RAIDPlus Integrated Mental Health Urgent Care Project
RAIDPlus is an innovative project that aims to achieve predictive, preventative, integrated and efficient mental health urgent care service for patients and their relatives with the use of combinatorial innovation.
 

Ideas (Publish, Detailed Submission)

Innovation 'Elevator Pitch':
The bespoke training programme aims to increase mental health awareness and increase skills in identifying and managing mental health crisis with emphases to referral pathways that can be applied in operational practice by frontline professionals.
 
Overview of Innovation:
RAIDPlus takes a more localised training approach and has identified priority front line services that frequently coming into contact with those suffering from mental illness and potentially at risk of crisis i.e. Police officers and Community healthcare professionals who are working with individuals with both physical and mental health difficulties.

The training aims to increase knowledge and understanding of mental illnesses as well as support early referral and appropriate management of individuals who are experiencing deterioration in their mental health. The overall aim is to build confidence and competence in front line professionals and generate a supportive and informed approach when working with those in mental health distress.

The training modules are as follows:
  • Understanding mental illness: Signs and Symptoms of mental health
  • Effective de-escalation and communication skills
  • Understanding Mental Health Act (1983) and Mental Capacity Act (2005)
  • Crisis Prevention and Management (including risk assessment of suicide and self-harm)
  • Dementia
The training package offers provision to tailor elements of the content to suit the locality’s policy and services available, should organisations wish to implement the RAIDPlus training. For example, the 'Crisis Prevention and Management' module explores referral pathways and services available within Birmingham and Solihull Mental Health Trust. These could be easily amended to reflect the organisations services to ensure the training maintains its bespoke, localised approach. The training can be customised but would generally take a full day to cover all modules.

This allows for local frontline professionals that come in contact with mental health patients to be able to identify and prevent patients going into crisis by referring patients to access appropriate mental health support in a timely manner.

The training is delivered by a registered mental health professional to ensure that the full potential of learning amongst participants is achieved. The experience and understanding of such an individual will aid questions posed throughout the training and allows them to draw to from previous experiences/scenarios from real life mental health practice within the delivery.
 
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Education, training and future workforce / Innovation and adoption
Benefit to NHS:
National directives indicate that, in general, the public should have a baseline knowledge and understanding of mental illness (Public Health England, NHS Five Year Forward View). It is nationally acknowledged that many patients with long term physical health care conditions have a diagnosed mental health issue (NHSE FYFV). Due to limited training and data sharing the co-ordination of care for these patients is often fragmented (Crisis Concordat, 2015). This may result in patients experiencing mental health crisis and entering the urgent care pathway unexpectedly. This causes pressure on urgent care services and could also impact the patient experience.

Our vision is to help develop a community healthcare workforce that is fully trained in mental health, with access to the right tools and pathways to support patients suffering with mental health issues. This will ensure that patients with comorbid conditions are positively supported to access the right care, at the right time in the right place. The better management of the mental health care can have a positive impact to patients' care as well as possibly avoiding their mental health deteriorating further.

In 2015 the Mental Health Network Confederation highlighted; "the police and mental health providers need to understand each other’s legal powers, roles and responsibilities "to manage /reduce the risks associated with mental health crisis". Additionally, the police often come in contact with people experiencing mental health distress and usually have to manage difficult and complex situations. Training is needed to equip them to recognise and assist when someone has a mental health issue or learning/intellectual disability. This is in line with the College of Policing requirements for mental health awareness training within the police force.

The police are frequently in contact with people suffering from mental health problems, so to be able to identify these symptoms and be able to direct them to right pathway in a timely manner is a huge benefit as it can save the person further unnecessary complications and faster access to help. The police would also benefit by being able to correctly manage people undergoing mental health distress when responding to mental health-related incidents. They will be able to acquire practical skills to spot the triggers and signs of mental health issues and be able to confidently step in, reassure and support a person in distress.
  
