North West London NHS Foundation Research Articles

Working with Afghan Evacuees: Field Reflections on Five Useful Supervision Questions for Crisis Intervention Workers

Abstract This field reflection is a reflective dialogue between a supervisor and supervisee focusing on work with Afghan evacuees undertaken by the Centre for Anxiety, Stress & Trauma within Central and North West London NHS Foundation Trust. This field reflection focuses on five themes that emerged between the supervisor and supervisee during clinical supervision. The themes are posed as questions that may help others working in the context of a humanitarian crisis to utilize supervision to effectively support both staff and the target population. The reflections conclude with recommendations on how supervision can support staff well-being and, in turn, offer a supportive service to people feeling their homeland in the context of war.

Reducing health inequalities by improving access to hepatitis C testing and treatment in marginalised populations.

Eugenia Moyo-Hlahla (eugenia.moyo@nhs.net) and Beth Crossland, Clinical Nurse Specialists, Central and North West London NHS Foundation Trust, winners of the Gold Award in the Infection Prevention Nurse of the Year category of the BJN Awards 2023.

Obsessive-compulsive disorder in treatment seeking children & adolescents during the COVID-19 pandemic.

Few studies have investigated the COVID-19 pandemic's effect on children and adolescents with obsessive-compulsive disorder (OCD). This study aims to investigate whether the pandemic is associated with increased referral of young people with OCD, any changes in their symptom severity and treatment offered. Service data were used to investigate 58 young people (8-17years) referred and assessed in the Central and Northwest London NHS Foundation Trust Child and Adolescent Mental Health Service (CAMHS), before and during the COVID-19 pandemic (months March-October 2018-2020). Changes in symptom severity were measured using the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA). Patient records were reviewed to assess if COVID-19 had exacerbated symptoms. Type of treatment offered was compared. 26 (5.62%) assessments to CAMHS related to OCD in 2020, compared to 12 (1.30%) and 20 (2.27%) assessments pre-pandemic (2018 and 2019), showing a significant increase in the proportion of OCD cases (X2 (1, N = 58) = 20.3, p < 0.001). There was no significant difference in any HoNOSCA dimensions on initial assessment. However, 69.2% of patients in 2020 showed symptom worsening over the COVID-period, versus 46.7% of cases first assessed pre-pandemic. Significantly more patients were discharged without being offered treatment pre-pandemic (X2 (2, N = 58) = 12.7, p = 0.002). In 2020, there was an 8.5% increase in the frequency of medication offered. The proportion of OCD cases in CAMHS increased in 2020 despite the overall number of CAMHS referrals falling. Furthermore, many cases reportedly worsened during the pandemic, and services will need to address the increased burden of more severe cases. Further larger investigation of this subject is warranted.

Improving training and support by improving our out of hours handover, Central and North West London NHS Foundation Trust

AimsDuring out of hour handovers at St Charles Hospital – the two duty SHO (senior house officers) cover on site, whereas the on-call registrar and consultant are available to contact by phone. Some trainees may experience difficulties in contacting their seniors for support, or may not feel comfortable doing so. Trainees may also feel like they would benefit from being more informed of the hospital situation, or added learning and educational opportunities from the shift. The aim of this project was to improve the out of hours support for the on-call SHOs – which we hope to have positive short (such as improving confidence and performance) - and longer-term impacts (improving retention in the deanery and specialty).MethodThe project proposed instating a 15-minute Zoom call at the start of each night shift (9:30pm) which involved the on-call team (SHOs, registrar, consultants and ideally bed managers). Firstly – a survey monkey questionnaire was sent to trainees to gain a baseline on how supported/informed/ease and learning opportunities for that shift. The project then piloted three separate Plan Do Study Act cycles of change and collected feedback from trainees after each cycle. Both qualitative feedback and quantitative feedback from trainees were collected in the Likert scale format after each PDSA cycle.ResultResults showed that a key benefit of this call is that any pressing issues can be brought up and addressed. Furthermore, for the benefit of the trainees, generally trainees felt more supported whilst they are on call, and got to know the fellow on call team. In addition, trainees reported feeling more at ease when calling their senior colleagues.ConclusionIt is particularly important for doctors to feel supported and informed during their on call shift, especially in the current climate, where there are fast changes and adaptations taking place due to the pandemic. By adding a short meeting at the beginning of each night shift, doctors in the hospital demonstrated an increase in feeling supported, informed and having educational opportunities during their on call shifts. In the long term, by addressing on call issues and making trainees feel more confident and supported during their shift, is likely to benefit and improve recruitment and retention.

