You can download a full version of the CORE Fidelity Scale [pdf].
Below is a list of the 39 items of the CORE Fidelity Scale (draft version 2). If you click on each item you will see the scoring criteria for that item.
- Item 1: The CRT responds quickly to new referrals
- Item 2: The CRT is easily accessible to all eligible referrers
- Item 3: The CRT accepts referrals from all sources
- Item 4: The CRT will consider working with anyone who would otherwise be admitted to adult acute psychiatric hospital
- Item 5: The CRT provides a 24 hour, seven day a week service
- Item 6: The CRT has a fully implemented "gatekeeping" role, assessing all patients before admission to acute psychiatric wards and deciding whether they are suitable for home treatment
- Item 7: The CRT facilitates early discharge from hospital
- Item 8: The CRT provides explanation and direction to other services for service users, carers and referrers regarding referrals which are not accepted
- Item 9: The CRT responds to requests for help from service users and carers whom the CRT is currently supporting
- Item 10: The CRT is a distinct service which only provides crisis assessment and brief home treatment
- Item 11: The CRT conducts a comprehensive assessment with all service users accepted for CRT support
- Item 12: The CRT provides clear information to service users and families about treatment plans and visits
- Item 13: The CRT closely involves and works with families and wider social networks in supporting service users
- Item 14: The CRT assesses carers' needs and offers carers emotional and practical support
- Item 15: The CRT reviews, prescribes and delivers medication for all service users when needed
- Item 16: The CRT promotes service users' and carers' understanding of illness and medication and addresses concerns or problems with medication
- Item 17: The CRT provides to psychological interventions
- Item 18: The CRT assesses and addresses service users' physical health needs
- Item 19: The CRT helps service users with social and practical problems
- Item 20: The CRT provides individualised care
- Item 21: CRT staff visits are long enough to discuss service users' and families' concerns
- Item 22: The CRT prioritises good therapeutic relationships between staff and service users and carers
- Item 23: The CRT offers service users choice regarding location, timing and types of support
- Item 24: The CRT helps plan service users' and service responses to future crises
- Item 25: The CRT plans aftercare for all service users
- Item 26: The CRT works to provide acceptable ending of care for service users and families
- Item 27: The CRT has adequate staffing levels
- Item 28: The CRT has a psychiatrist or psychiatrists in the CRT team, with adequate staffing levels
- Item 29: The CRT is a full multi-disciplinary staff team
- Item 30: The CRT provides a thorough induction programme for new staff and ongoing training and supervision in core competencies for CRT staff
- Item 31: The CRT has comprehensive risk assessment and risk management procedures, including procedures for safeguarding children and vulnerable adults living with CRT service users
- Item 32: The CRT has systems to ensure the safety of CRT staff members
- Item 33: The CRT has effective record keeping and communication procedures to promote teamwork and information sharing between CRT staff
- Item 34: The CRT works effectively with other community services
- Item 35: The CRT takes account of equality and diversity in all aspects of service provision
- Item 36: The CRT has systems to provide consistency of staff and support to a service user during a period of CRT care
- Item 37: The CRT can access a range of crisis services to help provide an alternative to hospital admission for service users experiencing mental health crisis
- Item 38: The CRT provides frequent visits to service users
- Item 39: The CRT mostly conducts assessments and supports service users in their home
Item 1: The CRT responds quickly to new referrals
a) The CRT records and monitors response times to referrals and reviews breaches of response targets
b) The CRT responds to the referrer within 30 minutes
c) The CRT offers an assessment with the service user which takes place within 4 hours for at least 90%of appropriate referrals
d) The CRT offers a same-day assessment for at least 50% of appropriate referrals made before 6pm
e) The CRT offers a same-day assessment for at least 90% of appropriate referrals made before 6pm
f) The CRT provides an immediate mobile response to requests for assessment from emergency services
5: 6 Criteria are met
4: 5 criteria are met
3: 4 criteria are met
2: 3 criteria are met
1: 2 or fewer criteria are met
Item 2: The CRT is easily accessible to all eligible referrers
a) The CRT has no paperwork preconditions before referral;
b) The CRT is directly contactable for referrals by phone;