 
Initial Review Rating
1.00 (1 ratings)
Benefit to WM population:
Within the West Midlands 20-40% of police time is dedicated to those experiencing mental health difficulties. Therefore, the ability to identify symptoms and signs of mental health distress and be able to refer patients to the appropriate pathways ensures a better and efficient system. The training helps police develop skills to manage those with mental health illness/facing mental health crisis and saves time and resources. The training will cover the Mental Health Legislation and Mental Capacity Act which aligns with the College of Policing training requirement for the West Midlands Police.

By training the Birmingham Community Healthcare Trust staff, this supports staff being able to ensure the patients with long terms conditions that have signs of mental health issues are supported to access the right care in a timely manner. Having an understanding of the mental health support pathways and services for patients avoids patients experiencing mental health crisis by early intervention and reduces unplanned emergency visits to the urgent care system.

There is wider scope however for target audiences and suggestions to be considered for future delivery of the training include:
  • Wider community and health care teams within Birmingham/ Solihull
  • Schools, universities and colleges
  • Ambulance services
  • Fire Services
  • Workplace learning and team building
Current and planned activity: 
To date, the RAIDPlus training package has been created and delivered by the mental health trainer who is a registered mental health nurse with a number of years’ experience within acute mental health. The training was delivered to 1600 staff across the West Midlands Police and 150 Birmingham Community Healthcare staff.  

The police training was tailored and aligned to the learning objectives of West Midlands Police. This is in connection to the College of Policing requirements and Authorised Professional Practice for mental health within the police force. The community trust training was tailored to meet the learning needs of staff to capture the referral pathways and crisis prevention elements relevant to their services. Overall, the training was positively received by staff and early outcomes suggest improved capacity to provide supporting interventions to reduce the risk of crisis.
What is the intellectual property status of your innovation?:
BSMHFT is the provider of this training package.
Return on Investment (£ Value): 
medium
Return on Investment (Timescale): 
N/A
Ease of scalability: 
2
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Semhar Abraha 10/07/2018 - 09:29 Publish Login or Register to post comments
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Innovation 'Elevator Pitch':
CaDDI provides ‘live’ capacity and demand information across the Mental Health Urgent Care Pathway through an internet based dashboard. This provides a realistic resource and bed capacity and referral demand across the urgent care pathway and beyond.
Overview of Innovation:
The Midlands and Lancashire Commissioning Support Unit (MLCSU) , in partnership with Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT), have developed a live Capacity and Demand Dashboard Information (CaDDI) system for use across the mental health urgent care pathway. It delivers improved patient pathways by providing managers and operational staff instant access to ‘live’ patient flow information, allowing them to make more informed decisions on staff deployment and onward referrals based on data-led assessments. 

The CADDI package consists of two elements:
  • A mobile APP solution to collect ‘live’ data from operational teams, on their current capacity, and progress of their patients’ journey throughout the referral process;
  • A ‘live’ dashboard providing an overall capacity and demand summary status across the Urgent Care pathway, with drill down functionality to a service/team level.

The CaDDI system can be populated from any source that can send live structured data or can use the app developed to enable the live gathering of data.

Currently the data capture systems options include:
  • RAID teams (In-reach service hosted within another organisations)
  • Decision Unit (location based service, with defined number of places available)
  • Place of Safety (specialised location based service, with defined number of places available)
  • Street Triage Team (Out-reach service, mobile service providing reactionary support to urgent care situation within public areas, in partnership with Ambulance and Police Service)
  • Bed management (populated through PAS) – Inpatient demand and capacity, key metrics on patients waiting for a bed, occupancy rates, patients waiting for discharge, and patients out of area.
The CaDDI mobile app enables urgent care teams to access an ‘at an glance’ worklist view of the referrals currently open on their team, including at which point each patient is in within the referral process. The staff can then record timely information in the app any action taken, what is the next action and if patient is waiting for services. This chronological record of the steps from when the patient enters the system until departure helps in the completion of the patient’s clinical record and can be can be accessed by all team members until patient has been discharged.
 