Evaluation of an attention deficit hyperactivity disorder (ADHD) assessment &amp; treatment service

AimsThe Central and North West London NHS Foundation Trust ADHD clinic offers diagnosis and medication stabilisation for adults with ADHD, in preparation for discharge back to GP for continued prescribing and monitoring. Referral waiting time is shortened by efficiently managing the service and soon transfer of care to GP whilst referrals have been increasingly accepted years on years. A snap shot service evaluation was made to understand characteristics of service exploring its strength and areas to improve.MethodAll 115 patients offered in March and April 2019 for an ADHD specialist assessment were sampled from the new electronic patient record SystmOne in use since 1st March 2019.Data were collected forMale &amp; Female ratioAge range distributionClinical Commissioning Group referral sourceClinic attendance characteristicsADHD diagnosis, sub-types and psychiatric comorbidityADHD Medication prescribedFP10 Prescription duration by prescribersPatient data were anonymously encoded into Microsoft Excel Sheet for sorting, counting, summating and illustrating into tables and pie charts.ResultThe male &amp; female ratio of the sample was 6:5 and nearly half were in age range 20-29 years. Majority were referred from Westminster and West London Clinical Commissioning Groups.107 patients completed the assessment, of which 106 were diagnosed as having an adult ADHD.22% of follow-up clinics were cancelled or not attended (DNA) by patients. The majority of the patients (62%) required 1-2 follow-ups before transfer to GP, whilst 8% did not require or want follow-ups either already being on ADHD medication, not wanting medication or having lost to reviews. Only 3% require six or more follow-ups.Majority were reviewed after two- to five-week prescription, the peak being four-weekly.91% of completion to GP were discharged on ADHD medication, majority being singly on Elvanse (48%) and Concerta XL (25%). Discharge without ADHD medication was due to concerns for its addiction, preference on non-medication treatment, intolerance of medication adverse effect or mental health priority treatment.ConclusionCollaboration with GPs for their pre-treatment physical health screening facilitated prompt prescribing initiation on assessment with most discharges taken place after 1-2 follow-ups, enabling service turn-over with short waiting time (6-9 months in 2018/2019). Service expansion for increasing referral uptake is probably feasible from this baseline by appointing additional sessional clinicians and further efficiency management on clinic scheduling &amp; DNA with a target majority likely requiring 1-2 follow-ups with average four-weekly prescribing.

Prevalence, associated factors and prevention of burnout in psychiatry trainees in Central and North West London NHS Foundation Trust

