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Appendix 1: Triangle of Care self-assessment tool
Tips and Guidance
for staff completing the self-assessment tool
The Triangle of Care self-assessment tool
enables mental health providers to assess
their services on a ward by ward or team
by team basis.
The tool is easy to use and involves a
simple traffic light system for assessing
service delivery.
Guidance notes have been developed as a
result of feedback from members of the
Triangle of Care Steering Group who have
begun to assess their services.
General guidance
• Consistency – although individual units
and teams can complete the self-
assessment; it is recommended that all
teams complete the tool at the same time
as a coordinated exercise. Ideally,
completed self-assessments are sent to
an independent person (ward manager or
carer lead) to review. The review should
check the ratings and action points are
consistent. This will also enable
identificat ion of common issues across
teams, identify good practice and share
this across the organisation.
• Honesty and candor – adopting this
principle will benefit the organisat ion or
team when completing the self-assessment.
Staff who have completed the tool
previously have found it a more positive
experience to adopt a warts-and-all
approach. This enables teams to see what
they are doing well and be able to action
plan more clearly for areas that require
improvem ent . No team or ward is
expected to be perfect and some deficits
are to be expected. It is crucial to convey
to teams that these deficits will not be
punished and it is recommended that no
league table system is adopted.
• Traffic light ratings – there is an
expectation that when awarding a green
traffic light the team should have over
80% success rate. An amber traffic light
requires 50% or over.
ȣ For example: criteria 1.1 identifying
the carer routinely; this should be
occurring with 80% or more of carers.
ȣ Another example is criteria 2.1 staff
have received carer awareness
training; this should be when 80% of
staff have either received the training
or are booked on to it and when the
training is up to date and relevant.
Crucially this 80% must include the
most senior staff on the ward/team
including psychiatrists.
• Clarity – to ensure accuracy it is advised
that figures used are evidenced, for
example checked against training records.
• The By whom Section of the form – this
section should include the name of the
person completing the form; if this is not a
senior member of staff then they must
counter-sign. It may also be beneficia l to
include the name of the person who will
be responsible for this area as this gives
the whole team responsibility for the project.
Specific guidance
There have been requests for clarity on
specific points on the tool; therefore the
following have been identified for expansion.
Criteria 2.3 – Training is delivered by
carer trainers.
It is vital that carers are part of the training
team, if carers are not consistently delivering
training this cannot be marked green.
Standard 3 – Policy and practice
protocols re: confidentiality and sharing
information, are in place.
It is more likely that a Community Mental
Health Team will be responsible for
completing advance statements/informat ion
sharing agreements. However, an inpatient
unit or crisis resolution and home treatment
should have a clear protocol in place to
ensure that this agreement is available to
them if a service user enters their service.
Ideally, each inpatient team or crisis
resolution and home treatment should have a
protocol and an existing advance statement
and revisit or update it. However, if admission
to the ward is the first contact the service
user has had with mental health services then
it is the responsib ilit y of that team to ensure
an agreement is signed by the service user.
Standard 4 – Defined post(s) responsible
for carers are in place.
Any carer champion or carer link worker post
must be a live role and not exist in name only.
To clarify, the role should have a written
outline, training on how the post should be
fulfilled which should have been delivered and
a senior member of staff responsible for the
development of the role identified.
Criteria 5.1 – The crisis resolution and
home treatment provides the carer with
an introductory letter which explains the
service and points of contact. A clear communicat ion protocol should be in
place between the ward, crisis resolution and
home treatment and community mental
health team to ensure that this is provided to
the carer.
Criteria 6.4 – A new carer is automatically
offered a carer’s needs assessment and
support plan. If offering and providing carers’ needs
assessments is not an organisational
responsibility, there is a need to demonstrate
that referrals are being made.
Finally … Once completed, the self-assessment tool
should be reviewed with the entire team it
refers to. From this point an action plan
should be developed demonstrat ing how
improvem ents will be made and a set
timeframe for this action plan put in place.
At the end of this time the self-assessment
tool should be completed again to assess how
and where improvements have been made.
25
Triangle of Care Self-assessment Tool : High Peak Crisis Team.
This tool is suitable for all services however there may be words and phrases that are not used in your specific
service. If so, you will need to adapt the tool to meet your organization’s needs. This tool uses the Red Amber Green system to assess the current situation for each point.
Standard 1 – Carers and their essential role are identified at first contact or as soon as possible afterwards
Criteria R A G Where are we
now?
