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Length of visits
Target
a) The CRT has a written policy regarding length of visits which includes stipulation that on any day in which the CRT visits a service user, at least one visit should be at least 30 minutes duration.
b) The CRT records and monitors duration of visits and takes action if too many visits are excessively brief.
c) At least 80% of service users are visited for at least 30 minutes on one visit on days when they are seen by the CRT.
d) All sources agree visits by CRT staff are not limited to specific, pre-planned tasks, but allow discussion of service users' and families' concerns and priorities.
Why this is important
Service users and families we interviewed frequently stressed the vital importance of CRT visits being long enough for staff to listen and discuss all important concerns, and build up a helpful therapeutic relationship. CRTs are criticised if they provide little more than a brief medication drop.
In the video below, service users and carers talk about the importance of making sure visits are long enough to address their needs.
Ways of doing this well
Recording/ monitoring the duration of visits
Having a system to record the length of visits can help ensure that this is priority for the CRT, and can help identify any reasons why visits may be cut short.
Manchester North CRHT identified this as an area where recording and monitoring played a key role in service improvement:
MANCHESTER NORTH CRHT CASE STUDY
As a Home Treatment and assessment team we have always focused on the needs of the Service User and we have engaged with Service Users to evaluate our service. One of the areas that became apparent from feedback was that Service Users felt that they needed time to talk about what was happening to them and also to ensure that the family members were aware of and part of the care that we were providing. We identified that at times due to the pressures on the service visits could be curtailed or the focus would be risk assessment and not interventions or allowing people time to talk.
We looked at our recording system and identified that it could identify the length of visits and also the number of visits that team members undertake. We recently developed this into a dashboard which shows the activity of the team and individual team workers.
With the feedback from Service Users we changed the focus of the Managerial Supervision sessions to include the number of visits and also the length of time for these visits. This information was pivotal in the development of resource management for the team and we presented a business case to show that all contacts for a Service User in a Mental Health Crisis needed to be for 50mins to 1hr plus travel and documentation time. We were able to evidence this by the computerised records and we have established that all visits for interventions need to be for a set amount of time. We have a system where in hand-over all visits are allocated to Team Members for the shift and potential allocated time this needs.
We have been able to focus on interventions and giving time to 'hear' what the person wants to say. Our feedback has been very positive and service users have indicated that they value our approach in this area.
Zoning criteria for length of visits
Depending on where the service user is in terms of their recovery from crisis, they will have different needs for the amount of input from the CRT. Greenwich HTT use this mode of classification to stipulate the expected length of visit for each service user, and they make the following recommendations:
- Red classification. The service user is in the most acute stage of the crisis, requiring an average of 2.5 hours of input from the CRT daily.
- Amber classification. The crisis has remitted somewhat and the service user can be seen on alternate days, for an average of an hour daily.
- Green classification. The crisis is resolving, and the service user can be seen on less than alternate days for an average of 30 minutes per visit.
Further details can be found in the following document:
Clear question on feedback survey
Service users should be asked to comment on the length of visits, at the end of their time with the CRT, to ensure that their needs in this area are being met.
Examples of good practice
In our fidelity review survey of 75 crisis teams in 2014, the following teams achieved excellent model fidelity, and can be contacted for advice about how they achieved this:
- Manchester North, Manchester Mental Health and Social Care Trust
Relevant reading
McGlynn (2006) CMHT: A Practical Guide
Spending prolonged time with the client initially
Initial assessments can be lengthy affairs. Not only has a history to be taken from the service user and the social network, but a disturbed person may have to be engaged and calmed down. Then planning options have to be considered and a plan agreed. All this takes time if it is to be done properly. Hours will probably elapse, even for a service user who is familiar with the team. Because their focus is on crisis work, CRHT teams are able to do this. It is time well spent because it allows a therapeutic relationship between the team and the service user and their social network to develop. Teams should not be frightened of spending a lot of time on the initial assessment. (p.18)