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Lea S, Callaghan L, Eick S, et al. The management of individuals with enduring moderate to severe mental health needs: a participatory evaluation of client journeys and the interface of mental health services with the criminal justice system in Cornwall. Southampton (UK): NIHR Journals Library; 2015 Apr. (Health Services and Delivery Research, No. 3.15.)

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The management of individuals with enduring moderate to severe mental health needs: a participatory evaluation of client journeys and the interface of mental health services with the criminal justice system in Cornwall.

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Appendix 3Data collection fields

Criminal justice system data

Identified CJS records/databases.

The data generated from CJS records were located within separate databases.

  1. CIS. Individual records comprise a number of screens. The front screen for each case contains basic demographic information, flags and warnings as appropriate. The ‘back screens’ for each case provide detail and a rich picture of participants’ interactions with the CJS and other services as reported by police staff. The following fields will be accessed:
    • Subfield 1: nominal menu.
    • Subfield 1: nominal index update main screen.
      • Reason: demographics, PNC warnings and rationale, local warnings and rationale
    • Subfield 2: nominal index update secondary screens.
      • Reason: details of offence/incidents. Free text: report and rationales of arresting.
  2. OIS. This system contains the initial detailed logs created by operators and officers following a reported incident. The log is generated from the information that the police call handler obtains from the caller, it is graded and a response is generated. Owing to the level of detail required to be entered into the OIS, inclusion of these data to the data corpus enables the researchers to examine the decision-making processes of the police in their interactions with participants and other professionals within both the CJS and interagency. The OIS represents up to the first 72 hours of any case, after which the case is entered onto the CIS described above. The following fields will be accessed:
    • Subfield 1: AP’s view.
      • Reason: confirming identification (linkage), PNC warning flags (e.g. suicidal, etc.).
    • Subfield 2: associated incidents/persons.
      • Reason: collate number of incidents in research window, rationale for call, real-time log, identification of RPs (including HCPs).
  3. NSPIS custody system. This system provides current and archived data relating to individuals who have been through the three custody suites in Cornwall. A proportion of participants may be taken to the custody suite in Plymouth despite being resident in Cornwall dependent on the location of initial interaction with the police. The front screen pertaining to each individual provides a table with basic demographics and rationale for custody (e.g. Section 136 and/or alleged offence). The detention log in the back screens of this system provides a timetable of procedures and context to a range of decision-making processes including authorisation for searches, checks on individuals and calls and logs of requests for examination and advice from medical practitioners with responses . . . The following fields will be accessed:
    • Subfield 1: custody record.
      • Reason: PNC source documents.
    • Subfield 2: custody record front sheet.
      • Reason: initial reason for arrest, place of arrest/custody, circumstances of arrest, demeanour on arrival (substance use, mental state), prior offender.
    • Subfield 2: detention log.
      • Reason: real-time log of custody attendance, medical assessments, interactions with health/medical practitioners, Section 136, disposal.
    • Subfield 2: risk assessment.
      • Reason: mental health issues, risk to self/others.
    • Subfield 1: custody record.
      • Reason: detention management.
    • Subfield 2: national medical form.
      • Reason: HCP assessment of state (physical and mental health), examination and observation completed, medication, risk of self-harm, plan of treatment/referral, plan of observation/rousing, log of HCP movement times.
  4. NHRR. This is a spreadsheet-based system. Information is collated for addresses in the 12 policing areas of Cornwall based on repeat calls to addresses (three or more calls to the police in 3-monthly periods). The following fields will be accessed:
    • Subfield 1: location.
      • Reason: neighbourhood.
    • Subfield 1: history of attendance.
      • Reason: number of attendances to address.
    • Subfield 1: risk identified.
      • Reason: risk tendency score, PSP.
    • Subfield 1: underlying issues.
      • Reason: vulnerable person, children aged < 18 years, age-related alcohol misuse, ASB, domestic abuse, disability/medical, drugs, mental health, racial/hate, repeat missing person/truancy, other.
    • Subfield 1: free text.
      • Reason: opinion of reporting officer/main rationale for calls giving rise to inclusion to NHRR, rationale behind/expansion on underlying issues, background to incidents.
  5. PNC. Although the three systems used above are routinely used throughout police constabularies across the country, the PNC is the only national database. If the researchers find an incident(s) in OIS or CIS relevant to the research within the 12-month period, an application was made to view that data to the relevant data processing officer from the relevant force.