Action plan Evidence of
achievement
By whom? By when?
1.1 The carer is routinely
identified with the service
user when carrying out
an assessment.
Attempts are made to identify
carers upon referral where possible and
again at initial assessment. If /
when this has not been possible, the
team endeavor to establish this
information upon on-going contacts and at
the earliest opportunity.
Often completed by carers
champion.
Dip sample
indicates that
Continue to
identify carers at
the earliest
opportunity.
All staff to be
encouraged to
complete
appropriate
documentation to
promote
sustainability.
Audit compliance
3/12
Individual
PARIS records–
documented
within
assessment,
added to
associated
people and
discussed and
documented
within MDT.
Associated
People form.
associated people.docx
All members of
the team.
On-going –
review 3/12.
this does happen
over 80 % of the time, however
carer’s details are not then copied onto the
associated people form
which is where the information should be
appropriately documented and
also ensures carers receive the “Who Carers”
Trust magazine for carers.
1.2 Special circumstances
of carer are recorded,
for example:
• Parent of young family
• Single parent
• Caring for parents
• Young carer
• Carer with mental ill
health
• Friend
• Partner
• Relative
Information
regarding carer
is identified on
assessment
documentation
including their
relationship with
the patient.
Dip sample
indicated higher
than 50% for
relationship to
service user but
not always
further specific
information
documented.
Information
gained about the
carers to include
any special
circumstances
and any needs
that they may
have as the role
of the carer or in
future care
planning.
Carers champion
to continue to act
as point of
contact for
specific
intervention and
support.
Audits to be
implemented to
establish this
information is
being picked up
and actioned
accordingly.
Email staff TOC
once completed
and add to Team
meeting agendas
Minutes of
discussion at
weekly multi
agency liason
meeting.
Individual
PARIS records–
documented
within
assessment,
added to
associated
people and
discussed and
documented
within MDT.
MDT form
All staff
undertaking
assessment and
/ or intervention.
On-going 3 /12.
Ask Derbyshire
Carers
Association for
information /
audit of specifics
of referrals made
by team.
Training to
include
information on
how best to
support carers
and / or family
from all
demographics.
(continued)
Th
e T
rian
gle
of C
are
Ca
rers In
clu
de
d:
A G
uid
e to
Best
Pra
ctic
e
in M
en
tal H
ea
lth C
are
26
Standard 1 – (continued)
Criteria R A G Where are we
now?
Action plan Evidence of
achievement
By whom? By when?
1.3 Carer views and
knowledge sought
throughout the
assessment and
treatment process.
Carer’s views sought as part of
the assessment
Carers are
offered time to speak with staff
with or without their loved one to share
information and views.
Implement
collaboratively
created carers
feedback
questionnaire to
review this and
ensure
compliance.
Introduce audit as
above.
Individual
PARIS records–
documented
within
assessment,
added to
associated
people and
discussed and
documented
within MDT.
Compliments /
Thank yous.
compliments and thank you's.docx
Carers Questionnaire High Peak Final.docx
All members of
the team.
Carers
champion /
Lead Nurse to
complete audit
and introduce
feedback
questionnaires.
3/12.
1.4 Written consent of
service user routinely
obtained and recorded
re: carer involvement
Specific
questioning
regarding carer
identification and
sharing of
information
routinely takes
place and is
documented
from point of
referral and on
an on-going
basis however
written consent
from service
users regarding
carer
involvement is
not yet
requested.
If consent not
obtained or
refused, all
members of the
team will review
and encourage
this on each
contact and still
maintain support
to carer in their
Distribute carer’s
packs to all
carers including
Trust booklet on
consent and
information
sharing
Written consent
to be explored
and documented
- specifics of this
to be discussed
at team meeting
to establish and
communicate to
team and then
implement.
Paris
documentation
in casenotes,
assessment,
MDT and
capacity and
consent
assessments.
CRHTT
Assessment
All qualified
members of the
team.
3/12 and on-
going
own right without
breaching
confidentiality
and discussing
specifics of
individual’s care.
Where consent
has been
sought, regular
contact and
involvement of
carer’s is
routinely
included in care
from CRHTT.
Question within
capacity and
consents –
Cared for on
Paris asks
“patient gives
consent to the
provision of
copies of
correspondence
to their carer.”
Capacity and
consent
assessment now
recorded as
compulsory on
PARIS, this
includes specific
areas to consent
to relating to care
therefore carer
involvement can /
should be added
to this.
