With the news that Brookside adolescent unit has been re-inspected by the Care Quality Commission and received a ‘Good’ rating across all its domains, we took the opportunity to speak to Modern Matron Rebekah Bewsey. We asked Rebekah about the changes made at Brookside, her thoughts on the CQC rating and about the development of the Young Person’s Home Treatment Team.
What were the changes made at Brookside?
During the closure of Brookside an extensive refurbishment of the ward was undertaken, to create a more therapeutic, open, modern and fit for purpose unit. The design for this was undertaken following visits to other purpose built CAMHS inpatient units around the country and in consultation with young people and the ward nursing staff. The decoration of the new unit was based on evidence-based research and following service user forums to ensure the young people’s wishes were central to the design process. There is a new, dedicated family wing for visiting family to enable parents/carers to stay on the unit. Facilities include a separate kitchen where families can prepare and enjoy a meal away from the main unit. The High Dependency Unit and Day Hospital Service was closed and Brookside now comprises of one 15-bedded acute ward for male and female young people aged between 12-18 years old.
Alongside the physical changes to the ward environment, new treatment pathways, based on NICE Guidance, were devised to ensure young people received the best care, based on clinical evidence with specific, measurable, agreed, realistic and timely outcomes. Referral processes and criteria were also reviewed to ensure that admissions to Brookside going forward were safe and appropriate. We have devised and implemented a new robust governance structure under the Acute and Recovery Directorate which ensures Service Leads have a good oversight and level of clinical engagement with day-to-day operations.
Staffing vacancies were recruited to and bespoke training was delivered to the multi-disciplinary team on a variety of clinical topics such as Safeguarding Children, Care Planning and Risk Assessment, Prevention and Management of Violence and Aggression to name a few in preparations for reopening.
How have the changes improved the Unit?
Brookside is now a much enhanced therapeutic environment to provide care to young people. It is open plan and modern and young people have much better free movement around the ward. There is an excitement and enthusiasm from the staff and staff morale and motivation is high. Clinical improvements include duration of inpatient stay being decreased due to more effective care pathways and young people now being able to step down to our new Young Person’s Home Treatment Team (YPHTT). There has been a 50% reduction in the number of physical restraints undertaken on the ward compared to this time last year. We can see anecdotal evidence that we have a much wider mix of presentations than before closure, with by and large equal throughput on each of the treatment pathways. We are seeing less incidents of self-harm under the new model.
Are the young people receptive to the improvements?
The young people love the new unit, in particular the openness of the ward and having fob access to their bedrooms and to garden areas that they can access freely (risk assessment permitting). There is also a full therapeutic activity programme which the young people enjoy to engage in around their school lessons. We also have a state of the art sensory room that is used regularly by the young people and are in the process of creating an iPad station for young people to use while inpatients.
How did you feel about the improved CQC ‘Good’ rating?
I am delighted with our new rating of ‘good’. I feel that the rating was a reflection of the hard work and commitment put in by the whole team at Brookside and a rating in which we hope to continue to improve on. As part of this we are undergoing peer review by Quality Network for Inpatient CAMHS (QNIC) in May 2017 to begin the process of obtaining QNIC accreditation. I am very proud of the multi-disciplinary team over the past year and what they have achieved.
You’ve mentioned the Young Person’s Home Treatment Team, can you tell us a bit about it?
Home treatment, which implies, ‘hospital in the home’ is an alternative Tier 4 provision that allows collaborative working between inpatient services and community services. It provides less restrictive options and can prevent a hospital admission, or facilitate more swift discharge back to the community whilst reintegrating young people into mainstream activities. The concept is not new and very good outcomes have been demonstrated in Australia and New Zealand where this has been implemented.
The Young Person’s Home Treatment Team (YPHTT) was created allowing Brookside to offer Tier 4 CAMHS provision in young people’s own homes and is the first being nationally piloted by NHS England. It has the capacity to see up to 12 young people, from the London Boroughs of Barking and Dagenham, Havering, Redbridge and Waltham Forest, at any time in their homes, and is staffed by a multidisciplinary team of professionals including doctors, nurses, occupational therapists and psychologists. It is a 24 hours, 365 days a year service. The YPHTT act as gatekeepers for the inpatient ward throughout the 24 hour period and will facilitate early discharge from the ward. The purpose of the YPHTT is to provide treatment for those young people that are experiencing an acute mental health crisis with intensive treatment under NICE guidance. It supports local CAMHS teams by offering intensity into existing care plans without duplicating services, supporting the principles of CPA process.
Why is it better to treat patients at home?
It is widely known that treating any mental health client in the least restrictive environment as possible is preferred. This is important for young people in particular to ensure they remain within their family unit and can access their friends, school, hobbies and interests and not have to deal with the stigma associated with an admission to a mental health unit which for adolescents can be particularly problematic. The Young Person’s Home Treatment Team aims to increase the service currently offered by Brookside to provide best evidence-based practice for young people with acute mental health conditions and their families, in the least restrictive manner, to enhance patient, parents and carers’ experience. The ability to move young people quickly between YPHTT and inpatient ward while retaining continuity of care is an innovative approach with an apparent case for having significant advantages for recovery.
How successful has the service been?
Since opening in September 2016, the YPHTT is providing a viable alternative to inpatient admission (reducing inpatient admission by approximately 60%) as well as facilitating earlier discharge for patients with significant functional difficulties and a wide range of diagnoses. The largest mental health presentation admitted to the YPHTT to date is those YP in crisis and self-harming. The evidence base contraindicates an inpatient admission for this client group and the YPHTT allows this demographic of young people to remain at home.
We’d like to thank Rebekah for taking the time to explain more about the changes at Brookside and the development of the YPHTT. After a disappointing first half of 2016 for the Unit, Brookside now has a bright future both for staff and the young people under their care.
To see more photos from the official re-opening, click on the following link: https://goo.gl/photos/qCEjzKDof6xbGjhUA