Abstract
BackgroundTeams delivering crisis resolution services for people with dementia and their carers provide short-term interventions to prevent admission to acute care settings. There is great variation in these services across the UK. This article reports on a consensus process undertaken to devise a Best Practice Model and evaluation Tool for use with teams managing crisis in dementia.MethodsThe Best Practice Model and Tool were developed over a three stage process: (i) Evidence gathering and generation of candidate standards (systematic review and scoping survey, interviews and focus groups); (ii) Prioritisation and selection of standards (consultation groups, a consensus conference and modified Delphi process); (iii) Refining and operationalising standards (consultation group and field-testing).ResultsOne hundred sixty-five candidate standards arose from the evidence gathering stage; were refined and reduced to 90 through a consultation group exercise; and then reduced to 50 during the consensus conference and weighted using a modified Delphi process. Standards were then operationalised through a clinical consultation group and field-tested with 11 crisis teams and 5 non-crisis teams. Scores ranged from 48 to 92/100. The median score for the crisis teams was 74.5 (range 67–92), and the median score for non-crisis teams was 60 (range 48–72).ConclusionsWith further psychometric testing, this Best Practice Model and Tool will be ideal for the planning, improvement and national benchmarking of teams managing dementia crises in the future.
Highlights
Teams delivering crisis resolution services for people with dementia and their carers provide short-term interventions to prevent admission to acute care settings
Qualitative data Thematic analysis identified 165 standards, which formed 18 categories each capturing an aspect of crisis working for Teams Managing Crisis in Dementia (TMCD)
Examples of standards rated are: highly important ‘The team uses established and streamlined documentation that is appropriate to team member needs and kept up to date’; moderately important ‘Team members should be distinguishable by service users and carers from other health and social care professionals’; undecided ‘The team set expectations of the service with service users and carers at the beginning of the service’s involvement with the service user’ and not important ‘The crisis team is co-located with other relevant services’
Summary
Teams delivering crisis resolution services for people with dementia and their carers provide short-term interventions to prevent admission to acute care settings. United Kingdom (UK) health and care policy is committed to enabling more people with dementia to live longer in their own homes, and fewer unnecessary inpatient admissions [1] This is underpinned by a desire to maintain independence for people with dementia to improve quality. TMCDs are multidisciplinary teams, usually provided by Mental Health Trusts, based in the community as either independent teams or as part of a Community Mental Health Team or Memory Assessment Service Their typical model of working involves a rapid assessment to establish needs of the person with dementia and carers, most often on the basis of referral from primary care in response to a crisis situation, and an intensive short-term intervention to manage or reduce risk of admission whilst appropriate long-term support is arranged with other community health and social care services. A lack of established and validated guidelines for TMCDs results in variation in quality and effectiveness, and a postcode lottery of access to services
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