Test submission 1

Q1. Aims what are we trying to accomplish?

The overarching aim is to develop an intervention to address the emotional needs of children
and young people at risk of entering the youth justice system.
Within this aim two smaller objectives are improvement in the knowledge and confidence of
professionals to support identified emotional needs and recommendations for future service
development.

Q2. How will we know that a change is an improvement?

To evidence improvement, the intervention must result in measurable change in the
knowledge and confidence of professionals to support identified emotional needs.
Comparison can be made from measurement of these variables both immediately before
and after the intervention. It is important to understand if initial evidence of change is
sustained over time and whether the intervention results in practice change.
A deeper understanding of the limitations of the intervention will be useful for making
recommendations for future service development.

Q3. What change can we make that will result in improvement?

The introduction of a consultation model has the potential to result in improvement. This
would provide access to YOS and CAMHS input for an at risk population group, currently
underserved by local specialist agencies.

Strategy proposal
I intend to use an intervention led strategy as the literature review has established that
current practice issues are well defined. Firstly there is an established local practice of using
a consultation model for other vulnerable groups of children and young people (Rocco-

Briggs, 2008). Secondly the intervention aligns with the broader organisational aims of both
my immediate employer and seconded placement. Finally there is cohesion with the aims of
the national liaison and diversion programme (Durcan et al,2014). Consequently the primary
data collection will focus on an evaluation of the intervention.
Proposed research Question:
To what extent does consultation develop the knowledge and confidence of professionals to
support the emotional needs of children and young people at risk of entering the youth
justice system?
I anticipate two sub-themes emerging from the data:

Is this intervention effective? and

how can we improve it?

These will be helpful both in terms of answering the research question and providing an
evidence base for future service development

Test submission 2
What am I trying to accomplish?
The objective of this Service Improvement Project is to provide training that will increase Midwives
understanding of the complications, and the poor outcomes that are associated with gestational diabetes
for mothers and babies.
How will I know that a change is an improvement?
Following the training, my aim is to identify whether Midwives feel that they have increased their level of
understanding and confidence regarding gestational diabetes, and whether they feel better prepared to
support women who are either at increased risk of, or who develop gestational diabetes.
Whats wrong?
Midwives have identified through informal discussions that they feel anxious and have concerns about
their lack of understanding regarding the implications of diabetes in pregnancy.
A review of the literature has identified that there is an increased incidence of obesity globally, which is in
turn leading to an increase in incidence of gestational diabetes. This has become noticeable locally with
an increased demand for the number of GTT appointments due to women having a raised BMI. The
literature has highlighted the importance of diet and lifestyle as both a preventable measure and as an
aspect of the management of gestational diabetes.
Glucose tolerance tests (GTT) are used to detect diabetes in pregnancy which is called gestational
diabetes.
The Phlebotomists that carry out the glucose tolerance tests have recently highlighted the fact that several
women have not attended for their glucose tolerance test appointment. This could lead to a delay in
identification and treatment for women who are known to be at increased risk of developing gestational
diabetes.
Whilst there seems to be agreement on a list of risks factors that are used to determine which women
should be screened for gestational diabetes, it seems that there is some discrepancy regarding the timing
that a GTT should be undertaken in pregnancy, the amount of glucose used for the test and a variation in
results that are considered abnormal.
The review of the literature has identified that most of the information regarding Diabetes in pregnancy is
aimed at Nurses and Midwives with Specialist roles, rather than being aimed at Midwives in general.
However, locally Midwives work in an Integrated model of care, with the majority of them provide
Antenatal care to women. This will include screening women for risk factors and identifying women who
require a GTT and to arrange this to be undertaken at the relevant time.
Some studies highlighted the need to consider the womans experience following diagnosis of gestational
diabetes, management of the condition, and the way in which there is interaction between health care
professionals.
What might work?

Gathering information has helped me to identify an area for a Service Improvement project, which is to
improve Midwives knowledge regarding Diabetes in pregnancy to enable them to feel more prepared to
support women who are at risk of, or do develop gestational diabetes.
Process Strategy Intervention led
When considering what to include in the workshop I have asked staff to identify areas that they wanted
more information and how they might like to have the training provided.

Diabetes Workshop
Interactive

Results of Glucose
tolerance tests

Gestational
Diabetes

Case studies

Risk Factors

A pre test questionnaire will help to identify a baseline in the Midwives confidence and knowledge prior to
the training, which can then be compared to their post training questionnaires to enable me to evaluate the
impact of the training or intervention.
Questionnaires will be used to collect quantitative data regarding the Midwives skills and knowledge and
levels of confidence. It will also include some qualitative data through the use of some open-ended
questions.
Data analysis will be undertaken to identify whether the intervention has resulted in the desired outcomes
of improving midwives knowledge and confidence with gestational diabetes.
Next steps
Complete ethics checklist, organise 3rd party verification form, complete literature search
strategy.

