Triage

Defining the Street Triage intervention and formative evaluation of implementation in Cornwall
getty triage

The evaluation of the Street Triage (ST) intervention commenced in September 2018 following an extensive stakeholder consultation exercise in January 2018. The ¶¶Òõ¶ÌÊÓƵ worked alongside partners in Devon and Cornwall Police, Devon Partnership NHS Trust (DPT) and Cornwall Partnership NHS Foundation Trust (CFT) to develop a service evaluation plan. The service evaluation was approved by the ¶¶Òõ¶ÌÊÓƵ Faculty of Health Research Ethics and Integrity Committee, and was registered with DPT and CFT Research Development Departments. The first stage of the evaluation was conducted from September 2018-March 2019 to support the extension of the intervention into Cornwall. The second stage of the evaluation was conducted from September 2019-January 2020, with the evaluators based in Sentinel Healthcare, to develop a detailed understanding of the intervention.

This service evaluation aimed to provide timely, formative recommendations for the refinement, and development of the new service model. We focused on the mechanisms that are most effective, how the service could be improved and collected and interrogated available data to define the active ingredients and how the intervention works. We additionally conducted focused and timely data collection and analysis to support the extension of ST into Cornwall.

Aims

The service evaluation aimed to:

  • define key operational components and activities within the service
  • identify facilitators to service implementation and delivery
  • identify facilitators to service implementation in Cornwall
  • identify barriers to service implementation and delivery
  • identify barriers to service implementation in Cornwall
  • identify potential improvements to service delivery
  • understand perceptions of key stakeholders, including service users, police officers and mental health professionals delivering the interventions
  • understand how the service is being implemented and delivered on the ground.

Findings

Both the range of actions recorded as being carried out by ST practitioners and the range of disposals that diverted individuals away from the Criminal Justice System or detention under the mental health act, indicate that this intervention can provide support to decision making when individuals with mental health needs come to the notice of the police. Further, knowledge and communication of the intervention (particularly when being extended to another geographic area) and colocation of ST practitioners with control room staff ensure that the intervention is utilised.

The service user consultation provides a range of principles, guidelines and further enhancements that could be made to ensure that the intervention and interactions between police officers and people with mental health needs on the ground are optimal. The following sections present four categories of recommendations to enhance implementation and delivery of the intervention, including recommendations for intervention implementation; intervention delivery; project coordination and evaluation and monitoring.

Intervention implementation

  • Regular operational team meetings with representation from delivery teams (including management and practitioner representatives), project coordinator, service managers and evaluators. Operational meetings should meet regularly throughout delivery, with particular attention to ensure greater frequency of meetings in the early implementation phase to
    (i) support early organisational communication strategies and referral processes
    (ii) identify and solve early barriers.
  • Communication strategies need to be tailored for specific groups. For example, screen savers may be a good communication tool for some groups of officers, but control room staff do not see screen savers as their screens are always in use.
  • ST practitioners to develop working relationships with control room staff and visit control rooms to introduce themselves if necessary, to (i) enhance awareness of the intervention (both presence and remit)
    (ii) develop joint working.

  • ST practitioners to be directly appointed to the role rather than work as bank staff to facilitate role continuity and identity of the position within the control room. A small cohort of staff delivering the intervention would also ensure that patient record system licences could be purchased for all staff, facilitating parity of delivery across geographical areas.
  • Inclusion in training/intervention communication for all control room staff to consider if a ST referral is appropriate in all calls where the subject is regarded as vulnerable.
  • Inclusion of the remit and availability of the intervention in all mental health training delivered to front line police officers to ensure that they are aware of the availability and scope of the intervention to support decision making on the ground.

Intervention delivery

  • Development of an intervention delivery platform including an intervention manual and specific intervention training to ensure:
    (i) parity of understanding of inclusion/exclusion criteria; aim of the intervention
    (ii) practitioners are aware of and able to utilise the full range of the intervention, in particular in relation to intervention activities
    (iii) parity of provision across sites.
  • Joint training with ST practitioners and control room staff to support collaborative working and understanding of remit of the intervention
  • Colocation of ST practitioner and control room staff where possible. Where this is not possible, an indication on the system that the ST practitioner is on duty and available to take referrals.
  • All ST practitioners should be able to access patient record systems for:
    (i) all geographic areas
    (ii) all ages

Project coordination

  • Jointly commissioned project/intervention manager to coordinate early implementation and ongoing delivery across both mental health and police services
  • Regular points of monitoring of referral numbers, intervention activity and outcomes in order to troubleshoot barriers to implementation/delivery

Research/Evaluation and monitoring

  • Development of an agreed common dataset (from Police and NHS patient record systems) to support monitoring of referrals, intervention activities and outcome
  • Regular monitoring of intervention fidelity to ensure that the intervention is delivered as intended.
  • Secure research funding to:
    (i) test and refine the proposed theory of change (i.e. how the intervention is proposed to work) represented in the draft logic model
    (ii) conduct a longitudinal study to test the effectiveness of the intervention in terms of:
    enhancing access to appropriate care/services, enhancing mental health and wellbeing of patients and reducing police contact.