The 'live' dashboard will then display this information obtained by the mobile app and bed management system, providing a holistic and comprehensive view of capacity and demand across services. 
Stage of Development:
Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Wealth creation / Digital health / Innovation and adoption
Benefit to NHS:
The CADDI system aims to streamline the way in which patients move through the Urgent Care pathway. The new system will be able to demonstrate realistic capacity and demand across the Urgent Care system. The information team will be capturing the data delivered by the RAIDPlus CADDI mobile app and using this data to better understand the way in which the Urgent Care teams deal with increasing demand.
 
Expected Outcomes

The system will be able to provide an overview of the urgent care system in real time which will allow proactive realignment where required. It will also help capture data that can be used to inform decisions on the ground.
 
Patient experience:
  • Reduction in waiting times
  • More timely response from services
  • More clinician time to ensure appropriate placement that meets needs
  • Reduction in out of areas placement
  • Reduction in overall in-patient admissions
  • Safer care for patients as a result of a more efficient system
  • Improved patient focused services leading to improved patient and carer experience
Operational Effectiveness
  • The availability of valuable structured quantitative data that has not been collected before
  • Increased ability to monitor and plan across the system
  • Better decision making and improved use of system resources
  • Live data on demand allowing for prioritisation
  • Reduction in duplication and waste within the referral process
The CADDI system has been developed so it is scalable to regional and national requirements. The system can be adapted to an organisations patient administration system and the dahsboard can also collect data  using an alternative system, if available, as long as data is available in real time. 
 
Initial Review Rating
1.00 (1 ratings)
Benefit to WM population:
The CADDI system will provide the most realistic and timely method for assessing the capacity of Urgent Care mental health teams across Birmingham and Solihull. As a result, potential savings can be made by  utilising resource effectively to meet demand. We expect to see a reduction in acute hospital waiting times as a result of more efficient staff deployment.

Our RAIDPlus test bed partners West Midlands Ambulance service and West Midlands Police will be better informed about the more appropriate pathway to bring patients experiencing mental health crisis. Unnecessary pressure on staff will be evidenced by the CADDI system and will lead to a precise reporting system examining capacity and demand across the system in a way that is not currently possible.

RAIDPlus has links with the MERIT Vanguard programme, the project aims to spread the experiences, learning and opportunities identified through the development and implementation the CADDI system throughout the partnership.
Current and planned activity: 
The MLCSU and BSMHFT are working on new ways to populate the internet dashboard directly from the patient administration system as an alternative for using the mobile app.
 
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
2
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Semhar Abraha 06/07/2018 - 10:46 Publish Login or Register to post comments
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Innovation 'Elevator Pitch':
This is a risk stratification model that aims to predict and prevent crisis by segmenting the mental health patient population by risk and likelihood of an acute mental health crisis.
 
Overview of Innovation:
Currently, the response to mental health crisis is mostly reactive. To address the increasing pressures faced by the urgent care services by patients presenting with mental health crisis, prevention and early intervention must be prioritised. This will not only alleviate pressure of several emergency care services but will also improve patients’ prospect by ensuring  timely interventions that avoid patients’ mental health deteriorating further.

The RAIDPlus project, in partnership with Telefonica Alpha, aims to achieve this by developing and validating a risk stratification model and algorithm to predict mental health crises. The risk stratification model will use four years of pseudonymised clinical and sociodemographic data to capture potentially robust predictors from a wide range of sources to provide an overall indication of a patient’s risk of experiencing a mental health crisis.

By applying the model onto the Trust’s mental health population, we can stratify the patients into different risk groups and subsequently target the highest risk segment of the population for preventative early intervention with improved accuracy. This information will be provided to clinicians who will determine the necessary measures required to prevent the progression from high-risk status to actual mental health crisis. This will act as a ‘clinical support tool’ for clinicians in making their decision and does not replace the clinicians decision on how to manage patients.