Consent to be
revisited and
reviewed
regularly and
documented
accordingly.
Carers to be
informed of any
issues relating to
consent to share
information and
be supported to
contact CRHTT to
share information
with us even in
this instance.
1.5 Carer is regularly updated
and involved re: care
plans and treatment.
Carer support
and involvement
is acknowledged
and routinely
requested and
included within
personal care
plans and
staying well
plans.
Dip sample
indicates that
over 80% of
identified carers
are included in
care planning.
Ensure TOC self
assessment is
communicated to
all the team and
included on team
meeting agendas
and / or within
peer supervision.
Carers to
continue to be
actively
encouraged to
contribute to care
planning and be
included within
decisions about
care.
Paris
documentation
in casenotes,
MDT and
discussion,
liason and care
plans.
Care plan and
Staying well
plan
compliments and thank you's.docx
Staying Well Plan.docx
All members of
the team.
On-going
1.6 Treatments and
strategies for medication
management are
explained to the carer
All members of
the team seek to
include carers in
all aspects of
care particularly
when they are
supported within
their own home
as per CRHTT
input.
Carers are
asked for
feedback re:
medication
concordance
and / or effects
this is fed into
the MDT
Hard copies of
information
leaflets available
for staff to carry
to give to service
users and carers
as required.
.
Team to continue
to spend time
with identified
Carers to discuss
medication and to
evidence this
within the PARIS
case notes.
Carers to be
routinely offered
time to discuss
care and
treatment with or
without service
user.
To be added to
clinical meetings
and supervision
agenda item.
Audit to capture
this data perhaps
looking at Paris
documentation
alongside
questionnaire
responses.
Paris
documentation
in casenotes,
care plans.and
Staying well
plans
Medication
effects and
concordance
discussed
frequently and
within MDT
where carer’s
views and
information
relating to this is
obtained and
documented.
Carers
questionnaire
All members of
the team.
On-going
1.7 Carer has access
to advice re: advocacy,
equipment and welfare
rights
Once identified
all carers are
offered referral
to Derbyshire
Carers
Association for
independent and
personalised
assessment and
support.
Carers
assessments
look at all
aspects
including
advocacy and
welfare rights
and CRHTT can
also signpost
carers to such
services as well.
CRHTT also
offer on-going
advice and
support 24/7 to
carers from first
contact.
Staff to continue
to offer referral
and support to
Carers from
Derbyshire
Carers
Association for
independent
carers
assessment
however CRHTT
also seek to
support carers
needs inclusive of
advocacy and
welfare rights
locally. Always to
be documented
on PARIS.
Derbyshire
Carers
Association’s
preferred choice
is for referral via
telephone to
their referral
line.
Paris
documentation
in casenotes,
assessment,
care plan and
MDT.
carerpacks.jpg
All members of
the team.
Ongoing
27
Standard 2 – Staff are carer aware and trained in carer engagement strategies
Criteria R A G Where are we
now?
Action plan Evidence of
achievement
By whom? By when?
2.1 All staff have received
carer awareness training
Training need
identified and
escalated to
relevant dept.
E-learning
assessment
carers package
but not
compulsory.
Care Programme
Approach and
Core Care
Standards
training includes
specific training
but on a 3 yearly
rotation and not
compulsory.
Discuss with
Carer lead
regarding training
department to
devise an e
learning package
and make
essential on
passports.
Face to face
training also
required.
Explore
incorporating into
Think Family
package.
Training
package and
team compliance
Team training
matrix
Trust Carer
Lead - Wendy
Slater.
Carers
champion to
chase.
3/12
2.2 The training includes:
• Awareness of care
needs
• Carer expectations re:
assessment, treatment
and support
• Dealing with carer
queries and concerns
• Advising on sources
of help
• Advising on treatments,
strategies and
medicine management
• How to involve and
engage with Carers and
service users
No current
training
packages meet
these
requirements.
Carers champion
has raised deficit
to carer lead.
Await feedback
from carer lead
and training co-
ordinator and
ensure all staff
undertake
training once
established.
Think Family
learning
objectives.
Trust Carer
Lead - Wendy
Slater and
Training Co-
ordinator tracey
Shaw.
Carers
champion to
chase.
On-going and
3/12
2.3 Training is delivered by
carer trainers or Carers
are part of the training
delivery team.
Carers are not
currently
employed or
engaged to
deliver training.
