Essex Partnership University NHS Foundation Trust

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a comprehensive assessment of young people in a timely manner at, or soon after admission. Staff regularly reviewed and updated this assessment at regular time points during their stay at the service.

We reviewed minutes from multidisciplinary meetings, these evidenced young people’s care and treatment being reviewed by the multidisciplinary team, young people and their carers with a person-centred approach being taken to meet their needs.

Young people had their physical health assessed soon after admission and regularly reviewed during their time on the wards. This included electrocardiograms (ECG’s) and blood tests on admission and when needed. Staff used the National Early Warning Score (NEWS2) and escalated concerns.

Staff developed a care plan for each young person that met their mental and physical health needs. Care plans were personalised and recovery orientated. Plans for treatment set out the young person’s goals, as well as arrangements for occupational therapy, psychology and risk management.

Staff used Dialectical Behaviour Therapy techniques (DBT is a form of cognitive behavioural therapy which can support people expressing distress and agitation) and “DBT prescriptions” tailored to each young person.

Young people had a Positive Behaviour Support Plan (PBS). PBS plans supported staff and young people to manage potentially triggering situations by focussing on the underlying needs and circumstances that may contribute to them. This meant staff had a clear understanding of individual needs and preferences.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well

Staff provided a range of care and treatment interventions suitable for the group and consistent with national guidance on best practice. They ensured young people had good access to physical healthcare and supported young people to live healthier lives.

Staff delivered interventions in line with National Institute for Health and Care Excellence guidelines. During admission young people were placed on a care pathway, which helped determine the interventions they were offered. The pathways delivered guidance for professionals involved in the young person’s care, providing timescales and protocols for different presentations. There were 6 pathways: Core, trauma, neurodivergent, disordered eating, emotional dysregulation and psychosis. All young people were placed on the core pathway and additional pathways were added if necessary.

Young people and their families had access to a range of therapeutic interventions tailored to their individual needs, these included Dialectic Behavioural Therapy (DBT), trauma informed assessments and interventions, Eye Movement Desensitisation and Reprocessing (EMDR), Cognitive Behavioural Therapy (CBT) Systemic and Family Psychotherapy, Art Psychotherapy and Occupational Therapy (OT).

Staff ensured that young people had good access to physical healthcare, staff referred young people to specialists when required. Young people had access to a physical healthcare drop in weekly and physical health was regularly monitored.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. The service conducted numerous monthly audits which included medication, young people’s records and observations. Actions were documented and audit findings were shared and discussed in meetings.

Managers used results from audits to make improvements. For example, feedback and actions from audits were shared with staff, including specific tasks for named roles to improve compliance.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff shared information about young people at effective handover meetings within the team, these took place twice a day, before the commencement of each shift. There was also a morning meeting which the MDT and leaders attended. There was a process to escalate any high-level concerns which staff were aware of.

Staff had regular and effective multidisciplinary team (MDT) meetings. There were professionals involved in the assessment and review of young people’s health, care and treatment, wellbeing and communication needs. Professionals were engaged in reviews and assessments.

Staff worked closely with external organisations such as local authorities and commissioners of health care services. We saw evidence in young people’s care plans of the service working with commissioners, community mental health teams, social workers and advocates to support young people.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff assessed young people’s physical health on admission and developed individualised physical health care plans to address any identified needs which were regularly reviewed. We saw examples of individualised care plans for conditions such as diabetes and disordered eating. Young people’s physical health was also monitored whenever psychiatric medications were prescribed or adjusted.

Young people were supported with education and guidance around healthy eating, shopping and food selection, portion control and balancing food groups, If necessary, young people could access dietician input to address specific nutritional needs.

The multidisciplinary team promoted health and wellbeing through daily interactions and structured activities. Occupational therapy and nursing staff facilitated regular exercise groups, young people could access things such as cycling, trampolining and swimming. There were also groups for gardening and yoga.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff continuously monitored young people’s health, their mental state and well-being. At twice daily handover meetings, staff noted details of young people’s sleep, food and fluid intake, personal hygiene, compliance with medication, and engagement in activities.

Staff used recognised rating scales to assess and record the severity of young people’s conditions and care and treatment outcomes. For example, reporting measures included Outcome Rating Scale (ORS), this is a 4-item measure designed to assess areas of life functioning known to change as a result of therapeutic interventions. Staff also used the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) used in child and adolescent mental health services as a measure of young people’s general health and social functioning and the Children’s Global Assessment Scale (CGAS) which is a clinicians rating tool of psychological and social functioning for children and young people.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff assessed young people’s capacity to consent to admission and treatment. Staff assessed young people’s capacity for specific decisions throughout their care and treatment. Capacity was monitored and recorded at multidisciplinary team meetings. Staff we spoke with told us if a young person lacked capacity to make a specific decision, staff made decisions in their best interests, recognising the importance of the person’s wishes and involving their carers.

Staff took all practical steps to enable young people to make their own decisions. Young people made their own choices and decisions on a day-to-day basis about what they did, what they ate and how they filled their time. When staff felt a young person may have lacked capacity to decide, staff provided support. For example, if a young person was thought to lack capacity to consent to treatment, staff explained why the treatment was important, how they would benefit from it and described any possible side-effects.

If a young person was detained under the Mental Health Act 1983, the arrangements for their detention and treatment were consistent with the requirements of the Act and accompanying code of practice. Staff supported young people to understand how the Mental Health Act applied to their situation and that young people understood their right to appeal.