The project will look at how the risk stratification model can be implemented into practice, working with Community Mental Health Teams (CMHTs) to pilot the model. The model will be refined, tested and validated by a team of data analysts, clinicians and to embed it into systems for routine clinical care. Using this tool can help improve patient care by avoiding unnecessary admission, presentation at A&E, or potentially prevent an escalation in the worsening of a patient’s mental health state.
 
Stage of Development:
Trial stage - Trial stage to prove that the idea actually works as intended
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Innovation and adoption
Benefit to NHS:
In a pressurised financial environment, faced continually with greater challenges to meet quality objectives, this innovative product can simultaneously improve patient outcome by reducing intensity and/or preventing mental health crisis as well as reduce costs by stopping the over saturation of emergency services.
 
The use of technology systems and data is at the centre of the NHS Five Year Forward View. It highlights how the use of data and technology will transform outcomes for patients and citizens. The insights derived from the risk stratification model will help the NHS explore how the information/ data they hold could be used in clinical settings to benefit patients. It will highlight patterns in the data that can be used to develop proactive preventative measures to support mental health patients.  The ability to stratify risk and predict those who might be at risk of mental health supports frontline mental health clinicians to de-escalate situations before crises arise. This leads to improved patient outcomes by avoiding the further deteriorating on mental health and potential saving where the intervention has prevented an entry to the crisis care system.
 
The reduction in demand for emergency and inpatient mental health services will relieve the pressure from the crisis care pathways resulting in enhanced patient experiences, improved staff support and morale, and greater efficiency and effectiveness within urgent care mental health services to respond to current and future patient needs.
 
Initial Review Rating
1.00 (1 ratings)
Benefit to WM population:
Mental health crisis is a significant and increasing problem across Birmingham and Solihull. The number of crises in the region has increased by an average of 7% year on year for the past 5 years and is projected to increase further in the future, according to the Midlands and Lancashire CSU. Therefore, this places increased level of pressure on urgent care services and it is important to be able to introduce proactive measures to stop at risk patients from going into crisis.

The redesign of the crisis care pathway is a key NHS England target for CCGs and a central theme within the STPs. Within the Birmingham and Solihull STP, one of the key mental health objectives is to ‘Manage – preventing mental health crises and managing them better when they do’. Identification of at risk patients and supporting them by intervening sooner fall in line with the STP objective and while this tool doesn’t directly prevent the onset of crisis, it helps refine predictions and manage at risk patients proactively. The use of data-informed decision making leads to better clinical outcomes for West Midlands patients and can potentially release both capacity and resources across the emergency and urgent care system
Current and planned activity: 
The risk stratification model was developed collaboratively between BSMHFT and Telefonica Alpha as part of the RAIDPlus NHS Test Bed. The pilot work testing is being supported by The Health Foundation.
 
The tool is planned to be tested in real time by Community Mental Health Teams (CMHTs) in Birmingham and Solihull from September 2018. The CMHTs were identified to be in the most suitable position to be able to utilise a predictive model for crisis presentation into their working practice. The patients at risk will be flagged in real time and this will be reviewed by the CMHTs and an effective intervention put in place to avert the crisis. A robust evaluation is being conducted by the CSU looking at the effectiveness of the tool in supporting clinician’s decision making.
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
N/A
Ease of scalability: 
3
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Semhar Abraha 02/07/2018 - 12:59 Publish Login or Register to post comments
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Recent Activities

RAIDPlus - Predictive Analytics for Mental Health Crisis has been moved from Initial Submission to Publish 12 weeks 2 days ago
Capacity and Demand Dashboard Information (CaDDI) has been moved from Initial Submission to Publish 12 weeks 2 days ago
Mental Health Training and Effective Crisis Intervention has been moved from Initial Submission to Publish 12 weeks 2 days ago

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