Scoping review of intensive psychiatric inpatient care provision for young people in Scotland: report

Appendix IV. Proforma used to guide discussions and data collection.

Review of Adolescent Intensive Psychiatric Care Units (IPCU) in Scotland - NHS Scotland Regional Consultation Pro forma

Introduction

• Current inpatient units
  • Please tell us about the inpatient service you work in and your role within that.
  • What age are you patients?
  • How many beds in the unit?
  • What mix of professionals currently work in your inpatient service?

Care Pathway

• Referral
  • What would prompt your decision to refer a patient to a more intensive unit?
  • What organisations can make a referral? (Where do referrals come from?
• Admission
  • What criteria do patients need to meet to be admitted to an IPCU?
  • Once a referral is accepted, what's the process for new admissions?
  • What needs to be considered in relation to transferring patients to an IPCU?
• Barriers to admission
  • What would exclude a patient from being admitted?
  • What happens when a patient is not suitable for an IPCU? Or if a bed can't be found?
  • Are there any other barriers to patients accessing an IPCU if they require it?
• Discharge
  • When does planning for discharge begin?
  • What is the pathway for discharge?
  • What type of barriers could prevent patients from being discharged?

Current Adolescent IPCU Options

• IPCU Service Options in your region
  • Currently in your region, what are the options for a patient who requires more intensive psychiatric care?
  • How well does this match the need for adolescent intensive psychiatric care?
• Staffing
  • What staff disciplines are present in the IPCU in your region?
  • What mix of staff would you want to see within an adolescent IPCU?
• Patient Management
  • Are there any patient management issues specific to adolescents who require intensive psychiatric care? (e.g. restraint procedures, risk assessment, observation)
  • What guidelines would you refer to for this? (Are these sufficient?)
  • How well are these issues currently provided for in your region?
• Interventions/Facilities
  • What facilities need to be in place for adolescents who require intensive care? (e.g. access to schooling, anything treatment specific?)
  • What else could be provided to facilitate their care? (e.g. violence reduction options; meaningful activities)
  • How well are these facilities currently provided in your region?

Relationships across Services

• How do intensive care services and CAMHS/Community Services communicate generally?
• How do you maintain communication with intensive psychiatric care services regarding specific patients?
• How do intensive care services and CAMHS/Community Services communicate with social work regarding specific patients?
• National Secure Adolescent Inpatient Service:
  • What do you anticipate the relationship being between your service and the new National Secure Adolescent Inpatient Service?

Future Adolescent IPCU Options

• Current unmet need (if not already covered in above discussion)
  • What is lacking in current adolescent intensive psychiatric provision?
  • What are they key unmet needs?
• Future options
  • Would it be possible to adapt current services to meet need?
  • What would be the preferred option in your region? (e.g. current arrangement / adapt beds in an adult IPCU / have a dedicated unit adjacent to an adolescent inpatient unit / other)
  • What are the benefits of your preferred option?
  • What are the disadvantages of your preferred option? (On patient care? / On staff? / On families?)
  • What clinical considerations need to be taken into account for these options?

Activity Data

• Admissions to open inpatient adolescent psychiatric units by Health Board?
• Duration of stay of patients in these units.
• Referral/Admission rate - (How many are referred vs accepted and admitted) to open units but also to IPCU services from open units.

Patient Profile (for patients requiring intensive psychiatric care)

• Diagnosis/Conditions - prevalence of conditions existing in patients in the wards.
• Age of patients admitted.
• Level of deprivation - (SIMD)
• Location - Admitted from/discharged to.
• Detention status - how many patients were informal/detained?
• Patients placed on observation - and varying levels of this?

Staffing Data

• Core Team - Nursing and Medical Staff required to run the ward? Number of sessions? Daily staffing levels per shift?
• Allied Health Professionals/MDT - Clinical Psychology, Occupational Therapy, SLT input etc. Number of sessions?