L Letting 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% 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)

L et 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 artificial variation 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?