Regular liason
and feedback
given and gained
from local carers
as carers
champion
Carers
Champion to
raise to carers
Lead to establish
if this is part of
the Trust plan.
Carers champion
to continue to
laise and
collaborate with
local carers.
Carer’s
champions
attendance at
meetings.
Carers
questionnaire
which is now in
use that was
collaboratively
created with and
for local carers
after need and
Trust Carer
Lead - Wendy
Slater and
Training Co-
ordinator tracey
Shaw. Carers
champion.
On-going and
3/12
attends local
monthly Carer’s
Forums, Stress
Buster groups
and has good
links for
communicating
with carers via
email.
Carer
employment to
be discussed at
senior
management
level.
deficit became
apparent
following initial
meetings
between carers
champion and
local carers
groups.
Th
e T
rian
gle
of C
are
Ca
rers In
clu
de
d:
A G
uid
e to
Best
Pra
ctic
e
in M
en
tal H
ea
lth C
are
28
Standard 3 – Policy and practice protocols re: confidentiality and sharing information, are in place
Criteria R A G Where are we
now?
Action plan Evidence of
achievement
By whom? By when?
3.1 Service user consent is
sought to share
confident ia l
information with the
carer.
Specific
questioning
regarding carer
identification and
sharing of
information
routinely takes
place and is
documented
from point of
referral and on
an on-going
basis however
written consent
from service
users regarding
carer
involvement is
not yet
requested.
If consent not
obtained or is
refused, all
members of the
Re-implement
previously used
forms to be
completed on
initial
assessment or as
soon as
practicable,
requesting
written consent to
share information
and with whom.
Distribute Core
Care Standards
service user
packs to all
service users
including Trust
booklet on
consent,
confidentiality
and information
sharing.
Paris
documentation in
casenotes,
assessment, MDT
and capacity and
consent
assessments.
All members
of the team
3/12 and on-
going
team will review
and encourage
this on each
contact and still
maintain support
to carer in their
own right
ensuring no
confidentiality is
breeched.
Capacity and
consent
assessment now
recorded as
compulsory on
PARIS, this
includes specific
areas to consent
to relating to care
therefore carer
involvement can
/ should be
added to this.
Written consent
to be explored
and documented
- specifics of this
to be discussed
at team meeting
to establish and
communicate to
team and then
implement.
Consent to be
revisited and
reviewed
regularly and
documented
accordingly.
Carers to be
informed of any
issues relating to
consent to share
information and
be supported to
contact CRHTT
to share
information with
us even in this
instance.
3.2 Agreement is reached
with service user
about the level of
information which can
be shared with the
carer
If consent has
been sought,
routinely the only
amendments to
this would be if
consent is
withdrawn or
should any
changes or
specific issues
that become
apparent which
are then
actioned.
Significant
events and / or
issues can be
documented and
then members of
staff can be
“notified” via
Paris to inform all
relevant parties.
Audit of level of
information
regarding
consent to be
undertaken and
any amendments
or new
paperwork to be
implemented to
address any
areas of deficit.
Senior /Lead
Nurse / carers
champion to
explore current
audit tools and
implement new
documentation if
/ as required.
PARIS case notes,
Capacity and
consent
assessments.
All staff
3/12 and on-
going.
3.3 If service user wishes no
disclosure, staff
regularly revisit this
decision with the
service user
This is currently
clearly
documented
within the
assessment,
Safety Plan and
casenotes
including MDT
documentation
and this is
revisited and
documented at
each contact.
Continue to
revisit frequently
and explore
completing
advanced
statements etc
with service
users when they
are in recovery.
Paris team state
that they are
currently working
on an update to
clearly identify
this information
at a glance on
the Paris system.
Patient status at a
glance board.
Liason with Paris
development
team.
patientpacks.jpg
Senior/Lead
Nurse.
Paris Team
3/12 and on-
going
3.4 Carer is offered
support and general
information when the
service user wishes no
disclosure
If consent not
obtained or
refused, all
members of the
team will review
and encourage
this on each
contact and still
maintain support
to carer in their
own right without
breaching
confidentiality
and discussing
specifics of
individual’s care.
Referral for carer
support and
assessment from
Derbyshire
Carer’s
Association does
not require
service user’s
details or
consent and all
CRHTT carers
are offered
referral for this.
Once a carer has
All members of
the team to
continue to
respect service
user’s views and
and rights under
confidentiality
whilst also
supporting and
acknowledging
the role of the
carer and carers
needs in their
own right.
