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Crisis Resolution and Home Treatment Team North Manchester

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The Crisis Resolution and Home Treatment Team notched up an impressive highly commended spot in the inaugural Student Nursing Times Awards in May 2012, and here’s how they did it.

The motto of the Manchester Mental Health and Social Care Trust and Crisis Resolution and Home Treatment Team North is “together we are better” and that is certainly the approach that this team takes when it comes to incorporating students into the placement. Their health, their work life balance, teaching needs and sense of belonging are all catered for, and it is little wonder that students opt to return again and again as an elective placement despite the emotionally challenging environment that this type of placement can sometimes offer.

Based in a busy part of North Manchester, working with mental health service users who are experiencing mental health difficulties, CRHT aims to keep them out of in-patient units by providing alternative intense home support.

“Because it is based in people’s homes as well as other environments, it makes it hard to control the situation students find themselves in, and yet time is built in for reflective practice, and the approach is structured,” said one of our judges at the Student Nursing Times Awards. “This is a real challenge to achieve, and the fact that they have managed it is a real success.”

The CRHT is able to support up to three students per intake across other disciplines as well as nursing from universities in the Greater Manchester Area.

The multi-agency approach gives students a range of experiences, including working closely not only with nurses, but consultants, OTs and psychologists. Students get exposure to practitioners who have specialised in areas such as: cognitive behavioural therapy, safeguarding and child protection, non-medical prescribing and alternative therapies, some with over 20 years’ experience. The CRHT work as a hub to most services so students on placement get to experience most areas within a mental setting, from in-patient wards, CMHTs, drop-in centres, schools and the general medical wards. It works with 16-65-year-old service users, so students get to work alongside service uses from varied backgrounds, ethnicity and demographics.

But as well as the ability to get access to a broad range of staff and service users, it is in the consistent and structured approach to providing experiences for students using various methods such as observation, reflection, supervision, formal and informal teaching and role play that impresses.

While it may be structured, it is not depersonalised. Students certainly don’t feel like they are getting a cookie cutter approach to learning.

“Our skills as practitioners enable us to identify a student’s learning style and then maximise the potential for learning, in order to get the best out of the students on placement,” says acting team leader CRHT North Ibrar Ahmed. “But we also recognise that at times students need to be encouraged to move out of their comfort zones and experience different types of learning to enhance their experiences. We will look at students and which stage of their training they are at and then allocate appropriate experiences for them. But also ask what particular area they are interested in within mental health and provide them with a learning opportunity to meet this requirement.”

The team’s psychologist does formal teaching sessions with students and has access to various learning and evidence-based materials.

“As the practice education facilitator for Manchester Mental Health & Social Care Trust it is my aim to provide high-quality learning environments for students placed within our Trust for their practice experience. From regular evaluations and feedback from the students CRHT North certainly have proven that they put the student experience high on their list of priorities,” says Hilary Stratton-Powell, CRHT’s practice education facilitator.

The judging panel particularly liked this approach. “This would be an inspiring and motivating place to spend time,” they said.

Mr Ahmed agrees: “We will build upon our recent experiences and hope to encourage and inspire our future workforce.

“The process of entering the Student Nursing Times Awards enabled us to consolidate and reflect on what we do with students. Things such as making the student feel part of the team whist they are with us, and valuing their opinions, as they come to the team with their own diverse life experiences and placement experience, which enhances the team’s knowledge and in-turn gives patients a better standard of care.”

Although the team has been established for four years, it recognises that for students it can be difficult to integrate into a new team. “At the start of each placement we provide a student pack, which gives details of the placement, our student philosophy, who we are, names of all the staff, and other details that help the student orientate to the placement,” says Mr Ahmed. “They are introduced to their mentor as soon as possible, but are invited to visit the team prior to them starting their placement, to get a sense of the environment but also to look at practical things such as travel time, parking, and so on.”

CRHT North recognises that students not only have to be on placements and meet their set objectives, but have to balance their academic work and home lives. It is flexible because it is a seven days a week service so it can allow students to work weekends when required, if they need to get to the library or have other commitments. “As long they complete their required hours and learning is not affected, we aim to accommodate where possible,” says Mr Ahmed.

All students are allocated a mentor, and where possible an associate mentor to cover the times when their mentor is off. But CRHT also informs the student the other people they can approach if there are any difficulties, such as the senior practitioners or manager.

The practitioners provides formal teaching sessions, but often takes students along to their own study days, if it will enhance learning, such as conferences, presentations and journal clubs. “Via observation, supervision and understanding learning styles we are able to enhance learning, and where needed to alter our own approaches if objectives are not being met. We try and mirror teaching styles that students have at university so will look to provide feedback after a skill is performed, so questions such as ‘How do you think that went?’ and ‘How would you do that differently next time?’.

This incorporation of reflective practice particularly impressed the judges, who liked that the CHRT built in time for reflective practice between visiting people in their visits. “It is great that they make use of this time to provide instant feedback,” said our panel.

Flexibility, understanding and empathy - this team has it all.

“Being highly commended at the awards has raised our profile within the trust and we are getting positive feedback from the executive management team,” says Mr Ahmed. “The University of Manchester has complimented us and as part of our student evaluation of our practice area they ensured that our highly commended recognition was included in the formal paperwork to achieve our accreditation. We hope that in the future that we can roll out our model to other practice areas within the trust to standardise student experiences on placements, and to draw out skills and expertise of the staff to enhance the student experience using creative ways of working.

And we hope that we can go one better next time at the Student Nursing Times Awards 2013 and win.”

Tips for providing a great placement

  • Make sure there is time built in for reflective practice and ask questions about how the intervention or visit went and what could have been done differently
  • Offer a set structure for the student
  • Make sure the experiences offered are relevant to that stage of learning
  • Recognise that an established, albeit friendly, team can be intimidating to a newcomer so give them their own post trays and so on to make them feel they have a space
  • Spend time learning the student’s preferred style and work with that
  • Don’t be afraid to push the student out of their comfort zone
  • Take students to your own study days if they are relevant and they mix well with formal teaching sessions
  • Be flexible and let them work weekends or evenings to fit in with their study schedules and other commitments
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