LLetting 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%

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)

Let 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 artificialvariation 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?