c) The CRT decides whether to assess clients directly following referral and does not ask another service to assess them first
d) The CRT contact details and referral routes are publicly available
5: all 4 criteria are met
4: 3 criteria are met
3: 2 criteria are met
2: 1 criterion is met
1: no criteria are met
Item 3: The CRT accepts referrals from all sources
a) all secondary mental health services;
b) GPs;
c) other health services
d) emergency services
e) agencies other than health services which support people with mental health problems;
f) known service users and their families;
g) new service users and their families
5: all criteria are met
4: 6 criteria are met
3: 4 criteria are met
2: At least 3 criteria are met
1: 2 or fewer criteria are met
Item 4: The CRT will consider working with anyone who would otherwise be admitted to adult acute psychiatric hospital Scoring criteria: will work with the following in circumstances where they would otherwise be admitted to an acute mental health ward:
a) Personality disorder;
b) Drug and alcohol problems;
c) Learning difficulties;
d) Age 16+ (unless specific youth or older age crisis services cater for these groups);
e) AND written service guidance/protocol clearly specifies and publicises these criteria
5: all 5 criteria are met
4: 4 criteria are met
3: 3 criteria are met
2: 2 criteria are met
1: One or no criteria are met
Item 5: The CRT provides a 24 hour, seven day a week service
5: The CRT visits service users at home, when needed, 24 hours a day, seven days a week
4: The CRT visits service users at home at least 14 hours per day, and can provide telephone support and assessments at health service premises at other times
3. The CRT visits service users at home at least 12 hours a day, and can provide telephone support and assessments at health service premises at other times
2. The CRT visits service users at home less than 12 hours per day but can provide telephone support and assessments at health service premises at other times
1. The CRT does not provide telephone support and assessments on health service premises 24 hours a day.
Item 6: The CRT has a fully implemented "gatekeeping" role, assessing all patients before admission to acute psychiatric wards and deciding whether they are suitable for home treatment
a) The CRT assesses in person at least 90% of voluntary admissions to psychiatric hospital
b) The CRT assesses in person at least 98% of voluntary admissions to psychiatric hospital
c) The CRT assesses in person at least 67% of compulsory admissions to psychiatric hospital
d) The CRT assesses in person at least 90% of compulsory admissions to psychiatric hospital
e) The CRT assesses in person at least 90% of people brought to a place of safety by the police before a decision to admit to hospital is made.
f) The CRT and acute wards have systems to identify and review failures in gatekeeping and plan to avoid recurrences
5: all criteria are fully met
4: 5 criteria are met
3: 4 criteria are met
2: 3 criteria are met
1: 2 or fewer criteria are met
Item 7: The CRT facilitates early discharge from hospital
a) CRT staff attend all acute wards serving the CRT catchment area at least three times per week to screen all service users for potential early discharge;
b) CRT staff assess in person for early discharge for at least 50% of voluntary patients or patients detained for assessment in local acute wards;
c) CRT staff assess in person for early discharge for at least 80% of voluntary patients or patients detained for assessment in local acute wards;
d) At least 20% of the CRT's caseload are service users being supported with early discharge from hospital;
e) The CRT facilitates a patient leaving the ward within 24 hours for at least 90% of patients identified by the CRT and ward staff as ready for early discharge
f) There is all-source agreement that the CRT offers a same-day home visit to CRT service users discharged from hospital
5: all criteria are met
4: 5 criteria are met
3: 4 criteria are met
2: 3 criteria are met
1: 2 or fewer criteria are met
Item 8: The CRT provides explanation and direction to other services for service users, carers and referrers regarding referrals which are not accepted
a) The CRT manager and staff team identify clear care pathways and sources of support for service users requiring urgent help but not requiring hospital admission or CRT care;
b) There is all-source agreement that the CRT provides a written response phone or face-to-face contact to referrers for service users assessed in person but not taken on, explaining their decision and identifying appropriate sources of support where needed;
c) The CRT will refer in person to appropriate sources of support for service users not using other mental health services assessed in person but not taken on;
d) The CRT monitors referrers for accepted and declined referrals and provides clear guidance about referral thresholds, especially for those who frequently make referrals that are not accepted.