Emphasis to be
on supportive
communication
and
encouragement
for keeping
dialogue open
within CRHTT
even if specifics
cannot be
discussed.
PARIS records.
Referrals to
Derbyshire Carers
Association.
Core Care
Standards carer
and service user
support packs
completed and
distributed locally
by carers
champion.
carerpacks.jpg
patientpacks.jpg
All staff with
support from
carers
Champion.
3/12 and on-
going
been added as a
carer on
associated
people form on a
service users
notes within
Paris, they will
automatically
receive carer
information from
the Trust in the
form of the “Who
Cares”
newsletter.
3.5 Carer is encouraged to
share information re:
service user to inform
the assessment and
treatment
Carer support
and involvement
is encouraged,
acknowledged
and included
within service
users care plans,
casenotes and
staying well
plans.
Team to continue
to spend time
with identified
Carers to discuss
medication and
to evidence this
within the PARIS
case notes.
Carers to be
routinely offered
time to discuss
care and
treatment with or
without service
user.
Carers continue
to be actively
encouraged to
contribute to care
planning and be
included within
decisions about
care.
PARIS records.
Carer
questionnaire
responses.
All staff
supported by
carers
champion.
3/12 and on-
going
3.6 Carer’s care plan,
notes and letters are
kept in a separate
section of the service
user’s notes/on IT
systems
Carers are
registered as a
carer in their own
right on the Paris
system and are
added to
associated
people on
service users
records to link
together.
Carers
assessments are
completed by
Derbyshire
Carers
Association
therefore none of
this information
is accessible by
CRHTT unless
requested.
Carers champion
to continue to
liase with Paris
developers and
raise issue that
any person
cannot be
registered on
Paris with a dual
role eg Service
User and Carer.
Audit of Paris
records to ensure
compliance of
staff adding
carers to
associated
people.
PARIS records.
Carer audit
outcomes.
All staff
supported by
Carers
Champion.
3/12 and on-
going.
29
Standard 3 – (continued)
3.7 Advance statements or
directives are routinely
used.
Advance
Statements are
patient specific
and on a case by
case basis, these
however are not
yet routinely in
place and use
within CRHTT.
Liase with
Neighbourhood
teams and
colleagues and
recommend on
discharge from
CRHTT that it
may be
appropriate to
consider devising
these whilst
Service Users
are in recovery.
advanced statement about_001.pdf
All staff 3/12 and on-
going.
3.8 A recovery plan is in
place.
Safety plans are
collaboratively
completed on
assessment and
staying well
plans are
routinely
completed on
discharge from
CRHTT. Copies
are sent to the
service user and
a copy is kept
and scanned
onto service
user’s notes on
Paris.
Care planning
including
discharge care
planning and
liason begins at
first contact and
is discussed and
documented
within MDT
weekly as well as
updates in daily
casenotes.
Continue to
ensure all service
users
collaboratively
complete care
plans, safety
plans and staying
well plans
throughout
CRHTT
intervention.
Audit compliance
to provide
evidence.
My Recovery Plan - Feb 2013.pdf
5_ways_self_help_booklet FINAL (1).pdf
All staff and
senior nursing
team
3/12 and on-
going
100 % of
discharges in dip
sample had a
collaboratively
completed
staying well plan
completed as
part of the
discharge
paperwork and
planning.
3.9 Practice guidelines re:
information sharing with
Carers are in use
Guidelines
including best
practice are in
place and
CRHTT adhere
to these.
Refresher
information is
included within
annual
mandatory
training and
senior nursing
team contactable
to clarify any
issues.
Add to team
meeting agenda
to ensure on-
going awareness
and
understanding.
Sharing information with family and carers booklet.pdf
All staff 3/12 and on-
going
Standard 4 – Defined post(s) responsible for Carers are in place
Criteria R A G Where are we
now?
Action plan Evidence of
achievement
By whom? By when?
4.1 A carer lead is identified
within the team or on
the ward.
Ellie Brett is High
Peak CRHTT
Carers
champion.
Ellie to continue
to engage with
cares to ensure 2
way
communication
and collaboration.
Attendance at
monthly cares
forum and
stress buster
meetings.
Carers feedback
questionnaire
which was
collaboratively
devised with
local carers after
shared note for
deficit was
identified.
carer champion evidence.jpg
Ellie Brett Ongoing.
