral and attendance and improve the referral rate into the group. Increasing referrals would mean that sufficient outcome measures could be collected to evaluate clinical effectiveness of treatment. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; Sustainability Tool - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-sustainability-model.pdf. Project Impact: The referral rate increased to 81% of the full capacity for the group. Seeing patients in a group rather than 1:1 has: Saved 18 hours of staff time per cohort (108 hours of clinical time saved over the last year). £373.74 has been saved per cohort. This equates to savings of £2242 over the last year and up to £2616 next year. Attendance at the groups has enabled us to collect and compare data through outcome measures. These have shown large clinical benefits which have been maintained when 1 year post group outcome measures have been repeated. Average improvement in 6 minute walk test (6MWT) scores for GMFCS 1 and 2 patients show a statistically significant improvement. The group has progressed to running face to face and since re-starting in January 2023 has successfully run with patients within each group and referral rates above 50% maintained in each cohort. All patient feedback has been positive. The average improvement in strength (MRC) showed increase or maintenance in all areas for each patient.
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QI 171 Improving Autism Spectrum Disorder (ASD) Support in the Early Intervention Team (EIT)Aim: To Improve the knowledge of early intervention team (South) regarding support and referral options for patients with suspected or confirmed autism spectrum disorder (ASD) The EI team has recently supported patients with either a new or existing diagnoses of ASD alongside their presentation of psychosis. An initial survey of the team showed there were areas where we could improve the teams knowledge. In particular of how to access referrals to key services and specific support and improving understanding of the role of different teams and services. Tools used: PDSA; Driver Diagram Project Impact: Overall an improvement in knowledge of services and referral processes was demonstrated in many areas. Results on re-assessment appeared more polarised with less “unsure” answers recorded. There has been some staff turnover during this period which may have also impacted on results. This is a specific area and although most staff will come across this at some stage it is not frequent for many team members. Further knowledge will come as they face this issue clinically and refer back to resources which have been developed or as further training opportunities arise. This initial screening work has resulted in some improvements but has also identified further areas future work can target more specifically.
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QI 177 Patient Care Starts With Your DiaryAim: To increase patient facing activity for Planned Therapy to reduce the length of the waiting list times by 30% by April 2022. As a result of COVID and the redeployment of staff the waiting list for Planned Therapies had grown considerably. A driver diagram was used to develop change ideas to help tackle the growing problem. PDSA cycles were used to monitor and develop the change ideas. Diary slots were maximised with the implementation of diary templates, a new system of operation for admin staff and the development of the Patient Flow Coordinator role. These contributed to increased productivity and reduced waiting times. Tools Used: Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; SPC Charts - www.england.nhs.uk/statistical-process-control-tool/ Project Impact: The team exceeded the aim of a 30% reduction in waiting times with a 40% reduction in wait times for Physio and a 47% reduction in wait times for OT.
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QI 155 Improve bone health of patients at increased risk of osteoporosisAim: To ensure Eden Ward patients have bone risk factors identified, assessed and required interventions applied within 3 months of admission. Epilepsy and a diagnosis of Intellectual Disability have both been shown to independently contribute towards poor bone health and osteoporosis. Decreased bone mineral density and vitamin D deficiency are independent risk factors. Many female inpatients with intellectual disability with and without Epilepsy admitted to a low secure unit have multiple risk factors for poor bone health. This includes admission to secure services, medication, physical inactivity, poor nutrition, smoking, falls/trauma. This increases their overall risk of osteoporosis and fractures. Bone health has not previously been monitored. Tools Used: Staff Questionnaires; PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf Project Impact: 100% of patients on Eden Ward have had their risk factors for bone health assessed (previously this was 0%). Bone health education workshops have been delivered to staff to increase awareness and improve practise. As part of the care plan, appropriate investigations are now being requested and monitored. Next steps will be; 1. Explore if changes can be rolled out to other inpatient wards. 2. New patient admissions to have 1:1 information sessions and completion of bone health care plan within 3 months of admission. 3. Annual audit of Bone Health Care Plans.
