Gate-keeping or free choice in crisis resolution and home treatment teams

2012 ◽  
Vol 7 (3) ◽  
pp. 111-115
Author(s):  
Dieneke Hubbeling
Keyword(s):  
Free Choice ◽  
Home Treatment ◽  
Crisis Resolution ◽  
Gate Keeping

scholarly journals Implementation of crisis resolution/home treatment teams in England: national survey 2005–2006

2008 ◽  
Vol 32 (10) ◽  
pp. 374-377 ◽  
Author(s):  
Steve Onyett ◽  
Karen Linde ◽  
Gyles Glover ◽  
Siobhan Floyd ◽  
Steven Bradley ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Online Survey ◽  
Home Treatment ◽  
Clinical Implications ◽  
Successful Implementation ◽  
Crisis Resolution ◽  
Out Of Hours ◽  
Face To Face ◽  
Gate Keeping ◽  
Made In

Aims and MethodTo describe implementation of crisis resolution/home treatment (CRHT) teams in England, examine obstacles to implementation and priorities for development. We conducted an online survey followed by a telephone or face-to-face interview among 243 teams.ResultsConsiderable progress has been made in implementation with a subset of teams demonstrating strong fidelity to the Department of Health's guidance, particularly in urban settings. However, only 40% of teams described themselves as fully established. Many teams reported a high assessment load, understaffing, limited multidisciplinary input and patchy fulfilment of their gate-keeping role.Clinical ImplicationsSuccessful implementation of the CRHT teams as alternatives to hospital admission requires resources for home treatment out of hours, effective systems working among local services, stronger local understanding and advocacy of the teams' role.

scholarly journals Crisis resolution/home treatment teams, gate-keeping and the role of the consultant psychiatrist

2008 ◽  
Vol 32 (10) ◽  
pp. 378-379 ◽  
Author(s):  
Hugh Middleton ◽  
Gyles Glover ◽  
Steve Onyett ◽  
Karen Linde
Keyword(s):  
Important Determinant ◽  
Care Pathway ◽  
Home Treatment ◽  
Clinical Implications ◽  
Team Size ◽  
Crisis Resolution ◽  
Consultant Psychiatrist ◽  
Gate Keeping ◽  
The Relationship

Aims and MethodThe working relationship between consultant psychiatrists and crisis resolution/home treatment (CRHT) teams varies quite widely. Data from the national survey have been used to investigate the effects of consultant psychiatrist intput upon functions of the CRHT team. Logistic regression was employed to consider the effects of team size, team maturity and consultant input upon gate-keeping and fidelity to model (how many of six criteria teams' activities included).ResultsThere were statistically significant effects of size and maturity upon fidelity, and of maturity and consultant input upon gate-keeping.Clinical ImplicationsThe relationship between the consultant psychiatrist and other elements of the acute care pathway is an important determinant of how it functions. Depending upon how they relate to them, consultants can assist or hinder a team's capacity to fulfill their intended purposes.

Staff experiences of working in crisis resolution and home treatment

2011 ◽  
Vol 16 (2) ◽  
pp. 76-87 ◽  
Author(s):  
Jon Freeman ◽  
Andrew Vidgen ◽  
Ellen Davies‐Edwards
Keyword(s):  
Home Treatment ◽  
Crisis Resolution ◽  
Staff Experiences

P02-08 - Mental health crisis resolution and home treatment teams: a qualitative evaluation

2010 ◽  
Vol 25 ◽  
pp. 626
Author(s):  
B. Ferguson ◽  
H. Middleton ◽  
R. Shaw ◽  
R. Collier ◽  
A. Purser
Keyword(s):  
Mental Health ◽  
Qualitative Evaluation ◽  
Home Treatment ◽  
Mental Health Crisis ◽  
Crisis Resolution ◽  
Health Crisis

scholarly journals Improving quality and assessment of referrals to the Enfield Crisis Resolution and Home Treatment Team (ECRHTT)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S202-S202
Author(s):  
Margarita Kousteni ◽  
John Cousins ◽  
Ajay Mansingh ◽  
Maja Elia ◽  
Yumnah Ras ◽  
...  
Keyword(s):  
Home Treatment ◽  
Absolute Difference ◽  
List Type ◽  
Treatment Team ◽  
Crisis Resolution ◽  
Post Intervention ◽  
Improvement Project ◽  
Consultant Psychiatrist ◽  
The Impact

