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Type and Title of Submission


Title:

Early intervention in psychosis service

Description:

The Trust developed an early intervention service as part of an overall service delivery model for people with psychosis when evidence of clinical and cost effectiveness was limited. This service has been particularly successful in engaging people in vocational activity, providing support to families and psycho-education to clients of the service. The multidisciplinary team has demonstrated excellent results in these areas and has been working closely with partners in statutory and non-statutory services to achieve this success. Engaging with hard to reach groups has been a key focus of the team. The recent update of the schizophrenia guideline found new evidence of clinically significant benefits of early intervention services. Please note that this example was originally submitted to demonstrate implementation of CG82 Schizophrenia (update). CG82 has now been replaced by CG178. The example has been reviewed and continues to align with the new guidance.

Category:

Clinical

Does the submission relate to the general implementation of all NICE guidance?

No

Does the submission relate to the implementation of a specific piece of NICE guidance?

Yes

Full title of NICE guidance:

CG178 - Psychosis and Schizophrenia in adults

Category(s) that most closely reflects the nature of the submission:

Is the submission industry-sponsored in any way?

No


Description of submission


Aim

The aim was to develop an early intervention service in one locality of a large Trust providing mental health, substance misuse and learning disabilities services, as part of an overall service model for people with psychosis. A key aim of this initiative was to provide early intervention services with the full range of pharmacological, psychological, social, occupational and educational interventions. Within the development of the core interventions the service team identified the need for a particular focus on vocational interventions (sustaining, achieving and preparing for work and/ or education) and for family interventions and carer support. The service also aimed to develop full partnership working with service users, carers non-NHS organisations in an ongoing and sustainable manner.

Objectives

1) To implement an EIP service model in one locality of a large Trust - The service would be developed and supported with the emerging evidence base and would actively seek to add to the evidence base for early intervention services. This would include consideration of multimedia communications strategies appropriate to the client group and strategies to address issues of social inclusion/ stigma as well as evaluating clinical and cost outcomes compared to standard service delivery. Once the service is established the aim is to rollout across the rest of the organisation using evidence of what works well/ the optimum model. 2) The service will - Work with clients/ families for up to 3 years - See new referrals within 48 hours - Add to existing assessment, team discussion and interventions - Work with clients wherever they are - Support early discharge, use of low dose anti-psychotics - Client centred and flexible - Focused look at vocation, family work and psychosocial interventions (including CBT for psychosis) - Criteria to include prodrome and drug induced psychosis 3) Involve key stakeholders in all aspects of service development, implementation and monitoring

Context

Delivering high performing early intervention in psychosis (EIP) services is consistent with Sussex Partnership NHS Foundation Trust's ambitions towards clinical excellence, increased prevention and more local specialist services. EIP is a recommendation in the NICE guidelines for schizophrenia and EIP key performance indicators are incentivised schedule 5 targets and performance against them is critical to the Care Quality Commission rating. People experiencing psychosis are a core client group for the Trust. Intervening early on can bring significant clinical and economic benefits. EIP proactively engages with clients and their carers, and provides holistic interventions early on. Needs are therefore addressed early, independence is always maximised and admissions are reduced. The EIP model is backed by an unprecedented amount of robust quality evidence both in the UK and internationally. The Early intervention service has been keen to ensure that interventions provided by the service have been supported by the emerging evidence base and aim to address issues of social inclusion. Further to this the service has been determined to work on the priorities that the service user brings to the team ? this is why vocational interventions and supporting young people to achieve, 'ordinary lives' has been so important in the interventions provided by the service.

Methods

All clients of the West Sussex Early Intervention service and their support network (usually family but could include friends, siblings and support staff) are offered psycho-education and/ or family work as standard. This intervention is tailored to what the client and family want and can range from one session to ongoing sessions. The feedback from clients and carers who have engaged with this has been excellent and figures show that 91% of clients of the service have family involvement compared with the national average for standard care (CMHT) for family involvement is 49% (Smith & Shiers, 2008). There has been a 100% pass rate in practitioners participating in the family work module at the University of Surrey. This educational partnership has now developed and created an accredited Early Intervention in Psychosis Module partnership with Surrey Early Intervention Service and the University of Surrey. 63% of clients of the west Sussex Early Intervention Service are engaged in vocational intervention that includes paid work, education and voluntary work. National data shows that at first contact 40% of clients with a first episode of psychosis are unemployed and this figure rises to 75-95% in the first year. 50% of early intervention clients have had less than 10 years of education limiting longer term employment prospects (Kilackey & Smith 2008). Based on the feedback the service has received from clients and carers and our ongoing statistical analysis it is clear that our innovative solutions result in the significant benefits outlined in the review of the NICE guideline. The West Sussex Service hosts the national, 'special interest group for occupational therapists and vocational workers working in Early Intervention in Psychosis'. This demonstrates the Trust commitment to learning and partnership working with other experts in the field of vocational attainment.

Results and evaluation

The carers of clients have been engaged in service development via the family nights organised by practitioners. These sessions are held in the evenings and run for five weeks concurrently. The group discuss how the service can improve and participants complete a questionnaire. Action points from these have been incorporated into service improvements. Clients of the service list areas that they would like to engage with in service development. They were keen that service user participation could be fed back into their vocational goals. Therefore it is a service standard that there is a client of the service on the interview panel for all staff recruited into the service and the team are currently working with service users on a mentoring scheme that would see clients in the third year of the service buddying clients who have just entered the caseload. A steering group has been established which includes members from statutory and non-statutory services

Key learning points

West Sussex is a large county with a population of approximately 750,000. It is a mixed urban/ rural area and staff often have to drive long distances to see clients. In some parts of West Sussex there are limited opportunities regarding public transport and access to youth focused services. There are also some areas of West Sussex with high levels of deprivation and unemployment. To motivate and engage young people in opportunities in some of these areas has been challenging and required innovative solutions. The service is currently at capacity with regards to the number of clients it can care co-ordinate. At times this has meant that staff feel under pressure and feel stretched when trying to provide a full range of interventions to clients. Many young people do not want to disclose their mental health difficulties to employers or educational establishments for fear of stigma and discrimination. The service has put together guidance for young people regarding this and, 'how/ when to talk about my mental health', is an ongoing topic of conversation between practitioners and clients. The Trust is tackling stigma and discrimination through using service user case studies as part of the, 'Time to Change', campaign. Some young people and their families do not want to engage in family work or to share information together. The family nights are therefore a crucial addition to what the service offers as there is a second option for carers to engage in psycho-education and have an opportunity to seek support and advice. The original service specification was based on a hub and spoke model. This does not lend itself to working with non-NHS organisations as the focus of the service is with partnerships being made with community mental health teams. The Trust agreed that after 2 years the service would move to a stand alone model of service. This provides greater access to those at risk of psychosis as well as those experiencing psychotic symptoms

Contact Details

Name:Wendy Harlow
Job Title:NICE & SCIE Implementation Facilitator
Organisation:Sussex Partnership NHS Foundation Trust
Address:Aldrington House, 35 New Church Road
Town:Hove
County:East Sussex
Postcode:BN3 4AG
Phone:07917592984
Email:wendy.harlow@sussexpartnership.nhs.uk

 

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This page was last updated: 29 September 2009

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.