Test submission 3
Section Three Action Plan
What am I trying to accomplish?
It is my proposal to undertake the checks within my work place myself as I have the necessary skills
and see if the checks are carried out to a greater degree and to see if there are any physical health
problems that have not been picked up. My line manager has agreed for me to have protected time
to undertake this for the project which is time limited.
How will I know if the change is an improvement?

After a proposed time I will audit my findings to see if any early recognition of deteriorating in
physical health due my checks have been found and improvement to physical health following the
outcomes. I will then show my findings to the three CMHT teams which I work across as focus
groups and ask members of staff via questionnaires their opinions to see if this has improved patient
care and if this is a viable option to continue.

What changes can I make that will result in improvement?

If this is an area that people feel has improved patient care then I will continue to carry out these
checks as part of my role after agreement with my line manager.

Enquiry-led or Intervention-led propose choice and justification

This will be intervention led as my primary research will be towards the end of the project after
presenting to the CMHT teams and asking for a questionnaire to be completed. I will use a
qualitative research approach as I will be using questionnaires and peoples opinions rather than a
quantative research method.

Proposed research question, research method and research analysis proposed choices and
justification
The research question will be two fold. Has the early detection of metabolic syndrome been
improved by the checks being carried out in house by myself, and if so can the service be improved
by making this the responsibility of some body within the team. This may lead on to a later job
description or development being made as a further project.

I plan to use a combination of direct questions on a questionnaire to ask this, along with an optional
area for people to write in any barriers or other areas for improvement or problems.

Expected impact

I would hope that the patients on second generation antipsychotics would have earlier detection of
metabolic syndrome and for the team within I work to take responsibility for this to improve both
physical and mental health wellbeing

As a second part of this improvement I would look to asking management to make this part of a job
description so that this work could continue if I left, but this would be a further piece of work
additional to the project of which I am conducting and also ask that other members of staff be
trained up to carry out these checks.

Test submission 4
AMHP Nearest Relative: Identification, communication, reporting
My SIP project will be intervention led and look into Oxfordshire AMHP Service
and how AMHPs communicate with Nearest Relatives and how this is reflected
in the reports.
Background for this project is criticism by CQC that the reports do not evidence
contact with NRs and often the reports are not clear on how NR was identified.
Project plan:
27/11 Meet with Senior AMHP to plan
January 15/ March 15 Cribsheet + training session at a policy meeting to set
up SIP task.
Recruit group of volunteers to work on defining cribsheet + using it.
Data collection:
- Document analysis before/after to monitor whether there has been a change
in communication/ recording communication.
- Interviews with volunteer group on training/ cribsheet. How it worked? Did
it make a difference? (Compare with documentary data) How could it have
been done differently/ better?

Test submission 5
Section 3 : Aims and objectives
Q1- What are we trying to accomplish?
The aim is to improve the knowledge and confidence of practitioners in older adults
CMHT to use the Mental Capacity Act 2005 whilst trying to remove a vulnerable
adult who lacks capacity, and to help the practitioners to understand the clear
pathway for the removal of vulnerable patients who lacks capacity, and who are at
risk and to prevent harm to them.
Q 2. How will we know that a change is an improvement?
-The practitioners will become knowledgeable and confident enough to undertake
the removal process
-the practitioners will be familiar with the care pathway for the removal of vulnerable
patients who lacks capacity, and who are at risk and to prevent harm to them,
- And the practitioners would completely stop the referrals to AMHP services for the
removal of vulnerable adult from his home to a care home.
Q3. What change can we make that will result in improvement?
I will be providing training to the practitioners on the removal process under Mental
Capacity Act 2005.
Prior to the training, I will request the participants to complete a pre training
questionnaire and assess their level of knowledge and confidence, and use this
information as base to prepare training material. After the training, I will ask the
participants to complete the post training questionnaire and use the data to
measure the change, this will be achieved by comparing the data from pre and post
training questionnaire .
Process strategy;
The process for my SIP will be intervention led because it has already been
established that there is a lack of knowledge and confidence in applying the mental
capacity act to remove a vulnerable adult who is lacking capacity. This is evidenced
by the inappropriate referrals received at AMHP service in the past two years.
Research Question
To what extent did the training help to improve the knowledge and confidence
of the practitioners to use the Mental Capacity Act to remove a vulnerable
adult who is lacking capacity?