Health data

Identified NHS records/databases: CFT initiated use of the BT RiO system in August 2010 for all service users with severe and EMHN. RiO is an electronic health record, which captures referral processing, details of assessments and ongoing care. CFT uses RiO to record all interactions with service users, all care plans and all risk assessments. The feasibility study identified a range of folders within the system that would enable the researchers to gain a holistic picture of participants’ access to and interactions with mental health services. Furthermore, it was clear that the level of detail of the combined documents would enable the researchers to answer the research questions. The following list details the folders that have been identified to be included in the data corpus.

Core assessment

  • Subfield: core assessment.
    • Form: presenting situation and referral outcome decision.
      • Reason: professional decision-making: provides rationale for referral based on presenting situation of service user.
    • Form: social history/care management form.
      • Reason: professional decision-making: level of vulnerability and management in the 12-month research window.
    • Form: mental health legislation/protection of vulnerable adults.
      • Reason: professional decision-making: critical interagency information in the 12-month research window.
    • Form: forensic and probation history.
      • Reason: professional decision-making: history in the 12-month research window and comparison with CJS recording.
    • Form: substance and alcohol use.
      • Reason: professional decision-making: recording of problematic substance and alcohol use can be recorded here or provide indication of escalation to problematic use within the 12-month research window. Impacts on CJS involvement.
    • Form: problematic substance and alcohol use.
      • Reason: professional decision-making: as above.
    • Form: mental state examination.
      • Reason: professional decision-making and health economics: provide evidence of assessment taking place and joint decision-making.
    • Form: client and carers understanding of assessment.
      • Reason: professional decision-making: provides details of client role in decision making.
    • Form: formulation/summary.
      • Reason: professional decision-making and health economics: provides summary of core assessment of service user.
  • Subfield: core assessment overview – point in time.
    • Reason: professional decision-making and health economics: provides overview if presenting situation and associated issues within the 12-month research window.

Risk information

  • Subfield: HCR-20.
    • Reason: professional decision-making and health economics: DH violence risk assessment tool, evidence of an assessment being carried out within the study window, factors leading to this decision and impact on professional decision-making.
  • Subfield: risk assessment.
    • Reason: professional decision-making and health economics: evidence of assessments carried out in the 12-month research window with information including risk of harm to self, harm to others, accidents, other risk behaviours, factors affecting risk, summary of assessment.
  • Subfield 2: view risk incidents history.
    • Reason: professional decision-making: evidence of incidents recorded in the progress notes assessed by professionals as involving risk.
  • Subfield: safeguarding children – adult form 1.
    • Reason: professional decision-making and health economics: evidence of concern for welfare of children.
  • Subfield: safeguarding children – adult client form 2.
    • Reason: professional decision-making and health economics: evidence of child/children specifically at risk: check if form completed (not for content).
  • Subfield: risk incidents/risk history.
    • Reason: professional decision-making: evidence of incidents recorded in the progress notes assessed by professionals as involving risk.

Role as carer information

  • Subfield: carer assessment overview.
    • Reason: professional decision-making and health economics: evidence of carer involved in care of service user, evidence of assessment of needs of carer in the 12-month research window.
  • Subfield: carer care plan review.
    • Reason: professional decision-making and health economics: evidence of review of carer needs in the 12-month research window.

Specialist assessments

  • Subfield: observation/seclusion.
    • Form: access to fresh air, observation, seclusion.
      • Reason: health economics: assessments carried out during any inpatient admission in the 12-month research window.

Outcome measures

  • Subfield: clustering assessment.
    • Reason: professional decision-making and health economics: Health of the Nation Outcome Scale outcome measure.
  • Subfield: clustering allocation.
    • Reason: professional decision-making and health economics: allocation to superclass and cluster outcome measures.
  • Subfield: experience of service.
    • Reason: professional decision-making: service user perspective of journey.
  • Subfield: Health of the Nation Outcome Scales (older adults; HoNOS65+).
    • Reason: professional decision-making and health economics: outcome measure for specific client group (older adults).
  • Subfield: Health of the Nation Outcome Scales (acquired brain injury; HoNOS-ABI).
    • Reason: professional decision-making and health economics: outcome measure reflecting specific client need.
  • Subfield: Health of the Nation Outcome Scales (learning disabilities; HoNOS-LD).
    • Reason: professional decision-making and health economics: outcome measure reflecting specific client need.
  • Subfield: Health of the Nation Outcome Scales (secure care; HoNOS Secure).
    • Reason: professional decision-making and health economics: outcome measure for service users discharged from inpatient care by tribunal in the 12-month research window.

