Dual Diagnosis Street Team

Transcription

1 Dual Diagnosis Street Team DDST n Cambridgeshire and Peterborough NHS Foundation Trust We work with the homeless who are experiencing mental health and substance issues A member of Cambridge University Health Partners

2 Who are we The Dual Diagnosis Street Team is designed to support and empower individuals experiencing street homelessness, alongside mental health and substance misuse issues. How can we help you? We will provide personalised assessment to create individual support plans based on your needs. This could range from enabling you to access the services which will best meet your requirements, to providing individualised intervention. How to access our service To refer yourself to this service, please complete as many of the following questions as you feel able to, and hand in to a member of our team or one of our partner agencies: Jimmy s, Wintercomfort, CEA, Inclusion or the Street Outreach Team. What happens next? Once we receive your referral, we will make contact with you on the phone number or address you have provided to clarify any missing information or answer any questions you may have. A member of our team will offer you an appointment, at a place where you can easily access, to further assess your needs. All support options will be discussed and together we can make a plan about the best way forward to help you with the issues you have raised. We aim to make this service as simple and stress free as possible, so please let us know of any way we can aid your contact with our team. We look forward to working with you to support you to gain the help you feel you need.

3 Self-referral form Personal information First name...gender... Surname...Title... Date of birth...contact number... Can we leave a voic ? Yes No Are you happy for us to text you? Yes No address... Can we you? Yes No How did you hear about this service Your GP name... GP address Can we inform your GP of your self-referral? Yes No

4 Other services involved Please give details of any other services supporting you at present:. Current difficulties Do you have a mental health issue? Please give details: How long have you had this issue e.g. weeks, months, years:... Have you been referred to mental health services in the past?... Do you have a learning disability? Please give details:... Do you have any physical health issues? Please give details?... Are you currently taking any medication? Please give details... Are you currently receiving any treatment?...

5 Assessing risk Do you currently feel you are a risk to yourself?... Do you currently feel you are a risk to others?... Do you currently feel you are at risk from others... If you have answered yes to any of the above questions, please give details: Housing issues Please give details of your current situation - e.g. sleeping on the street, sofa surfing: Benefits Please give details of any benefits you are receiving: Ethnicity... Religion... Sexual orientation... Ex-British forces...

6 Your needs Please use the diagram below to tell us more about your current needs For example I need help with managing my mood. Your needs Feel free to add as many additional lines as you may need.

7 Drug use Do you currently use any illicit drugs? Please give details of: Substance/s used... How often you take the substance/s... How long you have taken the substance/s for... Can you identify why you use this substance/s? Are you engaged with any services to help with this and, if so, who is your keyworker?...

8 Alcohol use To help us identify your alcohol use, please complete the following AUDIT C form: Questions Scoring system Your score How often do you have a drink containing alcohol? Never Monthly or less 2-4 times a month 2-3 times a week 4+ times a week How many units of alcohol do you drink on a typical day when you are drinking? How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? Never Less than monthly Monthly Weekly Daily or almost daily Scoring: total of 5+ indicates increasing or higher risk drinking. An overall total score of 5 or above is AUDIT-C positive Score Department of Health 2009

9 What DDST will do Treat you as an individual with your needs at the centre of our assessment Treat you with respect and dignity Work with you to enable the best possible outcome in terms of identifying and achieving your goals Identify other services who may be able to support your needs, and assist you in accessing these Work in collaboration with other services who may be involved with you, to ensure where possible information is shared and efforts are made to make your journey as smooth as possible.

10 Consent to share information for Dual Diagnosis Name:.. Date of Birth:... Address: Patients have a right to expect that information about them will be held in confidence. This means that nothing can be shared without your consent unless it relates to significant risk to others, is in the public interest, you lack capacity or there is a requirement under the law for information to be shared. I consent to share information held by Cambridgeshire and Peterborough NHS Foundation Trust with the following: Yes / No with my GP Yes / No with my family (please specify).... Yes / No with the Multi Agency Protection Arrangements (MAPPA) panel. Yes / No with probation or approved premises staff Yes / No with other mental health services (for example in prison mental health team, community mental health team or hospital settings) Yes / No with housing providers Yes / No with Police Yes / No with Drugs and Alcohol Services Yes / No with my solicitor (please specify) Yes / No with prison staff( for purposes of ACCT / Reviews) Yes / No Other Organisations - Please specify

11 I do not want information on the following shared: Please specify any restrictions to information sharing: I understand that I have the right at any time to change my mind about who I information is shared with at any time and will inform my link worker. I understand that this may impact on the effective dual working with other organisations involved in their care. Signed... Date... The DDST is a pilot project and as such will be collecting anonymized data to help identify the service outcomes. In order for us to do this we need to gain your consent. If you give permission for us to share your information in this manner, please tick this box to confirm:

12 Contact us Dual Diagnosis Street Team DDST The Bridge, 154 Mill Road, Cambridge CB1 3LP T: This is not an emergency service and therefore we are not able to offer crisis support out of hours, or respond to a crisis immediately. If you are in a mental health crisis please call the First Response Service on 111, Option 2, 24 hours a day. Other useful services Samaritans Saneline Shelterline Patient Advice and Liaison Service (PALS) If you have any concerns about any of CPFT's services, or would like more information please contact: Patient Advice and Liaison Service (PALS) on freephone or pals@cpft.nhs.uk Out-of-hours service for CPFT service users Contact Lifeline on pm-11pm 365 days a year Leaflet updated December 2017 Leaflet review date: December 2018 For more information en Elizabeth House, Fulbourn Hospital, Cambridge CB21 5EF. q c ïïïkåéñíkåüëkìâ