Test submission 6
The main field that I gave further consideration to was Knowledge Deficits within the
Team:
Addressing this field through the SIP would require an enquiry led approach, as the
intervention would be designed to improve knowledge around areas not yet identified. As a
result, I would need to generate primary data from care coordinators (CCOs) in the team,
through qualitative methods such as focus groups. I like the idea of this second topic, as I
would not enter with any preconceived problem, except for the assumption that there are
some areas where some practitioners feel they lack specialist knowledge. I also like the fact
that the intervention would be a training session on one or more identified topic, as this seems
specific and small-scale enough for the project, as well as being relevant to the team.
As a result, and pending feedback from this submission, I shall now briefly outline how I
envisage an outline for a PSIP submission around the knowledge deficits within the team
might look:
Section 1: Context and rationale.

Context I work as a care coordinator in a multidisciplinary adult community

mental health team...

Key Drivers generic multidisciplinary working requires practitioners to be a jack

of all trades, and the CPA approach imposes a legal duty on CCOs to undertake or
oversee a wide range of elements of a persons care, whether or not they had
training on that role as part of their professional qualification. There is a high degree
of skill and knowledge in my team, but the varied and demanding nature of the work,
combined with the professional requirements on CCOs to continuously strive to
update and acquire new knowledge, led me to feel confident that there will be areas
that at least some CCOs would benefit from greater training in if offered.

Personal approach I feel that despite its strengths my service requires much
improvement, and my personal value base and my professional training both lead
me to strive to be open and honest in addressing this. I am conscious of the
limitations of my own knowledge, and aware of how uncomfortable this is as a
professional. As a result I understand that it is an area that will need to be addressed
sensitively, and so my methodology will need to take into account the difficulties of
asking professionals to be open about their weaknesses. Perhaps as a result of
having been brought up by a philosopher and a child psychotherapist I adopt a
relativist perspective. I usually struggle with the presentation of absolutes, and as a
result lean towards qualitative research. Ideologically then, I lean towards an enquiry

led approach (fearful of basing the entire SIP on an assumption), and of using
qualitative data to attempt to identify individual perceived personal deficits.
Section 2: Literature Review.

I will undertake a literature review to attempt to identify relevant themes from

research. This could include identifying common knowledge deficits in CMHTs such
as mine. Given the relevance of the multi-disciplinary team to the SIP, it will be
important that I search literature from a range of professional viewpoints. As such I
will ensure I include key journals from Social Work, Occupational Therapy, and
Mental Health Nursing.
Research may also indicate the success/failure of specific interventions aimed at
knowledge acquisition in this setting.
I will also be interested as to whether existing literature addresses the learning styles
of front line mental health workers, in order to bring an evidence-based pedagogical
perspective to knowledge acquisition and service improvement in settings such as
the NHS.
As a result I plan to also search journals that are not specifically linked to any NHS
profession , and so would look to include journals concerned with learning (so
perhaps from the teaching profession), and with service improvement in general, so
perhaps from a management perspective. However, this is in danger of generating a
wealth of literature far too broad and numerous for the purposes of my PSIP, and so
I will need to ensure that my search terms generate literature that is relevant to my
work.

Although I have not yet given serious consideration to the literature review, my initial
thoughts are that my possible search terms might include:

CMHT

AND

Knowledge

AND

Deficit

AND/OR

AND/OR

AND/OR

Mental Health

Learning Needs

Aquisition

Section 3: Action plan/strategy proposal

MFI Questions see above

 Research Question What are the main learning needs of care coordinators
within a specific multidisciplinary CMHT?

Methods Predominantly qualitative. Perhaps focus groups, though issues of

honesty in the presence of colleagues may be a factor. A questionnaire could
potentially ask open questions to identify themes in a confidential manner?

Sampling CCOs form the CMHT. I will have to think about whether I ask all or a
select few, and how any selection might introduce bias. This could be a reason for
questionnaire rather than focus group? I will also need to think about confidentiality,
and interviewer bias how can I best get honest answers?

Analysis This will depend on the method used, but I envisage the use of some
sort of thematic analysis.

Quality This ties with the method and the sampling, but I need to ensure my
colleagues are comfortable with the process. I could have initial conversations with
colleague to attempt to establish any potential anxieties, though this in itself could
generate the same problems as the method itself! Ill have to think about this more...

Expected impact My desired outcome is that as a result of my SIP, CCOs in my

team will have had the opportunity to acquire greater knowledge in an area that they
previously felt their knowledge was below that required of them by their job role.

Ethics and risk assessment I will not be involving patients. There could be
ethical concerns around the confidentiality of information that CCOs wish to disclose
about their knowledge levels, and so consideration will need to be given to
methodology. I believe this proposed SIP to be low risk to those involved.
Section 4: 3rd party verification
My hope is that this proposed SIP aligns well with the needs of the team, and I hope
that as a result I should not encountered resistance from my seniors.
End.