My experience of 'Care and Treatment Reviews'

Care and Treatment Reviews (CTRs) are part of NHS England’s commitment to transforming services for people with learning disabilities, autism or both. CTRs are for people who develop mental health condition and whose behaviour is seen as challenging. CTRs happen in the community - with its purpose being to prevent admission to hospital. CTRs happen for people already in hospital and its purpose is to make sure they are receiving the right treatment and starting the discharge process.

We started to hold CTRs in 2015 and the first held CTR was an absolute disaster. Firstly we didn't provide the right information, the files were in a mess and staff thought they were under pressure by the panel. I have been responsible for coordinating Care and Treatment Reviews (CTRs) at Atlas House and for personalising the system since 2017.


I might sound like a geek but I really enjoy the preparation for the CTRs and when they are actually held. I start off the process by assessing if the person has the capacity to make the decision if he or she want to hold a CTR. For all of those who have capacity they have agreed to hold a CTR, mainly because the person sees this as an opportunity to be heard and heading towards a discharge date.




Next job for me is to support people to complete a one page profile. This so the panel get to know a little bit about the person and its the first thing they will see when they open the CTR file. Below is my own one page profile. We then include loads of photos of the person engaging with their peers, staff and doing their hobbies and interests.  

The CTR files contain the following sections:

1. Legal status

Paperwork if under any sections of the Mental Health Act or Deprivation of Liberty Safeguards.

2. Mental capacity assessments and best interest considerations

If there has been assessments or best interest considerations regarding serious decisions.

3. Incidents involving restraint

Any incident involving restraint since admission and any lessons learnt.

4. Safeguarding

If any safeguarding alerts have been raised and what the outcome was.

5. Progress notes

These are our daily records of the person and we provide this for the last 28 days.

6. Risk assessment

The most recent risk assessment regarding self harm, aggression, neglect etc.

7. Care plans and Care Programme Approach (CPA)

Copy of care plans, accessible care plan and risk management plan. Also the most recent CPA minutes, 

8. Nursing

The most recent nursing report, hospital passport and personal health profile.

9. Occupational Therapy (OT)

An OT report, daily activity timetable, interest checklist, sensory assessments and community risk assessments.

10. Psychiatry

An updated report and the persons current medication card.

11. Psychology

Psychology report, most recent positive behaviour support plan and ABC charts.

12. Speech and Language Therapy

An updated report, communication passport and anything related to dysphagia.

13. Art and music therapy

Updated reports.

14. Placement profile and 'My Ideal Home' and  'My Ideal Support'

Placement profiles are about every disciplines point of view of what home is best for the person. If the person is able to understand, then we talk about what's important to the person in relation to their new home and support.  

The best part of the CTR process is looking back at the progress people have made since being at Atlas House. We support people to go out everyday in the community and here's some of the places we visit.

  

 

Well that's my experience of CTRs, please let me know what your experience is by leaving a comment!


Steve Hardy
Practice Development Nurse
Oxleas NHS Foundation Trust