4.2 All members of staff are
responsible for identifying,
involving and supporting
Carers
All staff and key
workers are
aware of and
supportive to
family members
and / or Carers
and offer support
and act as the
point of contact
throughout
admission.
Add to regular
team meeting
agenda.
Carers champion
to continue to
lead on this and
support and
educate team on
roles and
responsibilities.
Supervision and
team meeting
records.
Carers
champion
feedback.
All staff
supported by
carers
champion and
senior nursing
team.
Ongoing.
4.3 A carer champion
network or peer support
forum is in place locally
to provide career
support
Lynn Dunham
currently
circulates
updated lists of
carers
champions to all
carers champion
regularly.
Lynn also invites
and informs
carers
champions to
and about local
and trustwide
events.
Ellie liases with
other local carer
champions as
they are
identified and
begin to become
active in their
roles.
Significant
support from
senior
management
gained from Ellie
regarding her
recent and
Continue with
referrals.
Activities in the
hub are being
reviewed
currently that will
include the offer
to carers at
planned times.
Activities in the
hub are being
reviewed
currently that will
include the offer
to carers at
planned times.
Ellie’s
attendance at
local and Trust
meetings and
activities.
Email trail of
laison.
carer champion evidence.jpg
Carers
champion and
carers lead.
On-going
on-going work.
Core Care
Standards and
Care Programme
Approach team
as well as the
Triangle of Care
Steering group
are and have
been
approachable
and supportive.
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Standard 5 – A carer introduction to the service and staff is available, with a relevant range of information across
the care pathway
Criteria R A G Where are we
now?
Action plan Evidence of
achievement
By whom? By when?
5.1 Upon first contact, the team
or ward provides the carer
with an introductory letter
which explains the service
and points of contact
(for example, psychiatrist,
named nurse and care
coordinator’s name)
Core Care
Standards carer
packs are made
up locally which
include High
Peak CRHTT
Team Leaflet
and are
distributed to
every identified
carer at the
earliest
opportunity. Dip
sample indicates
not all carers
receive a pack.
Continue to
provide packs to
carers.
Carers Champion
to continue to
make these up
with relevant and
local information.
Carer feedback
questionnaire
responses.
Carer Thank
you’s and
compliments.
compliments and thank you's.docx
carerpacks.jpg
All staff
supported by
carers
champion.
On-going.
5.2 An early formal appointment
is offered to the carer to
hear their story, history
and address carer concerns
Carer’s are
offered at first
contact, time to
speak to CRHTT
with or without
the service user
present.
Identified carer’s
are also referred
with their
consent, to
Derbyshire
Carers
Association for
assessment and
support in their
own right- time
from referral to
assessment
however is
currently around
6 weeks.
Continue to work
within best
practice
guidelines and in
response to carer
need and
feedback.
Support
Derbyshire
Carers
Association to
fast track
referrals and
contact sooner
Paris
documentation
including
casenotes,
assessment and
MDT.
Carer feedback
responses.
All staff with
support from
carers
champion if / as
required.
On-going.
5.3 Upon first contact, the ward
or team has meeting and
greeting protocols in place
to reduce carer distress
and address concerns.
Carers are
contacted or
approached and
given information
as per Core Care
Standards carer
packs devised
locally by carers
champion.
Carers are
involved in
assessment and
care planning
wherever
possible and with
the consent of
the service user.
Carers are
encouraged to
contact CRHTT
at any point and
a full explanation
of CRHTT
working and the
role of
Derbyshire
Carers
Association and
other relevant
services is given.
Review feedback
– formal or
otherwise from
carers and add to
team meeting
agenda to
address / use to
implement
positive change.
Documented on
service users
and / or carers
notes on Paris.
Feedback
responses from
carer
questionnaires
and feedback
from meetings
and forums etc.
carerpacks.jpg
All staff 3/12 and on-
going.
5.4 Carers are routinely given
an information leaflet
covering immediate
practical matters upon
referral to the ward or team
Carers are
provided with
Core Care
Standards
information
packs devised
locally by carers
champion
including High
Peak CRHTT
team leaflet.
Dip sample
evidences
achievement to
be above 80 %
however not
always official
team leaflet
given.
To ensure this
becomes
common practice
with all staff not
just carers
champion and
that this is clearly
documented
within Paris once
completed.
PARIS record.
Carers Handbook - final.pdf
carerpacks.jpg
All staff. 3/12 and on-
going.
