The Role of Assessment in Care in the UK - Term Paper Example

The Role of Assessment in the Care in the UK The assessment of care given to mental health patients is mainly implemented through the Care Programme Approach which is made mandatory by The Mental Health Act Code of Practice. The assessment of mental health condition is important to effect a positive change to the outcome of the patient after the treatment and ensure stability of the mental condition through review meetings and follow ups. The outcome of a patient is improved through the coordinated efforts of social and health care workers and the criteria to be followed as per the CPA enables to achieve this goal through the assessment of the individual’s social and mental condition. The Care Programme Approach (CPA) is designed to care patients with mental health requirements in England. The CPA was first applied on inpatients at the time of discharge and on referring them to undergo treatment in special mental care service but the application of CPA was then broadened to include all patients who contact specialist mental care services. The main objective of CPA is to conduct systematic assessment of patients with social and health care requirements, the appointment of required service personnel to supervise the delivery of care, formulation of care plan to meet the requirements, regular review and change the care plan whenever it is necessary to meet the changing requirements of the service user. The CPA gives importance to the coordinated effort of social and health services and also stresses the requirements to involve both carers and services users to result in a better outcome to the mental health care requirement of the patient (Warner, L p.2). The implementation and interpretation of CPA widely varies throughout the UK. The differences are however bridged through the guidance provided by inter-agency that works towards the protection and care of severely ill mental patients. There is a notion that uniformity is not required in implementing the CPA because it is a systematic approach to provide care. It is also suggested that only the neediest patient would avail a complete multidisciplinary CPA. Therefore, the assessment of care required can be categorized into a two or three tired CPA. A service user or mental health patient can be assessed and categorized based on the factors like disability, duration and diagnosis to define the severity of mental sickness. In 1999, the assessment of service requirements for mental health patients was revised and combined under Care Management to generate a single care coordination method that serves as the basic format for assessment, review of care given by social and health care workers in all settings and the planning of care by considering patients in all settings. A patient with a two tier care requirement as per the CPA was considered nationally under enhanced and standard conditions for mental care whereby Care coordinators replaced the position of key workers. Standard CPA is prescribed for patients whose requirement can be addressed by a single professional or an agency or when the patient requires low key support and can manage their mental health illness by themselves and does not pose a threat to others and self and has the ability to continue their contact with service providers when needed. Mental health patients under the enhanced CPA level require multiple-care that demands the service of inter-agency through a coordinated effort, intensive and frequent interventions. These individuals are at a risk of causing self harm and harm to others and are more probable to disengage from requesting services (Warner, L p.3). The National Service Framework for Mental Health requires mental health service users to possess a written copy of the care plan as per their CPA. The care plan is required to comprise the action by the service users themselves during crisis and action to be taken by care coordinators and carers. The plan should also comprise the advice to be given by the GP when the service user requires more help and the care plan should be systematically reviewed by care coordinators. The important principles of the CPA policy is aimed to integrate health and social care by providing consistency to the approach from a national perspective by adopting common definitions of enhanced and standard levels of care. The CPS also guarantees a streamlined method of assessment by recording and collecting relevant information (advance recording of the patient’s next review) to emphasis the assessment and management of risk. The CPA was formulated by commissioners, providers and interest groups with simple principles to support the effective implementation, development and operation of CPA. The principles are set to deliver complex packages of service and identify the role of the administrator in successfully implementing the approach in the case of mental health service user groups. A computer based CPA improves the quality of data in care plan and this system has been implemented in Maudsley and South London NHS trust. The eCPA has the facility to email information between inpatient wards and community groups when the mental health service user goes through a care system. This provides easy and quick access to information and enables service workers to keep the health information updated and allow systematic intervention and assessment for patients with enhanced CPA level to coordinated treatment needs with social and health care services. A research by Balls and Thomas on behalf of the London Integrated Mental Health Electronic Record Project on eleven trusts that offer mental health service that developed electronic data record of patients in enhanced CPA level was conducted to evolve a debate about using the common approach. The research concluded that several trusts started electronic record of patients from scratch (Warner, L p.4) and the methods of feeding information and the rules to control access to data broadly differed among the trusts. The researchers argue that eCPA will save money and time if trusts collaborate in standardizing eCPA and paper based methods that are significant for services in the UK. The assessment of mental health service users using the CPA is widely accepted for its effective assessment, joint working strategy and care planning. A case study by Wolfe et al in 1997 on eighty service users who were leaving inpatient care of a London service revealed that three quarters of the patients participated in the CPA gathering before their discharge but only half of the patient received copies of care plan and another half of them knew the key worker when they were discharged. The researchers also analysed the requirements of the service users group as assessed by staff and conducted a relative study to the needs of the service users. It was noted that the service users made a self assessment and revealed that their needs were more than the assessment of the staff though there was a coincidence regarding the extent of medication, intervention required (Warner, L p.5) and other assistance for mental health issues. While the service users made additional assessment for medical needs, the staff was likely to assess the employment and housing as a problem for the service users with an additional financial problem. The research was then continued with reference to the services in the care plan. The service users agreed to have received most of the services and were satisfied with it. Since the care plan was drafted for