5: all 4 criteria are met
4: 3 criteria are met
3: 2 criteria are met
2: 1 criterion is met
1: no criteria are met
Item 9: The CRT responds to requests for help from service users and carers whom the CRT is currently supporting
Service users and carers are all given a contact phone number for the CRT
a) Phone calls from service users or carers using the CRT are answered in person by a clinician able to give advice
b) The CRT achieves for at least 90% of calls a response time of 1 hour or less for response by a CRT clinician able to give advice;
c) The CRT achieves for at least 90% of calls a response time of 20 minutes or less for response by a CRT clinician able to give advice;
d) The CRT schedules additional same-day home visits where needed in response to enrolled service users' and families' requests for help
5: All 4 criteria are met
4: 3 criteria are met
3: 2 criteria are met
2: 1 criterion is met
1: no criteria are met
Item 10: The CRT is a distinct service which only provides crisis assessment and brief home treatment
a) CRT staff's work involves crisis assessment and home treatment at least95% of the time (e.g. not also delivering A&E liaison or a more general community assessment or continuing care service)
b) At least 70% service users stay with the CRT <6 weeks
c) At least 90% service users stay with the CRT <6 weeks
d) There is all-source agreement that the majority of service users accepted for treatment would have otherwise been admitted to hospital
e) There is all-source agreement that at least 90% of service users accepted for treatment would have otherwise been admitted to hospital
5: 5 criteria are met
4: 4 criteria are met
3: 3 criteria are met
2: 2 criterion is met
1: 1 or no criteria are met
Item 11: The CRT assertively engages and comprehensively assess all service users accepted for CRT support
a) A structured assessment is carried out documenting: i) circumstances of the presenting problem and potential triggers for the crisis; ii) mental state examination; iii) symptoms; iv) current medication and adherence; v)family and social network; vi) social functioning including difficulties with employment, housing and finances; vii) substance misuse; viii) risks and safety; ix) strengths, goals and treatment preferences; x) personal and psychiatric history (or reference to where it is already accessible in patient records); xi) involved carers' views; xii) religion/spirituality and religious needs
b) The CRT uses assertive engagement strategies to assess service users in person if there are difficulties making initial contact
5: Assessments documenting at least 9 domains are completed with at least 90% of service users and the CRT uses assertive engagement strategies
4: Assessments documenting at least 8 domains are completed with at least 90% of service users and the CRT uses assertive engagement strategies
3: Assessments documenting at least 8 domains are completed with at least 80% of service users
2: Assessments documenting 7 domains are completed with at least 80% of service users
1: Assessments documenting at least 7 domains are completed with fewer than 80% of service users
Item 12: The CRT provides clear information to service users and families about treatment plans and visits
a) Written information about the CRT, its role and contact details is provided to all service users and carers present at initial assessment:
b) A written treatment plan identifying the interventions the CRT will provide is provided to all service users and involved family/carers within 4 working days;
c) Home visits are arranged the day before for at least 80% of service users currently on the caseload
d) Service users are given a definite time, or a window of time of not more than one hour, at which visits will occur
e) CRT staff arrive within an hour of the planned time at least 90% of the time;
f) Service users are phoned in advance if CRT staff will be more than 15 minutes late at least 90% of the time;
5: All criteria are met in full
4: 5 criteria met
3: 4 criteria are met
2: 2 or 3 criteria are met
1: 1 or no criteria are met
Item 13: The CRT closely involves and works with families and wider social networks in supporting service users
a) Initial assessment or treatment plans identify the key people in service users' family or social network;
b) The CRT have documented attempts to contact at least one key family or other person in their social network for all service users;
c) At least one key family member or other person in the social network is invited to care planning or review meetings, where the service user's consent is given;
d) An individualised role for at least one key family member or other person in the social network in treatment plans is identified in service users' treatment plans/case notes, where the service user's consent is given
e) There is all-source agreement that the CRT works closely with families in supporting service users
(Criteria A-D: Met = provided for at least 80%of service users)
5: All 5 criteria are met
4: 4 criteria are met
3: 3 criteria are met
2: 2 criteria are met
1: 1 or no criteria are met
Item 14: The CRT assesses carers' needs and offers carers emotional and practical support
a) The CRT offers families/carers the opportunity to meet CRT staff separately from the service user to discuss their own support needs;
b) The CRT provides carers/families with information about local services for carers (e.g. welfare advice, carers groups);