AimsTo assess burnout, resilience, professional quality of life and coping mechanisms in Central and North West London psychiatry traineesObjectivesTo determine Key factors associated with stress and burnout in workplace Effects of burnout on patient care and doctors Coping mechanisms used by traineesBackgroundBurnout is a well established condition that has been recently reported to affect a third of doctors. Psychiatrists in particular represents a high risk group among doctors for experiencing burnout, alcohol and drug use, posing suicide risk and other forms of work related stress.MethodThe study comprised of a cross sectional questionnaire survey which included measure of stress (General Health Questionnaire), burnout (Maslach Burnout Inventory), and satisfaction with medicine as a career and personality (Big Five). During October to December 2019, core trainee and specialty trainee doctors in CNWL were asked to complete an online survey via emails.ResultWe collected data from 50 CNWL psychiatry trainees. The sample consisted of 20 females (40%) and 30 males (60%). Ages varied from 26–58 years old, with a median age of 28. Core trainees (CT1–3) were recorded as 72% and specialty trainees at 28%.Of those who responded, around half of the trainees (52%) experienced high levels of stress outside of work in their personal life. The most common causes that trainees felt makes psychiatry a stressful profession were violence and fear of violence, limited resources, dealing with confrontational patients, inability to affect systemic change and increasing culture of blame. Around half of respondents (54%) felt that they have experienced burnout but only 26% of respondents knew where to go to find resources to help cope with burnout. Physical exercise and speaking to colleagues were the most common coping mechanisms used by trainees to deal with stress.Free text responses on what can be improved in workplace to enhance a positive experience of work included improving multidisciplinary interactions, easily accessible resources and increasing staffing levels. 74% of respondents felt they continued to care about what happens to patients regardless of working conditions.ConclusionHalf of CNWL trainee doctors who responded have experienced burnout. Some factors associated with stress and burnout in doctors are unique to psychiatry profession. Free text responses were useful in identifying areas for improvement in work places and useful coping mechanisms, which can be used to inform prevention and implement interventions to tackle burnout.

Quality improvement project to eliminate the occurrence of never events during insertion of intrauterine contraception

AimThis project aimed to reduce the occurrence of never events during insertion of intrauterine contraception (IUC), within Central North West London NHS Foundation Trust (CNWL) clinics, to zero within 6...

Current perspectives in HIV post-exposure prophylaxis.

The incidence of human immunodeficiency virus (HIV) infection continues to rise among core groups and efforts to reduce the numbers of new infections are being redoubled. Post-exposure prophylaxis (PEP) is the use of short-term antiretroviral therapy (ART) to reduce the risk of acquisition of HIV infection following exposure. Current guidelines recommend a 28-day course of ART within 36–72 hours of exposure to HIV. As long as individuals continue to be exposed to HIV there will be a role for PEP in the foreseeable future. Nonoccupational PEP, the vast majority of which is for sexual exposure (PEPSE), has a significant role to play in HIV prevention efforts. Awareness of PEP and its availability for both clinicians and those who are eligible to receive it are crucial to ensure that PEP is used to its full potential in any HIV prevention strategy. In this review, we provide current evidence for the use of PEPSE, assessment of the risk of HIV transmission, indications for PEP, drug regimens, and management of patients started on PEP. We summarize national and international guidelines for the use of PEPSE. We explore the place of PEP within the wider strategy of reducing HIV incidence rates in the era of treatment as prevention and pre-exposure prophylaxis. We also consider the implications of recent data from interventional and observational studies demonstrating significant reductions in the risk of HIV transmission within a serodiscordant relationship if the HIV-positive partner is taking effective ART upon PEP guidelines.

Consensus for using an arts-based response in art therapy

This article sets out to describe provisional guidelines for the art therapist using an in-session art response. Art therapists are known to use art materials to respond to patients as part of their clinical work in health care settings. Using several survey and knowledge acquisition techniques, the author elucidates what techniques are being used and then establishes a first set of guidelines for art therapists working within Central and North West London NHS Foundation Trust (CNWL). The guidelines are not prescriptive, but offer a range of methods based on current practice. The guidelines pull together different ideas and methods and seek clinical consensus on the validity and reliability of each statement based on clinician and service user opinions. The resulting guidelines are in keeping with the ethos of NHS clinical governance to demonstrate clearly what interventions are being applied and to what effect. These guidelines are intended as a first set of principles to support innovation in clinical practice through recognition of standards to be developed.

Trust tops gay-friendly award list

Central and North West London NHS Foundation Trust, which provides mental health, sexual health and addiction services, has been named the top performing gay-friendly healthcare organisation in England by equality charity Stonewall this week.