Care planning, care programme approach and reviews

  • Subfield: care planning – clients.
    • Reason: professional decision-making and health economics: evidence of care planning in the 12-month research window.
  • Subfield: care plan contacts.
    • Reason: professional decision-making and health economics: provision of information to client in the 12-month research window: journey quality.
  • Subfield: care plan distribution.
    • Reason: professional decision-making: other services provided with care plan.
  • Subfield: crisis, relapse and contingency plan.
    • Reason: professional decision-making and health economics: rationale for interagency involvement.
  • Subfield: CPA management.
    • Reason: professional decision-making and health economics: number of CPA episodes in the 12-month research window.
  • Subfield: CPA review.
    • Reason: professional decision-making and health economics: detail of reviews conducted in the 12-month research window.
  • Subfield: pre-discharge planning.
    • Reason: professional decision-making: liaison with other services prior to discharge and cross check with progress notes.
  • Subfield: MAPPA review.
    • Reason: professional decision-making and health economics: evidence of review conducted in the 12-month research window.
  • Subfield: Section 117 review management.
    • Reason: professional decision-making and health economics: evidence of review conducted in the 12-month research window: after care (inpatient admission) plan relevant to condition for which detained. Evidence of service user right to be offered such a plan.

Medicines management and electroconvulsive therapy

  • Subfield: clinical management plan.
    • Reason: health economics: evidence of plan being completed in the 12-month research window.
  • Subfield: electroconvulsive therapy treatment.
    • Reason: health economics: evidence of treatment provision in the 12-month research window.

Progress notes

  • Reason: professional decision-making and health economics: progress notes of all health and social care professionals in contact with service user in the 12-month research window.

Diagnosis

  • Reason: professional decision-making and health economics: diagnoses made in the 12-month research window.

Clinical documentation

  • Subfield: document list view form: list of letters/related documents.
    • Reason: professional decision-making and health economics: letters/documents between professionals related to service user care in the 12-month research window.

Client-related data views

  • Subfield: care plan overview – point in time.
    • Reason: professional decision-making: direct access to care plan in action on specified dates within the 12-month research window.
  • Subfield: client diary view.
    • Reason: professional decision-making and health economics: all appointments in the 12-month research window (including those cancelled); referrals and associated rationales.
  • Subfield: HCR-20 overview.
    • Reason: professional decision-making and health economics: summary of HCR-20 H Factors for assessments made in the 12-month research window.
  • Subfield: inpatient care plan.
    • Reason: professional decision-making and health economics: problems and interventions during inpatient admissions in the 12-month research window.
  • Subfield: inpatient care plan – point in time.
    • Reason: professional decision-making and health economics: problems and interventions during inpatient admissions in the 12-month research window. Access on specific dates.
  • Subfield: progress note view.
    • Reason: professional decision-making and health economics: access to progress notes on specified dates.
  • Subfield: risk overview – point in time.
    • Reason: professional decision-making and health economics: summary of risk assessment in action at specified point in time.
  • Subfield: safeguarding children – adult client.
    • Reason: professional decision-making and health economics: evidence of child/children specifically at risk: check if form completed (not for content). Access to assessments on specified dates.
  • Subfield: safeguarding children – adult client – overview.
    • Reason: professional decision-making and health economics: summary of evidence of child/children specifically at risk: check if form completed (not for content). Access on specified dates.
  • Subfield: RiO significant events.
    • Reason: professional decision-making and health economics: incidents of significance flagged within the progress notes.

Mental Health Act

  • Subfield: Mental Health 1 assessments.
    • Reason: professional decision-making and health economics: assessments completed in the 12-month research window.
  • Subfield: client sections – history.
    • Reason professional decision-making and health economics: history of sections in the 12-month research window.
  • Subfield: Section 132 rights.
    • Reason: professional decision-making and health economics: record of rights explained in research window; level of service user understanding.

Archived forms

  • Form: safeguarding children summary, current interventions including medication, referral outcome decision.
    • Reason: professional decision-making and health economics: forms related to assessments conducted and decisions made within RiO data fields in the 12-month research window and evidenced in archived forms.
Copyright © Queen’s Printer and Controller of HMSO 2015. This work was produced by Lea et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK285793

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