REFERRAL. Single Point of Referral for CLDTs (Meets weekly) LD Forensic Panel (Meets monthly) Triage. Access Assessment.

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1 REFERRAL Tier 1 to 3 service Tier 4 service Single Point of Referral for CLDTs (Meets weekly) LD Forensic Panel (Meets monthly) Triage (Follow Core Pathway Guidelines) Access Assessment Regional Guidance Assessment Recommendations Formulation Intervention Step up to in-patient rehabilitation unit Step down from secure hospitals Not Eligible for LD Service Maintenance Discharge

2 Referral Referrals are received from primary, secondary and tertiary care services, local authorities, LD inpatient & community, Criminal Justice System (Police, Probation, Courts, Prison, LSC, MAPPA), NHS and Private sector secure and rehabilitation services, Adult mental health and forensic services, East Midlands Secure Commissioning Group (EMSCG).

3 Tier 1-4 If the referral is for Tier 1 to 3 services, the referral is logged and discussed at the weekly CLDT meetings. If the referral is for Tier 4 service ie. In-patient rehabilitation, the referral is logged and discussed at the LD Forensic Panel which meets monthly. The panel has representation from the LD forensic virtual team, in-patient rehabilitation staff, heads of services from local authorities, health commissioners, secure commissioners and adult forensic services. To decide where to send the referral, please table below Tiered Model of Care for LD Forensic Service Provision Tier 1 involves enabling other agencies (primary care and other mainstream services including criminal justice system) to support offenders with LD. This mainly involves provision of training, supervision and raising awareness of issues in relation to offenders with LD. Tier 2 involves supporting CLDTs and other agencies to assess and manage offenders with LD. This mainly involves signposting and providing advice. Tier 3 Involves hands on assessment and management of offenders with LD. It includes providing the specialist component of assessment and management of offenders with LD using structured professional judgement and includes access assessments for the EMSCG. Tier 4 involves the care and treatment of offenders with LD in the in-patient unit. This involves the rehabilitation of offenders and providing appropriate treatment programmes and working with agencies like the police, probation and MAPPA to facilitate the step down from higher secure hospital placements and gradual discharge of patients into the community.

4 Triage Triage in the CLDTs will be undertaken by the multi-disciplinary team in line with the Core Pathway guidelines to ascertain the urgency of the referral. The 2 levels of triage for service users with forensic issues and accompanying time scales are 1. Red = Immediate 2. Green = within 6 Weeks Those needing immediate input (Red) will be fast tracked to be assessed immediately. This is usually for service users with very high and immediate risk in the community.

5 Assessment The assessment process takes into consideration, the nature of the assessment, the setting where the assessment will take place, whether aids to assessment (rating scales etc) are needed and identification of the professional(s) who will do the assessment. a) It should be multi-disciplinary in nature and have a holistic approach b) It should include an assessment of the degree and nature of LD, assessment of mental health, challenging behaviour, environmental needs, communication needs and risks. c) Risk assessments should use structured clinical judgement aids like HCR-20 d) Baseline outcome scales like HoNOS LD and Patient Related Outcome Measures (PROMS) should be completed. e) Identification of catchment area psychiatrist, social worker, community / outreach nurse, where appropriate f) CPA Status determined with action plans g) MHA and MCA Status determined with action plans h) Allocation of Care Co-ordinator i) Decide on Formulation, Care Plan and Crisis intervention plan j) Service information leaflet to be provided to service user / carer

6 Access Assessments Access assessments will be undertaken by the virtual LD forensic team and depending on the outcome of the assessment recommendations will be made for suitability for step-down placements in community, locked rehab or step-up to low secure, medium secure and high secure provisions. The assessment will follow the guidelines provided by the East Midlands Secure Network.

7 Interventions The nature of the interventions will depend on the nature and source of referral. Interventions in Tier 1 to 3 services will be delivered by a multi-disciplinary and interagency team under the framework of Care Programme Approach with robust risk management plans. Recommendations on management strategies, support and training for community staff, liaison with relevant agencies (CJS) and signposting and advice will be undertaken depending on whether Tier 1, 2 or 3 service is provided.

8 Step Up Into In-Patient Rehabilitation Interventions in Tier 4 service (in-patient rehabilitation) will focus on four areas a) Work on offending behaviour (includes therapy programmes like ASOTP) b) Mental and physical health wellbeing. c) Social rehabilitation including education and employment using the Life Stars approach. d) Risk management planning using an inter-agency approach for step down to the community.

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