Central and North West London NHS Foundation Trust's (CNWL) Recovery College: the story so far …

Purpose – The purpose of this paper is to provide an introduction to recovery colleges, followed by an outline of the development and delivery of Central and North West London NHS Foundation Trust (CNWL) Recovery College, as well as key lessons learned. In doing so the aim is to help inform members of mental health organisations involved in the design or development of a recovery college or who aspire to create a college. A secondary purpose is to highlight the positive effects of recovery colleges for people using mental health services. Design/methodology/approach – The paper draws upon interviews with recovery college students and staff members, as well as other CNWL staff. Findings – Themes emerging include: the significant role of peer trainers; the importance of strong organisational support; how challenges were overcome without losing recovery principles; the shift in mind-set from clinical to educational ways of working. Quotes from students demonstrate the positive experiences gained through attending the college. Originality/value – The paper provides an informative account of one large NHS Trust's experience of running a recovery college, covering its planning, development, delivery and evaluation. Lessons from this experience may be of value to organisations aspiring to develop or already involved in the running of a recovery college.

Mapping offender‐patient pathways in the different jurisdictions of the European Union

Criminal Behaviour and Mental HealthVolume 22, Issue 4 p. 293-296 Special Issue Article Mapping offender-patient pathways in the different jurisdictions of the European Union Bradley Hillier, Bradley Hillier Institute of Psychiatry, King's College London, London, UKSearch for more papers by this authorChristopher Lambourne, Corresponding Author Christopher Lambourne [email protected] Central and North West London NHS Foundation Trust, London, UKChristopher Lambourne, Head of Organisational Change, Central and North West London NHS Foundation Trust, Suite 30, 101 Clapham High St, London SW4 7HF, UK. Email: [email protected]Search for more papers by this authorTina Gram Larsen, Tina Gram Larsen Aalborg Psykiatriske Sygehus, Aalborg, DenmarkSearch for more papers by this author Bradley Hillier, Bradley Hillier Institute of Psychiatry, King's College London, London, UKSearch for more papers by this authorChristopher Lambourne, Corresponding Author Christopher Lambourne [email protected] Central and North West London NHS Foundation Trust, London, UKChristopher Lambourne, Head of Organisational Change, Central and North West London NHS Foundation Trust, Suite 30, 101 Clapham High St, London SW4 7HF, UK. Email: [email protected]Search for more papers by this authorTina Gram Larsen, Tina Gram Larsen Aalborg Psykiatriske Sygehus, Aalborg, DenmarkSearch for more papers by this author First published: 26 September 2012 https://doi.org/10.1002/cbm.1842Citations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume22, Issue4Special Issue: Training in Forensic Psychiatry in EuropeOctober 2012Pages 293-296 RelatedInformation

Taking the Cinderella speciality to the PROM: developing a patientrelated outcome measure for an older adult mental health service

In the UK there has been a shift over the last decade towards the setting of targets by commissioning or regulatory bodies so that health services provide improved levels of care. For mental health services this has occurred in three phases: phase one related to simple key performance indicators (for example collection of patients' diagnostic codes); phase two placed greater emphasis on more meaningful clinical outcome data; the third and most recent phase placed prominence on patient‐focused data collection. We report the development and preliminary findings of a piloting of a patient‐related outcome measure (PROM) and patient‐related experience measure (PREM) created specifically for older adult mental health services in Central and North West London NHS Foundation Trust. PROMs/PREMs are in keeping with an increased focus on patients' experience of health care, the provision of quality services and various key policies such as the recent government white paper Equity and Excellence: Liberating the NHS.

Responding to the Delivering Race Equality (DRE) agenda in mental health services: national recommendations informed by local experience

This article summarises what the Department of Health's (2005) Delivering Race Equality (DRE) agenda in mental health services set out to achieve and the background to this. The article then provides commentary on the Central and North West London NHS Foundation Trust's experiences while acting as one of the 18 focused implementation sites (FIS) created as part of the Department of Health's five‐year Delivering Race Equality Action Plan and highlights the recommendations that developed out of this work and have national application.