5.5 Locally developed carer
information packs are
provided to new Carers at
first meeting
Carers are
provided with
Core Care
Standards
information
packs devised
locally by carers
champion
including High
Peak CRHTT
team leaflet.
Need to ensure
these are
provided to all
identified carers.
To ensure this
becomes
common practice
with all staff not
just carers
champion and
that this is clearly
documented
within Paris once
completed.
Carer
questionnaire
feedback
responses.
Documented
within service
user records on
Paris.
carerpacks.jpg
All staff 3/12 and on-
going.
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Standard 5 – (continued)
Criteria R A G Where are we
now?
Action plan Evidence of
achievement
By whom? By when?
5.6 The cultural and language
needs of Carers has been
addressed in the preparation
of the informat ion pack
Currently
considered and
packs remain
targeted at
English
speaking, literate
individuals as per
demographic
however carers
packs can and
will be adapted if
need is identified
and packs to be
individualized if /
as required as
per diversity
policy.
CRHTT are
effective at
assessing and
responding to
individual needs.
Ensure all staff
are aware how to
access
information
leaflets in
different
languages and
for individuals
with specific or
identified needs.
Local Core Care
Standards carer
packs.
Diversity policy.
Carer’s lead,
carers
champion and
administration
team.
3/12 and on-
going.
5.7 The format of the
information pack is flexible
and regularly updated
Carers champion
updates and
reviews packs
frequently to
ensure they
remain
appropriate and
current relating
to local
availability, Trust
and Derbyshire
Carers
Association
information.
Continue to
review packs
regularly and
identify someone
to take
responsibility for
this in the
absence of
carers champion.
Take advice /
input from local
carers.
Core Care
Standards carer
packs.
Carers lead and
carers
champion
supported by
senior nursing
team.
On-going and
3/12.
5.8 A member of ward or team
is made responsible for
commission ing, storing and
issuing the packs
Carers champion
takes this
responsibility and
orders new stock
as required.
Continue to
review packs
regularly and
identify someone
to take
responsibility for
this in the
absence of
carers champion.
Carer packs and
availability for all
carers that are
identified.
Carers
champion.
On-going and
3/12.
5.9 Staff from the ward or team
offer carers the opportunity
to have a conversation
and provide support
All staff routinely
engage with and
offer support and
involvement to
identified carers,
both informally
and formally.
Carers are aware
of how to contact
CRHTT if / as
required and are
encouraged to
work
collaboratively
with CRHTT and
their loved one
towards shared
goals.
Continue to
support and
engage with
carers and
promote the
relationships
between
professional,
service user and
carers.
Await further
responses from
carer feedback
questionnaires to
quantify self-
assessment.
Carer feedback.
Paris
documentation.
All staff. On-going and
3/12.
5.10 The carer is involved in the
discharge planning (either
from the ward or if in the
community from secondary
services) process and is
clear about what to do if …
Staying well
plans are
routinely
completed on
discharge from
CRHTT. These
are completed
collaboratively
with service
users and carers
are also
encouraged to
join the process
and at least be
made aware of
the document.
Care planning
including
discharge care
planning and
liason begins at
first contact and
is discussed
openly with
service users
and carers.
Continue to
include / attempt
to include
identified carers
in every aspect of
care planning
including
discharge from
CRHTT.
Documented
within service
user Paris
casenotes, MDT
and Staying
Well Plan.
Staying Well Plan.docx
All staff On-going and
3/12.
5.11 The carer is asked for
feedback regarding the
service provided as part of
service monitor ing and
improvement
Carers champion
has worked with
local carers and
a shared view
was that there
was a lack of
ability for carers
to give feedback
at a local level.
We subsequently
devised a
collaborative
carer feedback
questionnaire
which is sent out
to all carers post
discharge from
CRHTT – to be
amended with
TOC carer
questionnaire
now I am aware
of existence.
Feedback to be
brought at team
meetings and
also raised
upwards within
management
meetings as
appropriate to
inform and shape
.
Review
responses on
their return and
then also collate
data 3/12 to
identify any
shared themes.
Information
gained to be
shared with the
team in team
meetings and
also
communicated
upwards within
management
meetings etc.
Document to be
reviewed with
carers 3/12.
Carer feedback
questionnaire
responses.
Team meeting
agendas.
Carers Questionnaire High Peak Final.docx
Carers
champion.
On-going and
3/12.
positive and
collaborative
service change.
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Standard 6 – A range of carer support is available
Criteria R A G Where are we
now?