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QI 178 Improving In-Team TransfersTo establish a safe and effective process of transfer of patients between all professionals within Planned Therapy Services by the 26 August 2022. The team identified a lack of a defined auditable process for the effective and efficient management of transferring patients between staff groups. They worked together to streamline the transfer process to ensure that it was clear and concise and to ensure that workload was distributed fairly. Project Impact: A safe and effective process of transfer of patients was established. The percentage of staff who agreed or strongly agreed that workload was distributed fairly increased from 40% to 70% and the percentage of staff who agreed or strongly agreed that the process for transferring patients between staff groups was clear and concise increased from 10% to 70%. Tools Used: Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; Project Charter - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-define-your-project-charter.pdf; Brainstorming - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-brainstorming.pdf; Process Map - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf.
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QI 179 Supporting AHP Student Placement ExpansionTo increase the number of AHP student placements delivered from 115 (2021/22) to the Trust goal of 146 by 31st August 2023. In line with the NHS Long Term Plan (2019) and Health Education England initiatives there has been, and continues to be, a huge need to increase and secure our future workforce. This begins with education. AHP students are required to complete workplace placement training to complete their degree and therefore the demand for AHP student placements has significantly increased. This project was designed with the aim of increasing the number of AHP student placements delivered by CWPT. This project demonstrates (using a range of measures and QI tools) how this has been achieved. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf. Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf We exceeded our target of 146; 152 placements were delivered; an increase of 37 placements since last year. We have an increased understanding of the views of Practice Educators (PEs) and students on the placements provided. Practice Educator satisfaction with the student placement experience increased from 80% to 100% from September 2022 to April 2023. The percentage of students who rated their placement as "very useful" increased from 67% to 92%.
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QI 180 Implementing Behavioural Family Therapy (BFT) in the Perinatal Mental Health Team (PMHT)Perinatal Psychological therapies is part of the NHS England Long Term Plan (LTP). The national ambition is to expand access to evidence-based therapies within PMHT so that they also include parent > infant, couple and family interventions. A secondment post was introduced in the Trust’s PMHT to help achieve this aspect of the LTP to introduce and implement a ‘whole family’ approach utilising the BFT MERIDEN Programme which is already utilised in psychosis specific teams within CWPT (Early Intervention and Recovery). Tools used: Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; Stakeholder Analysis - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-stakeholder-analysis.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf. Project Impact: The project has helped offer more support and resources for client’s carers and families and upskilled staff and increased their confidence of this patient cohort. The project benefitted the Trust by securing a cost saving of £1,150 by negotiating training costs with the training provider. Not only has the project given carers of patients more of a voice and support system, it has united the PMHT and supported integrated working. Next steps are; 1. Secure Develop leaflets and handouts to support programme delivery 2. Continue BFT supervision for the contracted year with MERIDEN 3. Continue to complete data template 4. Adapt process for other mental health services in the Trust
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Practitioner Review: Continuity of mental health care from childhood to adulthood for youths with ADHD - who, how and when?Many youths with attention-deficit/hyperactivity disorder (ADHD) experience significant long-term impairment and may develop concurrent mental and somatic health difficulties as adults. This is associated with burden and costs for the individual and society which could be prevented through continued support in youth. Yet, only few young people transition to adult mental health services for ongoing care in different countries worldwide. We provide an overview on current transition practices, highlighting the gaps in knowledge and the barriers to effective service transitioning, while considering the large geographical variation in available guidelines and service provision. For ease of use, this review is organized in a question-and-answer format covering different aspects of the transition process and considering both service users' and clinicians' perspectives. Consensus is needed to identify those that require continued care, the optimal timing to arrange transition, and the most suitable services. Finally, we discuss cost-effectiveness of transition practices, consider examples of best practice, and propose recommendations on how to improve transitional care, including the importance of service users' input into transition planning.