AimsTriaging referrals to crisis resolution and home treatment teams is a significant undertaking requiring experienced and dedicated staff. We observed that the volume of inappropriate referrals to ECRHTT was high, and that staff processing these often felt inexperienced or lacking in confidence to discharge them back to the referrers and signpost them to appropriate services.The aims of this quality improvement project (QIP) were: a)to reduce the number of inappropriate referrals received by the teamb)to reduce the number of inappropriate referrals accepted by the teamThis would significantly improve access and flow to the service and facilitate better patient care.MethodA pilot study was first completed of the quality (appropriateness/ inappropriateness) and source of all referrals to ECRHTT in January 2019 (n = 177).Subsequently, the consultant psychiatrist for ECRHTT based himself within the assessment team. He was able to closely monitor the referrals, at the same time as providing medical input to patients at their first point of contact. To evaluate the impact of this intervention, the percentage of inappropriate referrals accepted pre- and post-change was compared by re-auditing all referrals received in February 2019 (n = 175).Further interventions were instigated to improve referral quality. These included continuation of psychiatric medical input to the assessment team, teaching sessions for GPs and the crisis telephone service, and weekly meetings with psychiatric liaison and community mental health teams (CMHTs). Change was measured by reassessing the quality of all referrals made to ECRHTT in February 2020 (n = 215).Result46.9% of inappropriate referrals to ECRHTT were accepted in January 2019 compared to 16.9% in February 2019 following the addition of medical input to the assessment team. The absolute difference was 30% (95% CI: 14%–44%, p < 0.001).71% of referrals from GPs were inappropriate in January 2019 compared to 36% in February 2020 post-intervention (difference 35%, 95% CI: 8.84%–55.4%, p < 0.05). Inappropriate referrals from CMHTs decreased from 55.5% to 12% (difference 43.5%, 95% CI: 9.5%–70.3%, p < 0.05). Overall, the percentage of inappropriate referrals fell from 38% to 27.4%, a difference of 10.6% (95% CI: 1.3%–19.8%, p < 0.05). The percentage of inappropriate referrals from liaison teams did not change significantly.ConclusionThis piece of work shows that better engagement with referral sources significantly improved the quality of referrals made to ECRHTT. Interventions included medical input at the point of referral, teaching sessions for general practitioners as well as ongoing liaison with referring teams.

Service innovations

2003 ◽  
Vol 27 (4) ◽  
pp. 148-151 ◽  
Author(s):  
Rahul Tomar ◽  
Neil Brimblecombe ◽  
Geraldine O'Sullivan
Keyword(s):  
Rating Scale ◽  
Diagnostic Category ◽  
First Episode Psychosis ◽  
Community Services ◽  
Home Treatment ◽  
First Episode ◽  
Crisis Resolution ◽  
Episode Psychosis ◽  
Significant Difference ◽  
At Home

Aims and MethodDemographic and clinical details were recorded for individuals with first-episode psychosis, potentially requiring hospital admission, who were assessed by two home treatment/crisis resolution teams over an 18-month period. The aims were to identify the proportion of such individuals that can be treated at home, factors associated with successful home treatment and reasons for hospitalisation when this took place.ResultsSuccessful home management was achieved in 20 (54%) of cases. No significant difference was found in any demographic variable, diagnostic category and initial Brief Psychiatric Rating Scale (BPRS) ratings between those who were hospitalised and those who were not. The most common reason recorded for admission was that of risk to self.Clinical ImplicationsMany patients with first-episode psychosis otherwise requiring hospitalisation can be managed successfully at home by an intensive home-treatment team. These findings have significant implications for both in-patient and community services, in view of the planned increases in home treatment/crisis resolution services proposed in the NHS Plan.

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