c) The CRT specifically records (using a structured form or as part of assessment/treatment plans) carers' needs and a support plan and provides the carer with a written copy;
d) The CRT staff demonstrate a clear, shared understanding of how carers may be supported even where service users refuse permission to share information with carers
(A-C: met = at least 80% of service users with an involved family member/carer)
5: All criteria are met
4: 3 criteria are met
3: 2 criteria are met
2: 1 criterion is met
1: No criteria are met
Item 15: The CRT reviews, prescribes and delivers medication for all service users when needed
a) The CRT team includes staff who can review and prescribe medication daily
b) The CRT has access to out-of-hours medication review and prescription
c) The CRT collects and delivers medication for service users up to twice a day where needed;
d) The CRT has written medication policies and procedures which are well understood by CRT staff
(Refer to scoring guidance for thresholds for fully and partially met criteria)
5: All criteria are fully met
4. 3 criteria are fully met and one partially met
3. 3 criteria are fully met and one unmet OR two are fully met and two partially met
2: 2 criteria are fully met and at least one unmet OR all 4 are partially met
1: Only one criterion is fully met OR <4 are partially met
Item 16: The CRT promotes service users' and carers' understanding of illness and medication and addresses concerns or problems with medication
a) CRT staff have access to and awareness of materials to give to service users regarding diagnosis and the nature of their mental health problems
b) Side effects are monitored with evidence of review or response to identified side effects with at least 80% of service users on psychotropic medication;
c) Service users and involved carers are provided with written details of the current medication regime;
d) Service users and involved carers are provided with written and oral information about the rationale, desired effect and possible side effects of prescribed medication
e) Service users' current adherence to prescribed medication is documented for at least 80% of service users
f) Strategies to aid medication adherence are implemented when non-adherence is identified.
5. All criteria are met
4: 5 criteria are met
3: 4 criteria are met
2: At least 2 criteria are met
1: 1 or 0 criteria are met
Item 17: The CRT provides psychological interventions
a) The CRT team includes a qualified psychologist practitioner or accredited CBT therapist at least 0.4 fte who sees CRT service users;
b) CRT staff demonstrate capacity to deliver brief psychological interventions to CRT service users and families.
c) Brief psychological interventions are provided to >30% of CRT service users
d) CRT staff can access direct psychological consultancy input from a psychologist practitioner or accredited CBT therapist regarding any service user where needed
e) CRT staff are provided with supervision or training in delivering psychosocial interventions from an experienced clinician at least every 2 months (>80% of the staff team)
5: all 5 criteria are met
4: 4 criteria are met
3: 3 criteria are met
2: 2 criteria are met
1: One or no criteria are met
Item 18: The CRT considers and addresses service users' physical health needs
a) Service users' physical health problems are asked about and documented in initial assessments (at least 80% of service users);
b) There is all source agreement that the CRT facilitates access to physical health investigations and treatments during CRT care for those with identified physical health problems
c) The CRT provides or arranges (or confirms provision during the last 12 months) screening for cardiovascular risk factors for at risk service users who consent to this (at least 80% of service users);
d) The CRT has working equipment and facilities and appropriately skilled personnel to carry out weight and blood pressure checks, urine testing for glucose levels
5: All criteria are met
4: Three criteria are met
3: Two criteria are met
2: One criterion is met
1. No criteria are met
Item 19: The CRT helps service users with social and practical problems
The CRT helps service users with the following life domains:
a) Basic living needs (e.g. ensuring access to food, heating and helping with immediately required cleaning or repairs);
b) Benefits and debts (e.g. ensuring access to essential benefits/sources of income + assistance with urgent debt management);
c) Urgent legal and social problems (e.g. assistance with urgent criminal justice matters; threats to current employment; threats to housing tenure)
5: All three life domains are fully addressed by the CRT
4: 2 life domains are fully supported and 1 is partially supported
3: 2 life domains are fully supported and one is not supported; or all 3 domains are partially supported
2: One life domain is not supported and at least one other is only partially supported
1: Two or three life domains are not supported
Item 20: The CRT provides individualised care
a) Service users' individual needs and goals are recorded in initial assessments or treatment plans (fully met = needs and goals recorded clearly for at least 90% of service users;partially met = some record of needs or goals at least 70% of service users);
b) There is agreement from all sources that CRT treatment and support reflects service users' needs and goals;
c) CRT intervention includes some form of intervention in addition to medication review/delivery, risk assessment and referral on to other services (fully met = at least 90%; partially met = at least 70%)
5: All criteria are fully met
