If an individual is involved with secondary or specialist mental health services and needs coordinated support to help with engagement and maintaining safety, then care will be delivered under The Care Programme Approach (CPA) framework. CPA is an umbrella term to describe the stages involved in supporting the recovery journey. The individual is central to CPA. If a person has straightforward needs, then they will receive their care and support by ‘Care Plan’. Assessment of the individual’s strengths and needs will determine if their care is to be supported by the CPA framework or Care Plan.
There are four stages to CPA:
The individual will be asked questions about most aspects of their life and history – personal, health, social, environmental; about their safety (this is sometimes referred to as risk); about anyone else all ready involved in their care and support; any carer involved will be identified and informed of the right to their own assessment. If the individual agrees, then the carer can participate in this process too. The focus of assessment will be on strengths, hopes and aspirations. The aim of the assessment is to determine the individual’s health and social care needs.
2. Care Coordination
A care coordinator will be identified to work closely with the individual and carer to arrange care and support and to review recovery progress. The Care Co-ordinator may be from the health, social care or voluntary sector. This may be a nurse, social worker, doctor, psychologist, occupational therapist or community worker. It will often be the person that has most contact with the service user, but not always.
The function of the care coordinator is to work closely with the service user and carer to:
3. Care Plan*
This is a written document describing the individual’s health and social care needs (these were determined at assessment). The care plan states which agencies and services will help with recovery; and what the individual is doing to help themselves.
The care plan is based around the service user. It will be developed with the individual and include a goals; what support is being offered; who is providing the support and when the support will be reviewed. The carer will be included too if the service user wants this.
The care plan will include:
These are sometimes called CPA meetings; they will happen at least every 12 months but can be more often. This is where the care plan is reviewed. This is done by discussing with the service user and carer (with agreement) what is working well and what may need to be changed or improved to support recovery. All aspects of the care plan will be discussed, including safety. Views are expressed by all involved in the care plan, especially the service user and carer and any agreed changes to the care plan are made. The review can be held in a way to suit the service user.
After the review the care coordinator will write up the care plan, the service user will be given a written copy of the revised care plan to check that it records accurately what was discussed and agreed. The service user will be offered a copy to keep. The carer can also have a copy of the care plan if the service user agrees.
What the service user and carer can do to prepare for the review?
Some people find it useful to:
Care Plan is the term used to describe the care of the individual who is within secondary or specialist mental health services; whose needs are straightforward; and who are seeing only one person in respect of their mental health needs.
The service user and carer can expect:
If you require any further information regarding CPA or Care Plan then please contact firstname.lastname@example.org or call Donna Kemp on 01132 952391