every patient there was less involvement of the carers (p.5). The assessment strategies of CPA using coordinated effort from health and social care institution is an achievable task through collaborative working and effective communication between agencies since it is an up gradation of the prevailing methods of good practice in the UK (Warner, L p.6). A positive outcome can be obtained by the coordinated efforts of the social worker and service user. There is a profound implication for the management of practice in social work, especially when it is a collective activity comprising multi-organisational and multi-disciplinary teams to achieve a positive outcome using various assessment methods to find the requirement of the service user. Teams and organizations are required to use past policies to assess needs and it is the joint effort of organizations and services users to define good service and practice (Statham, D 2004 p.9). A research by Barbara Hatfield on a group of mental health patients assessed by recognized social workers as per the Mental Health Act to study detention in psychiatric clinic and the reasons that lead to assessment and the outcome of the assessment was conducted. The report revealed that there are gender specific reasons and life stage vulnerability and lifestyle problems like alcoholism, drug misuse and isolation that lead a mental health patient to require care service. The role of the recognized social workers is to assess the social disadvantage and psychiatric problem of the patient which serve as a complex and challenging assessment need and formulate a solution for the crisis through a care plan. The social workers are specially equipped with the capability to assess and sort out problems through social approaches and implement necessary recovery model and social inclusion methods that serves as a solution in the long term in substantiating social support and reducing the requirement for crisis admission (Hatfield, B. 2007 pp.1553-1571). The role of assessment is of significance among mental health care providers to help children with mental disabilities. Only if the service provider is trained to provide care they can assess conditions and help the service users in post adoption, foster care and related services. A national initiative is required to design standards of competencies because children may have complex needs and only experienced service providers can assess them. It is also likely that an experienced service provider or mental health worker will readily agree to work for a low reimbursement when compared to an inexperienced health worker. Therefore experienced treatment providers are necessary to understand and assess the foster care policies and adopt techniques required to help children with mental health problems. Competency is an essential factor of assessment because new service providers coming up in the UK can follow the body of tested practice and train their social and health workers accordingly to achieve maximum possible positive outcome for mental health patients. The management of mental health service providers should allocate enough time for the rejuvenation of the social workers to decrease their stress and thereby increase their efficiency by creating a sense of support from the management. This enables the social and health workers to contribute more positively while dealing with mental health issues of patients and this positive impact has an effect on the client’s participation also (Hasenecz, N.M. 2009 p.30). The role of assessment is crucial in promoting equality in mental health services for individuals from different race, ethnicity, gender and origin. Equality is promoted to increase accessibility and effect changes in the experience and outcome of individuals with mental health requirements. Joint effort is taken by carers and service users in assessing mental health care needs for individuals from various backgrounds to effect a real change. The equalities workstream also works towards assessment of mental health care requirement of women and older individuals (Promoting Equalities in Mental Health). This is highly essential because the assessment of mental health of women and individuals from specific ethnicity is facing inequalities in the UK. Health and social care outcome in UK The effectiveness of assessment on mental health care service user groups was analysed through a number of surveys on in patients and on patient at the time of discharge. The analysis revealed that most of the mental health patients were involved in the formulation of care plan along with their key workers and had a copy of their plan. Specific details of the National Patient Survey conducted in 2004 are as follows: The Healthcare Commission conducted the initial national patient survey which is considered to be the largest research on service users in England. The opinion of 27000 individuals was collected through postal questionnaire. Around half of the individuals responded that they were given a copy of care plan while three quarters of them surely or to an extent were aware of the details in the plan. Half of the respondents had not undergone a review in the last year. Those individuals who underwent review got a chance to voice their opinion during the review meeting. Two thirds of the questionnaires responded that they knew their Care coordinator and an equal number had met them in the last thirty days. The research concludes the effectiveness of care plan approach and the improvement in patient outcome. The User Focused Monitoring was implemented in 1996 to assess the knowledge and satisfaction of user in three London trusts and is being applied on enhanced level patients (Back on Track). It may be concluded that the implementation of CPA as required by The Mental Health Act Code of Practice has resulted in positive outcomes on mental health patients though full implementation and electronic recording of data is yet to be completely practiced. The assessment of patient is mainly conducted on inpatients while there are inequalities in the assessment of women, black people and individuals of different origin. Therefore, the assessment of the mental health patient as a service user group has more opportunities to function effectively and serve the social and mental cause of individuals. Reference Back on Track CPA Care planning for service users who are repeatedly detained under the Mental Health Act SCMH: London. -Sainsbury Centre for Mental Health Available: http://www.scmh.org.uk/pdfs/briefing+29.pdf. Accessed on April 2, 2009 Hasenecz, N.M. 2009 Fixing Foster Care — 5 Strategies for Change. Social Work Today Vol. 9 No. 2 P. 30 Available: http://www.socialworktoday.com/archive/031109p30.shtml. Accessed on April 2, 2009 Hatfield, B. May 24, 2007. Powers to Detain under Mental Health Legislation in England and the Role of the Approved Social Worker: An Analysis of Patterns and Trends under the 1983 Mental Health Act in Six Local Authorities British Journal of Social Work 2008 38(8):1553-1571 Available: http://bjsw.oxfordjournals.org/cgi/content/abstract/38/8/1553. Accessed on April 2, 2009 Promoting Equalities in Mental Health Available: http://www.nmhdu.org.uk/our-work/promoting-equalities-in-mental-health/. Accessed on April 2, 2009 Statham, D. 2004 Managing front line practice in social care London: Jessica Kingsley Publishers Warner, L. Review of the literature on the Care Programme Approach Available: http://www.scmh.org.uk/pdfs/cpa+literature+review.pdf. Accessed on April 2, 2009 Read More