4: At least one criterion is fully met and the others are partially met
3. All criteria are partially met OR two criteria are fully met and one is unmet
2. Two criteria are partially met and one is unmet OR one criterion is fully met and two are unmet
1. one or no criteria are partially met; others are unmet
Item 21: CRT staff visits are long enough to discuss service users' and families' concerns
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 to address excessive numbers of brief visits;
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
5: All criteria are fully met
4: Criteria C and D are met, but one of criteria A or B is not met
3: Criteria C and D are met but criteria A and B are not met
2: Criterion C OR criterion D is not met
1: Neither criterion C nor D is met
Item 22: The CRT prioritises good therapeutic relationships between staff and service users and carers
a) Recruitment involves procedures explicitly designed to identify staff with good interpersonal skills when working with service users;
b) The CRT takes steps to monitor and develop all CRT staff's interpersonal skills with service users and families;
c) The CRT explicitly seeks feedback from service users (e.g. via survey or audit) within the last year and demonstrates action to address resulting concerns and complaints;
d) There is all source agreement that staff are caring and professional in working with service users and families
5: All criteria are met
4: Criterion D is fully met and 2 other criteria are met
3: Criterion D is fully met but fewer than two other criteria are met
2: Criterion D is partially met
1: Criterion D is unmet
Item 23: The CRT offers service users choice regarding location, timing and types of support
a) Accepting medication is not a precondition for receiving CRT care;
b) Service users' preferences regarding treatment options are considered and reflected in treatment plans;
c) The CRT meets service users in a range of locations (not just a casualty department or hospital sites) where home visiting is not possible or not wanted by the service user;
d) The CRT arranges the time of visits to fit around service users' or carers' preferences or commitments (e.g. work, childcare)
5: All criteria are met
4: Criterion A and 2 other criteria are met
3: Criterion A and 1 other criterion are met
2. Criterion A and no other criteria are met
1. Criterion A is not met
Item 24: The CRT helps plan service users' and service responses to future crises
a) The CRT develops or reviews partial basic relapse prevention plans with service users
b) The CRT routinely develops thorough relapse prevention plans with service users
c) CRT staff helps service users to use structured self-management programmes to promote recovery or respond to future difficulties
d) The CRT has systems to help service users develop advance directives where appropriate and to ensure existing advance directives are followed wherever possible
5: All criteria are met in full
4: Three criteria are met
3: Two criteria are met
2: One criterion is met
1: No criteria are met
Item 25: The CRT plans aftercare with all service users
a) The CRT discusses and agrees plans for ending CRT care and follow-on care with other involved secondary mental health services before a service user is discharged from the CRT
b) The CRT makes referrals to health services and other organisations identified to provide support post-discharge wherever additional support is required
c) A discharge meeting is arranged and service users and involved family are invited to attend;
d) Other involved mental health services attend the discharge meeting;
e) A written discharge plan identifying providers of support following discharge from the CRT is provided to service users;
f) Details of how to access crisis help in the future are provided to the service user and involved family members
5: All criteria are met
4: Criterion A and 4 other criteria are met
3. 4 criteria are met
2. At least 2 criteria are met
1. No or one criteria are met
Item 26: The CRT prioritises acceptability to service users in how CRT care is ended
a) Service users and involved family are given at least 48 hours' notice before discharge from the CRT (excluding hospital admission);
b) The CRT discusses with service users and involved family regarding how and when CRT care should end;
c) The CRT will "taper" care i.e. planned decrease in frequency of care before discharge to meet service users' needs and preferences;
d) Service users or families may contact the CRT directly for support or advice for at least 2 weeks following discharge (regardless of general referrals policy);
e) There is all source agreement that the CRT provides service users and families with information about other services they could access following CRT discharge
5: All criteria are met
4: 4 criteria are met
3: 3 criteria are met
2: 2 criteria are met
1: 1 or no criteria are met
Item 27: The CRT has adequate staffing levels
a) The CRT caseload of service users receiving acute home treatment is not too high (Fully met = median CRT caseload is no more than 25 per 14 full time equivalent clinical staff; partially met = median CRT caseload is no more than 30 per 14 full time equivalent clinical staff;
b) There is all source agreement that the CRT has the resources to carry out same day crisis assessments and home visits to CRT service users;
c) There is all-source agreement that the CRT has the resources to offer home treatment wherever possible to all service users who would otherwise be admitted or who may benefit from early discharge;
