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The Core Study

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Item 32

Maintaining safety of staff

Target

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 allow a service to be provided to higher risk service users (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.

Why this is important

CRT work involves lone working and home visits, sometimes with people who are not well known to services or whose clinical presentation may be changing rapidly. Robust systems to ensure staff safety are therefore very important.

Ways of doing this well

The West Suffolk HTT have trialled two different personal alarm systems, which they outline in the case study below:

Case study: lone worker devices

The West Suffolk HTT are currently involved with a Trust pilot project looking at lone worker devices for community working. The geographical area of the Trust covers many rural areas where mobile phone reception is not reliable. Whilst the Trust has a lone worker policy this focuses on knowing where staff are and what risks may be associated with the individual receiving a service rather than how staff would seek support or help in a difficult situation. 

It has been highlighted that if a member of staff needed to call assistance whilst in the community there are 2 potential problems. One is the lack of mobile phone service and the second is that there may be a need to discretely call for assistance so not to antagonise the situation further. 

The Trust contacted several different suppliers of devices and are currently trialling 2 favoured devices. The HTT have taken part in the pilot due to the acute nature of service they deliver. Service Users behaviour can often be unpredictable whilst acutely unwell and therefore staff may find themselves at unexpected risk. The 2 devices trialled both had advantages and disadvantages. The first device was the more discrete option as you can slot it alongside your I.D badge. However it was unclear at times whether staff had succeeded in activating it prior to entering the service users home. It worked by alerting a call centre that you had entered a property.  The second device was easier to use however more bulky in appearance making it less discrete.  Staff have reported feeling more confident at seeing service users at home knowing that they have a device they can call for help on however there needs to be some refinement of the devices to make them fit for purpose. 

The first device was useless as it was difficult to know if the device was even turned on.  The second device was more useful but is bulky.  I could see staff leaving it at home or in their cars due to its bulk.  If the second device was as light and transportable as the first, it would be ideal for our purpose.  

The 1st unit 

Failings:

• It did not clearly show that it was on or off after a period of time the led lights did not function unless you do the start up process again.

• Battery life was poor 

• The Buttons were very hard to press and at times I did not know if I would end up breaking them with the amount of force used

• Not user friendly

Pros:

• The unit looking like a card holder made it discreet when out in the community 

The 2nd unit

Failings:

• Not discreet and very bulky when using the badge holder and this came across as obvious to the clients

• It easily can set off an emergency by mistake due to the weak buttons (when in your bag, pocket etc)

Pros:

• More user friendly and easier to understand how to use

• With the added feature of phone calling your base is useful 

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:

  • Witshire North Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
  • Greenwich CRT, Oxleas NHS Foundation Trust
  • Sunderland, Northumberland, Tyne and Wear NHS Foundation Trust
  • Wyre Forest, Bromsgrove and Redditch HTT, Worcestershire Health and Care NHS Trust
  • Maidstone CRT, Kent and Medway NHS and Social Care Partnership Trust
  • Pontypool CRHTT, NHS Wales
  • Northamptonshire North (Kettering) CRHTT, Northamptonshire Healthcare NHS Foundation Trust
  • North East Kent CRHTT, Kent and Medway NHS and Social Care Partnership Trust
  • Shropshire CRT, South Staffordshire & Shropshire Healthcare NHS Foundation Trust
  • Newham Psychiatric Acute Community Team, East London NHS Foundation Trust
  • South Tyneside Initial Response Team, Northumberland, Tyne and Wear NHS Foundation Trust
  • Bromley HTT, Oxleas NHS Foundation Trust
  • Dudley CRT, Dudley and Walsall Mental Health Partnership NHS Trust
  • Waltham Forest HTT, North East London NHS Foundation Trust
  • Barking, Dagenham, Havering HTT, North East London NHS Foundation Trust
  • Tower Hamlets HTT, East London NHS Foundation Trust
  • Redbridge HTT, North East London NHS Foundation Trust
  • Walsall CRT, Dudley and Walsall Mental Health Partnership NHS Trust
  • Hastings CRT, Sussex Partnership NHS Foundation Trust
  • Great Yarmouth CMHT, Norfolk & Suffolk NHS Foundation Trust
  • West Berkshire CRHTT, Berkshire Healthcare NHS Foundation Trust
  • Eastbourne CRT, Sussex Partnership NHS Foundation Trust
  • Swale and Medway CRHTT, Kent and Medway NHS and Social Care Partnership Trust
  • Manchester North, Manchester Mental Health and Social Care Trust
  • Hounslow HTT, West London Mental Health NHS Trust
  • Brighton & Hove CRHTT, Sussex Partnership NHS Foundation Trust
  • East Berkshire CRHTT, Berkshire Healthcare NHS Foundation Trust
  • North West Sussex (Crawley) CRT, Sussex Partnership NHS Foundation Trust
  • Mid Surrey (Epsom) HTT, Surrey and Borders Partnership NHS Foundation Trust
  • Surrey East (Redhill) HTT, Surrey and Borders Partnership NHS Foundation Trust
  • South Essex West (Basildon) CRHTT, South Essex Partnership University NHS Foundation Trust 
  • South East Essex (Rochford) CRHTT, South Essex Partnership University NHS Foundation Trust 
  • Ealing CRHTT, West London Mental Health NHS Trust
  • Yeovil CRT, Somerset Partnership NHS Foundation Trust 
  • Bath Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
  • Mendip CRHTT, Somerset Partnership NHS Foundation Trust 
  • Teignbridge CRHTT, Devon Partnership NHS Trust
  • South Hams and West Devon CRHTT, Devon Partnership NHS Trust
  • North Devon CRHTT, Devon Partnership NHS Trust
  • East and Mid Devon CRHTT, Devon Partnership NHS Trust
  • Taunton and Bridgewater CRHTT, Somerset Partnership NHS Foundation Trust 
  • Wandsworth CHTT, South West London and St George's