Care Pathway Month 9-12:

Intervention and Ending

The intervention and ending phase prioritises revision of unhelpful and risky behaviours, implementing symptom management strategies and increasing opportunities for independence and self-management.

Therapeutic relationships remain central the care process as the relational security and secure attachment base developed during early phases of care are therapeutic tools to maximise recovery opportunities. Measures and scales will be reviewed to provide accurate progress reports but the focus in this phase of care increasingly shifts towards the person using Vestige services leading the care journey, with MDT support, in preparation for ending.

Care plans, risk management plans and positive behaviour support plans will be used to inform relapse prevention and crisis management interventions. Endings will be in the spotlight in order to reduce the predictable risk of abandonment and rejection schemas being activated as discharge approaches.

Vestige will work closely with statutory, community and voluntary organisations to support the early discharge process.

  • Vestige Psychiatry Team will:

    Continue to undertake clinical review including assessment of mental health and diagnosis, at a minimum or 4 weekly intervals. Review any ongoing mental health act status and associated community access plans still in place. Review medication with the aim of commencing self-medication regimes if not already done; considering efficacy, tolerance and side effects of existing prescriptions. Review PRN need and plans in the context of discharge planning. Begin to liaise with statutory services to provide a full handover of care to statutory services. Facilitate a CPA meeting to review and document progress as appropriate.

  • Vestige Psychology Team will:

    Continue to use the psychological formulation to guide and supervise the team using a Cognitive Analytic Therapy model of consultation, supporting relational security and symptom and risk management with a specific focus on revision strategies and ending of interventions. Offer ongoing compassion-focussed, needs-led individual therapy that is evidence-based and underpinned by trauma-informed principles. Continue to facilitate DBT skills-informed group interventions to support development of a range of psychological, interpersonal and practical skills to aid symptom management, relationships and well-being. Invite mental health professionals and carers into a consultation process to enable a joint process, with the person in our care, of sharing understanding, formulation and helpful revisions.

  • Vestige Nursing Team will:

    Continue to review mental health, coping strategies, daily living skills, lifestyle, diet, sleep, relationships and sexual health in order to inform discharge arrangements and associated plans. Collaboratively review risk assessments and plans in the context of the psychological formulation to inform relapse prevention and crisis planning. Support the MDT in positive risk taking; championing least restrictive practice. Continue to work within a psychologically-informed model of care undertaking symptom management interventions. With supervision, use the DBT protocol of ‘Chain Analysis’ to promote understanding, recognition and revision of challenging and risky behaviours. Continue to provide support to delivery of weekly DBT skills informed group interventions. Implement, in a skills and needs-led way with the support of the Psychiatry team, self-medication protocols. Continue to review wider plans of care, updating positive behaviour support strategies and maintaining aspirations for discharge.

  • Vestige Occupational Therapy Team will:

    Continue to review occupational functioning, activities and interests in the context of the psychological formulation and discharge plans. Undertake impact assessment and review scales and measures undertaken on admission to inform the need for further interventions. Review and revise weekly activity plans to reflect current functioning and remain aspirational in developing occupational skills and opportunities. Work closely with those in our care to achieve meaningful, social, educational, recreational and relaxation focussed activities that can be maintained after discharge. Maintain relationships with community and voluntary organisations and undertake community visits once move-on accommodation has been identified to optimise occupational opportunities in the discharge area. Undertake planned interventions to include budgeting, menu planning, shopping and cooking. Skills for independent living such as bill paying will commence in the intervention and ending phase to ensure confidence in independent living.

  • Vestige Support Staff will:

    Continue to work within a psychologically-informed, Cognitive Analytic model, within the MDT to use therapeutic relationships to maximise recovery opportunities by following specific, evidence-based, plans of care. Implement Occupational Therapy schedules and plans Actively engage with people in our care to provide skills coaching, promoting increasing independence and self-management when opportunity allows.