d) More than 80% of CRT staff (over the last three months) are permanent staff (not locum, bank or agency staff)
5: All criteria are fully met
4: Criterion A is fully met and two other criteria are met
3: Criterion A is fully met and one other criteria is met OR Criterion A is partially met and all other criteria are met
2: Criterion A is partially met and no more than two other criteria are met
1: Criterion A is not met
Item 28: The CRT has a psychiatrist or psychiatrists in the CRT team, with adequate staffing levels
a) Total psychiatric cover is at least 1.0 full time equivalent (fte) per median CRT caseload size of 30, involving some cover on at least 5 days per week (fully met); at least 0.6 fte per caseload of 30 involving some cover on at least 3 days per week (partially met);
b) Total consultant psychiatrist time is at least 0.6fte per median caseload of 30 involving some cover on at least 3 days per week (fully met); at least 0.3fte per caseload of 30 (partially met);
c) The CRT can obtain advice and arrange urgent psychiatric assessments within 4 hours for CRT service users from a psychiatrist within the local service system throughout the CRT's opening hours
5: All criteria are fully met
4: 2 criteria are fully met and one is partially met
3: 2 criteria are fully met and one is not met OR one criteria is fully met and two are partially met
2: Only one criterion is fully met and at least one is unmet
1: No criteria are fully met
Item 29: The CRT is a full multi-disciplinary staff team
CRT staffing includes dedicated time from: i) nurses; ii) occupational therapists; iii) clinical or counselling psychologists; iv) social workers; v) psychiatrists; vi) service user-employees; vii) other support staff without professional mental health qualifications; viii) pharmacists ix) Approved Mental Health Professionals or equivalent; x) non-medical prescribers; xi) family therapist; xii) registered cognitive behavioural therapist
5: The CRT team includes 8 or more of the listed staff groups
4: The CRT team includes 7 of the listed staff groups
3: The CRT team includes 6 of the listed staff groups:
2: The CRT team includes 5 of the listed staff groups
1: The CRT team includes 4 or fewer of the listed staff groups
Item 30: The CRT provides a thorough induction programme for new staff and ongoing training and supervision in core competencies for CRT staff
a) Induction for new staff involves at least 12 hours of CRT-specific training for staff who have not previously worked in CRTs;
b) At least 80% of CRT staff have received supervision at least monthly during the last 6 months;
c) The CRT has a programme of ongoing CRT service-specific training for CRT staff with sessions at least every two months;
d) The CRT manager or senior staff conduct field mentoring of at least 80% CRT staff at least once each year
e) At least 80% of CRT staff have had a formal appraisal within the last year
5: all 5 criteria are met
4: 4 criteria are met
3: 3 criteria are met
2: 2criterion is met
1:1 or no criteria are met
Item 31: The CRT has comprehensive risk assessment and risk management procedures, including procedures for safeguarding children and vulnerable adults living with CRT service users
a) Risk assessment: a structured risk assessment proforma is used documenting identified risks of self-harm or suicide, self-neglect, exploitation by others and harm to others + clearly identifying contact with children and vulnerable adults and potential related risks to them for at least 80% of service users;
b) Risk management: an individualised risk management plan is documented for all identified risks including current CRT response and plans for increase in risk, for at least 80% of service users
c) There is evidence that risk assessments and management plans are reviewed by staff during CRT care and changed where appropriate as perceived risks change and/or management plans require change
d) CRT staff training in safeguarding children and vulnerable adults is up-to-date in line with service guidelines and staff show awareness of thresholds for contacting other agencies; (met = at least 80% of staff team trained within time period specified in national and local guidelines)
e) High risk service users are identified and prioritised at CRT team level (e.g. specifically discussed at handovers, on team boards);
f) The CRT can provide staff to stay with service users at home for extended periods (up to 4 hours) to manage risks in exceptional circumstances (e.g. carer absence, start of medication)
5: All criteria are met
4: 5 criteria are met
3. 4 criteria are met
2. 3 criteria are met
1. Two or fewer criteria are met
Item 32: The CRT has systems to ensure the safety of CRT staff members
a) The CRT/local organisation has clear lone worker and safety check-in policies which are adhered to;
b) The CRT adopts practical solutions where required to provide a service while maintaining staff safety (e.g. visits in pairs, same gender workers, facilities to see service users on health service premises);
c) At least 80% of staff are up to date with local safety training procedures (e.g. "break away" or conflict resolution training);
d) The CRT manager or senior staff provide same day debriefing/reflection for CRT staff following a threatening or upsetting incident;
e) Serious untoward incidents involving staff safety are specifically recorded and reviewed at least annually to identify necessary changes to safety arrangements
5: all criteria are met
