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Frequency of visits
Target
a) At least 50% of service users are visited twice a day for a period of 3 consecutive days during their episode of CRT care.
b) The CRT visits service users more than twice a day when needed.
c) At least 50% of service users are seen/visited at least 7 times during their first week of receiving CRT support.
d) At least 50% of service users are seen 5 times per week on average throughout their period of CRT care (until planned tapering of contacts to end CRT care).
e) The CRT actively monitors frequency of contacts with service users.
Why this is important
CRT care is intended to be intensive, with multiple visits scheduled to support the service user through the period of crisis. This will be particularly the case during the start of CRT care, when the service user's needs are being assessed and when they may require the most help and support. The CRT should also have sufficient capacity to schedule additional visits where required.
Examples of good practice
In our fidelity review survey of 75 crisis teams in 2014, the following team achieved excellent model fidelity, and can be contacted for advice about how they achieved this:
- South Tyneside Initial Response Team, Northumberland, Tyne and Wear NHS Foundation Trust
Relevant reading
McGlynn (2006) CRHT: A Practical Guide
'Visiting frequently in the early stages
Many of the people taken on by the CRHT team would otherwise be in hospital, where their behaviour and mental state would be frequently monitored. These also need to be monitored when they are receiving home treatment. Practical and interpersonal problems may need to be addressed. It may be necessary to obtain further history.
Most importantly, the therapeutic relationship needs to be built upon with the service user and their carers to enable them to develop trust and confidence in the CRHT team. If this is their first experience of the CRHT team they will understandably be wary of what is happening; they will not have had such an intensity of home visiting offered (or given) to them in the past so they may be unsure whether it will be delivered. Frequent visiting helps to overcome this apprehension and any concern that team members have about the person's welfare. A person who is very unwell will be visited twice or even three times daily in the beginning. As their condition improves, so the frequency of visiting can be reduced.' (p.18)
National Audit Office (2008) CRHT: The Service User and Carer Experience
'Visiting times that are adhered to:
2.33 Expected visits that are made on time allow service users and carers to factor other activities into their day around the visit, and know they will not have to cancel or rearrange prior engagements because of unpredictable visits by the team. If the visit is in response to a phone call, service users appreciate prompt visits because it affirms their belief in the service, provides them with physical help when needed and does not build anticipation unfairly.
'They just popped in and saw if things were OK […]Everything they've said they'll do, they've done. They've been fantastic.'
Samantha (carer)
Source: NAO carer focus group
2.34 On the other hand, not knowing what time the team will arrive, or suffering short-notice cancellations (sometimes without any warning) were mentioned by service users and carers as examples of poor service provision that left them with bad impressions of CRHT. Some local survey respondents also mentioned that waiting for late or cancelled team visits could exacerbate existing anxiety associated with their illness.
'Last time she was under the acute service, they didn't come when they said they would, and they didn't ring when they said they would on several occasions […] On one occasion when she was in a real crisis, she rang the duty system three times, before anyone actually came back to her to talk to her. But they told her no one would come because they were too busy.'
Donna (carer)
Source: NAO carer focus group
Knowing which members of staff will visit
2.35 This factor has two dimensions. Firstly, it relates to knowing the name of the staff member intending to visit. Being aware beforehand of who will be visiting (and not just when) can help make the intervention more personal from the outset, and also reduce anxiety on the part of service users who may already be feeling vulnerable owing to their illness. The second dimension relates to continuity, and the benefits of knowing the individual staff member from previous visits. The issue of staff continuity and its practical challenges are explored in more detail below' (p.16-17)