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Care and support in a crisis – Activities to achieve integrated care

What is this and how does it work?

Urgent community response services are vital because they can prevent unnecessary A&E attendances and hospital admissions by delivering care quickly in people’s homes. In turn, this can contribute to improved patient flow through the whole health and care system and help to tackle wider capacity challenges such as discharging patients from hospital.

NHS Confederation 2022

The partnership between the housing association and the local authority resulted in a service able to respond to changing needs as well as identifying deterioration in residents’ health status. In conclusion, the use of a combined rapid response and telecare service resulted in elderly people remaining independent in their homes for longer, which improved their reported quality of life and relieved stress on carers and pressures on other service providers.

Health and Social Care in the Community 2021

Crisis services seek to respond to people at the times at which their health and/or social situation has deteriorated to the point at which they are at considerable risk and require additional support to remain in their current accommodation and/or prevent further harm. In the past, crisis services often involved people being taken to hospital or into residential care, but increasingly a range of intensive health services can be provided to people on a short-term basis in a community setting, including virtual wards, home treatment and urgent community response teams. New collaborative models are being developed to respond to the potential critical needs of populations which combine specialist skills with technology and bring together health and social care professionals with other sectors including housing and police.

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How do crisis response services relate to integrated care?

Service user participants described the intensity of the distress they experienced when in a mental health crisis, and the overwhelming nature of these feelings was associated with needing to be understood and to be treated with compassion and humanity.

Health and Social Care Delivery Research 2020

Crises can result in people losing their confidence and independent living skills, as well as being traumatic processes when experienced. Integrating services around people in these difficult times ensures that they will receive the best treatment and care available which in turn increases their likelihood of recovery and reduces their long-term trauma. Whilst crisis response services do have to act quickly, communicating clearly with the person and their carers to explain the situation and options to be followed will ensure that they feel informed and better able to make decisions when this is possible. Integrated care can also seek to prevent or minimise crisis situations from developing, through working with individuals and their families to consider potential risks and how formal and informal resources could be used to address these in-line with their wishes.

What do crisis prevention and response services need in order to succeed?

Critical factors for the Home Treatment Crisis Team to enable successful crisis resolution were: immediate action to reduce risk of harm, expertise in dementia care and carer education, communication skills to establish trust and promote benefits of home treatment, shared decision-making, medication management, addressing the needs of carers independently of the person with dementia and, local availability of respite and other community services.

Health & Social Care in the Community 2021

Be realistic about funding and resource. Work with the resources you have, to maximise the use of current services and personnel. Additional funding may not be available so you may need to repurpose the working of existing multi-disciplinary teams. Aim to provide a good service for many, not an excellent service for only a few. This may mean building gradually towards some of the more resource-intensive options.

British Geriatrics Society 2021

Responding to someone at a crisis point of their life is a highly skilled task for which professionals need to develop the related communication, assessment, and decision-making skills. There can be a tendency for professionals to rely on well-established processes and support options due to the urgency of the situation. Opportunities to learn about the role and contribution of others and how they can work together in advance of responding to a crisis are therefore important. Similarly, opportunities to collectively debrief can help to identify what worked well and what could be improved in the future.

Crisis services must be included in the overall vision for an integrated care system alongside long-term care. Population-level data and engagement with people of lived experience and professionals should inform the setting of priorities and considering of new collaborative options to respond to crises in people’s health and/or social situations. Alongside the capacity and skills of the professionals who will be involved, it will be important to consider the necessary technological innovations and how digital records can quickly facilitate information-sharing and improved decision-making.

What is the evidence for outcomes and impact?

Health and social care integration programmes can mitigate but not prevent rises in emergency admissions over the longer-term. Greater financial and expert support from national agencies and involvement in multiple integration initiatives can have cumulative effects.

BMC Health Services Research 2021

Evaluations of local pilot projects in which professionals collaborate around the needs of identified populations, such as older people living in residential care homes or people with mental health difficulties encountering a crisis in the community which leads to the involvement of the police, suggest that further deterioration in someone’s situation can be reduced or avoided. Studies which have considered the population-level impacts of integrated care programmes suggest that an overall reduction in admissions to hospital is hard to achieve but that in the longer term such initiatives can slow increased admission rates. This requires sustained investment and a stable policy environment so that the programmes have the opportunity to become embedded in local practices.

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