4: Criteria A and B and two other criteria are met
3: Criteria A and B are met and fewer than 2 other criteria are met
2: Either criterion A or criterion B is not met
1:Criterion A and criterion B are both not met
Item 33: The CRT has effective record keeping and communication procedures to promote teamwork and information sharing between CRT staff
a) The CRT has handover meetings between each CRT shift;
b) All day time shifts start with handovers reviewing clinical status and immediate action steps for all current CRT service users;
c) The CRT has whole-team meetings at least once per month to address staff issues, team procedures and organisation (clinical discussions of clients are not held at this meetings);
d) CRT staff contacts with service users are written up in patient records the same day at least 90% of the time;
e) CRT staff have immediate out-of-office access to read and write patient records
5: all criteria are met
4: 4 criteria are met
3: 3 criteria are met
2: 2 criteria are met
1: 1 or no criteria are met
Item 34: The CRT works effectively with other community services
a) Communication and joint meetings between CRT and involved staff from other community mental health services are evident for at least 80% of service users with involved community services during CRT care;
b) CRT discharge plans and treatment summaries are routinely sent to GPs and involved mental health services promptly (within 3 days) at the end of CRT care (for at least 80% of service users);
c) The CRT has an identified link worker or equivalent for at least one key community mental health service who visits the service at least monthly to discuss joint working issues;
d) CRT and community mental health service managers meet at least every two months to review care pathways and referral protocols and address issues re joint working;
e) There is all source agreement that there are good working relationships between the CRT and other community teams
5: All criteria are met
4: Criterion A and E and two other criteria are met
3: At least 3 criteria are met
2: 2 criteria are met
1: One or no criteria are met
Item 35: The CRT takes account of equality and diversity in all aspects of service provision
a) The CRT can access interpreters to attend in person/video conference within 24 hours and by phone within 4 hours for at least 90% of service users for whom this is needed;
b) The CRT monitors service accessibility
c) The CRT team broadly reflects the demographics of the local population;
d) The CRT can demonstrate at least one active attempt during the last 12 months relevant to the local population to make the CRT service more appropriate for a minority group
e) There is all-source agreement that the CRT provides a service which is sensitive to diversity and responds to service users' and families' needs regarding disability, race, gender, ethnicity or sexuality.
5: All criteria are met
4: Criteria A and E and 2 other criteria are met
3: Criterion A and E are met but other criteria are met
2: One of criteria A and E is met
1:Neither criterion A nor criterion E are met
Item 36: The CRT has systems to provide consistency of staff and support to a service user during a period of CRT care
a) The CRT allocates a named worker or equivalent for each service user who is responsible for ensuring key care tasks for that service user are completed;
b) Service users and carers are made aware who their named worker is (at least 80% of service users);
c) The CRT has effective systems to limit the number of staff seen by a service user during an episode of CRT care;
d) There is all-source agreement that CRT staff arrive with up-to-date information about the service user and treatment and succeed in avoiding unnecessary duplication of questions/information and provide a coherent treatment approach
5: All criteria are fully met
4: Criterion D and two other criteria are met
3: Criterion D and one other criterion are met
2: Criterion D is met but no other criteria are met
1: No criteria are met
Item 37: The CRT can access a range of crisis services to help provide an alternative to hospital admission for service users experiencing mental health crisis
a) The CRT can refer to a residential crisis service
b) There is all-source agreement that the CRT has good access to beds at a residential crisis service
c) The CRT can refer to an acute day service
d) There is all-source agreement that the CRT has good access to an acute day service
5: All criteria are met in full
4: Three criteria are met
3: Two criteria are met
2: One criterion is met
1: No criteria are met
Item 38: The CRT provides frequent visits to service users
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
5: all criteria are met
4: 4 criteria are met
3: 3 criteria are met
2: 2 criteria are met
1: 1 or no criteria are met
Item 39: The CRT mostly assesses and supports service users in their home
Where the service user has not actively expressed a preference to meet elsewhere:
5: At least 80% of CRT contacts with service users take place in the service user's home or current place of residence
4: At least70% of CRT contacts with service users take place in the service user's home or current place of residence
3: At least 60% of CRT contacts with service users take place in the service user's home or current place of residence
2: At least 40% of CRT contacts with service users take place in the service user's home or current place of residence
1: Less than 40% of CRT contacts with service users take place in the service user's home or current place of residence