Action plan Evidence of
achievement
By whom? By when?
6.1 A carer support service is
in place locally with
dedicated Carer Support
Workers in post.
Derbyshire
Carers
Association won
the contract as
lead provider for
Derbyshire and
they are currently
putting in place
local carer
support workers
including training
and breaks co-
ordinators.
Carers champion
has been
working closely
with Derbyshire
Carers
Association in
developing and
implement their
new service
particularly in the
Continue to work
with carers and
Derbyshire
Carers
Association in
order to ensure
appropriate and
equitable service
provision.
Carers
champoion’s
attendance and
participation at
meetings with
Derbyshire
Carers
Association and
local carers.
Carers
champion
facilitates events
locally.
carerevent1.png
carerevent3.jpg
co working 1.jpg
Carers
champion
On-going and
3/12
High Peak in
attempts to
ensure equity
given rural
locations.Local
carers forum and
stress buster
groups also in
place run by and
for carers.
6.2 Carer has access to local
carer advocacy services
Local advocacy
service recently
closed and taken
over by
Derbyshire mind
– carer
assessments
and Derbyshire
Carers
Association have
access to and
are able to refer /
signpost to
current and
appropriate
services both
locally and wider
a field.
CRHTT to remain
up to date with
local services
both statutory
and non-statutory
and signpost
accordingly.
CRHTT to
continue to refer
carers to
Derbyshire
Carers
Association for
assessment in
their own right
and outcomes
including
referrals for
advocacy.
Paris
documentation if
completed by
CRHTT.
Referrals to
Derbyshire
Carers
Association.
All staff On-going and
3/12
6.3 Carer has access to
one-to-one support when
needed.
1:1 and face to
face support
specifically for
carers now
provided by
Derbyshire
Carers
Association,
CRHTT refer any
identified carers
to them.
CRHTT also
offer support,
advice and
signposting to
carers if / as
appropriate.
Continue to offer
this service.
Documented in
service users
and / or carer’s
Paris casenotes.
Referrals to
Derbyshire
Carers
Association.
All staff On-going and
3/12
6.4 A new carer is
automatically offered a
carer’s assessment and
support plan
CRHTT aim to
identify and refer
carers to
Derbyshire
Carers
Association at
the earliest
opportunity.
Consent is
sought and
explanation
given prior to
referral.
CRHTT to
continue to offer
referral to
Derbyshire
Carers
Association for all
known carers
and document
this including the
outcome,
accordingly.
Documented in
service users
and / or carer’s
Paris casenotes.
Referrals to
Derbyshire
Carers
Association.
All staff On-going and
3/12.
6.5 The carer’s needs and
plans are regularly
re-assessed.
Assessments are
completed by
independent
organisation –
Derbyshire
Carers
Association who
are
commissioned
and reviewed
regarding their
service provision
to ensure they
are meeting all
recommendation.
Immediate plans
for carer’s needs
are documented
within the Paris
system and
CRHTT act on
these
accordingly. This
includes
identified need
for referral for
carers
assessment in
their own right as
well as any other
and more
pressing issues
relating to
Continue to
support carers
and refer for
assessment and
support to
Derbyshire
Carers
Association.
Check
Derbyshire
Carers
Association
policy on how
often they review
carer’s needs
following initial
assessment.
Referrals to
Derbyshire
Carers
Association.
Documented in
Paris casenotes.
All staff On-going and
3/12.
Advocacy,
housing or CAB.
This is also
inclusive of
carers health
needs and
CRHTT can
signpost to
relevant services
and / or
agencies.
6.6 Family therapy or talking
therapies are offered to
Carers and family if
required.
Carers can be
signposted to
IAPT talking
therapies by
CRHTT or often
as a result of
their own carers
assessment from
Derbyshire
Carers
Association –
Lead Provider.
Family therapy
may be available
within the trust
however rarely is
referral made
throughout
CRHTT
admission – this
may be
recommended as
part of discharge
and / or staying
well plan.
Senior nursing
team to confirm
provision within
the trust and
locally and
feedback via
email update and
/ or team meeting
agenda.
All staff to remain
aware of carer’s
needs in their
own right and
potentially as part
of the wider
family and
signpost to any
appropriate
services /
intervention.
Service user’s
casenotes on
Paris and also
within carer’s
own casenotes
in Paris if / as
appropriate.
All staff with
guidance from
senior nursing
team.
On-going and
3/12
