Shared learning database

Manchester Mental Health & Social Care Trust
Published date:
September 2009

In response to national policy including NICE guidelines and local clinical need, a standardised Clinical Assessment and Management of Risk Toolkit (CAMORT) was developed for use by multi-disciplinary teams in Manchester Mental Health and Social Care Trust. This project was designed to deliver a robust evidence based training programme for the assessment and management of risk and now been delivered to clinicians from all professional groups throughout the Trust. An evaluation of the impact of this training has been completed.

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aim of this implementation project is to provide an evidence-based, policy driven risk assessment, formulation and management training programme for clinicians throughout Manchester Mental Health and Social Care Trust (MMH&SCT) 1. To improve the knowledge and skills of mental health professionals undertaking risk assessments and management plans and to ensure that all clinicians are proficient in the use of CAMORT and to promote its routine use in all clinical settings 2. To improve the quality of risk assessments and management plans devised by all clinicians to make the process acceptable to service users and carers 3. To ensure that risk issues are managed in a safe and collaborative manner and communicated in a timely and accurate way to key stakeholders 4. To improve patient safety by reducing the frequency of serious untoward incidents in the Trust This training project is underpinned by CAMORT, which was developed by a multi-disciplinary panel providing a wealth of clinical knowledge, skills and experience. The training draws on current good practice guidelines (e.g. NICE Self Harm Guidance, NICE Violence Guidelines, Best Practice in Risk Management, DOH 2007), policy drivers and the latest research. Using a series of case studies highlighting specific risk issues in a variety of clinical settings, participants work in groups using facilitated role play scenarios to undertake a complete cycle of risk assessment and management. Service users, carers and clinicians have been involved in the design and delivery of this project. Participants are provided with a training pack which includes all presentation slides, recent references and reading lists, templates for the development of risk management plans, a summary of all relevant policy drivers and good practice guidelines and examples of high quality completed CAMORT forms. All participants are encouraged to complete a personal development plan to enable them to reflect on their clinical skills development in risk management. Additionally, the project has developed a 'Train the Trainers' initiative with the aim of increasing the capacity of delivery of risk management training throughout the Trust.

Reasons for implementing your project

In response to the National Suicide Prevention Strategy for England (NIMHE 2004) all Mental Health Trusts were expected to comply with specific standards concerning the implementation of risk policy. At this time MMH&SCT was participating in the Department of Health expert group which developed Best Practice in Managing Risk (DOH 2007), incorporating existing NICE guidelines. Prior to 2005 MMH&SCT did not have a consistent and reliable method of assessing or managing risk in clinical practice settings. Root cause analysis of several serious untoward incidents (SUIs) highlighted deficits in the skills of staff to identify and manage risk effectively and the lack of a consistent framework to assess, formulate, manage, record and communicate identified risks. In response to this the Trust Board established a multi-disciplinary steering group to produce CAMORT. A Trust-wide policy to support its implementation was agreed and staff briefing sessions were delivered to support the implementation of CAMORT. At these briefing sessions clinicians consistently requested a comprehensive training programme to support the full and effective implementation of CAMORT.

How did you implement the project

1. An evaluation of a pilot training project was conducted by an external evaluator in March 2008. This involved a thematic analysis involving all the 20 participating clinicians. The main outcomes of this evaluation indicated that clinicians found the course to be relevant, useful and considered their knowledge base, skills and confidence in assessing and managing risk had improved. In particular they found the involvement of service users in the delivery of the training extremely enlightening. The participants highlighted the need for some aspects of the course to be altered to reflect a wider variety of clinical settings. These results were further substantiated by a pre-post test multiple choice questionnaire which highlighted a consistent improvement in the participants' knowledge scores following training. 2. Since this training started three audits to determine the use of CAMORT have taken place. Results of these audits indicate a trend towards an increase in the use of CAMORT and the quality of the standard of the risk assessment and management plans undertaken by all professional groups. 3. Through Route Cause Analysis (RCA) of SUIs there is evidence of greater involvement of service users, carers and other stakeholders in the process of risk assessment, formulation and management. 4. Over the same period the number of SUIs where the lack of a risk assessment has been a contributory factor has significantly reduced thereby improving patient safety.

Key findings

1. Since the initial pilot we have now facilitated 10 training programmes with 230 participants from all professional groups. All subsequent courses have been continuously evaluated and modified in response to participants' feedback in relation to both the content and delivery. 2. RCA of all SUIs will continue to monitor whether poor risk assessment, formulation and management has been a contributory factor. 3. An annual audit of the use of the CAMORT will continue supported by MMH&SCT Research and Development team . Inter-rater reliability and validity of CAMORT will be established as an additional project in 2010.

Key learning points

1. To negotiate and securing protected time from management to design and develop the initial training plan and involve practicing clinicians, service users and carers in this process. 2. Making the case studies to illustrate the use of the CAMORT to all service settings and involving key clinicians in this process. 3. To ensure that the project team were effectively supported and represented at higher management level. 4. Secure funding is essential to ensure that the training will continue on an ongoing basis. This has necessitated the project team to become creative and opportunistic in identifying and securing appropriate funding streams 5. Information Management and technology teams should have been involved at an early stage to ensure that the CAMORT process was compatible with the organisation's existing electronic clinical record system.

Contact details

Ian Wilson
Dual diagnosis trainer / clinical nurse specialist
Manchester Mental Health & Social Care Trust

Secondary care
Is the example industry-sponsored in any way?