NHS Foundation Trust Dual Diagnosis Street Team A5... · Dual Diagnosis Street Team DDST The...

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

Transcript of NHS Foundation Trust Dual Diagnosis Street Team A5... · Dual Diagnosis Street Team DDST The...

Page 1: NHS Foundation Trust Dual Diagnosis Street Team A5... · Dual Diagnosis Street Team DDST The Bridge, 154 Mill Road, Cambridge CB1 3LP This is not an emergency service and therefore

A member of Cambridge University Health Partners

Dual DiagnosisStreet TeamDDST

We work with the homeless who are experiencing mental health and substance issues

nCambridgeshire and

PeterboroughNHS Foundation Trust

Page 2: NHS Foundation Trust Dual Diagnosis Street Team A5... · Dual Diagnosis Street Team DDST The Bridge, 154 Mill Road, Cambridge CB1 3LP This is not an emergency service and therefore

The Dual Diagnosis Street Team is designed to support and empower individuals experiencing street homelessness, alongside mental health andsubstance misuse issues.

Who are we

We will provide personalised assessment to create individual supportplans based on your needs. This could range from enabling you to accessthe services which will best meet your requirements, to providing individualised intervention.

How can we help you?

To refer yourself to this service, please complete as many of the followingquestions as you feel able to, and hand in to a member of our team orone of our partner agencies: Jimmy’s, Wintercomfort, CEA, Inclusion orthe Street Outreach Team.

How to access our service

Once we receive your referral, we will make contact with you on thephone number or email address you have provided to clarify any missinginformation or answer any questions you may have.

A member of our team will offer you an appointment, at a place whereyou can easily access, to further assess your needs.

All support options will be discussed and together we can make a planabout 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 pleaselet 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 youfeel you need.

What happens next?

Page 3: NHS Foundation Trust Dual Diagnosis Street Team A5... · Dual Diagnosis Street Team DDST The Bridge, 154 Mill Road, Cambridge CB1 3LP This is not an emergency service and therefore

Self-referral form

Personal information

First name.........................................................................Gender........................

Surname...........................................................................Title..............................

Date of birth.............................Contact number...................................................

Can we leave a voicemail? Yes No

Are you happy for us to text you? Yes No

E-mail address.......................................................................................................

Can we e-mail 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

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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?...........................................................

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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, sofasurfing:

.............................................................................................................................

.............................................................................................................................

Benefits

Please give details of any benefits you are receiving:

.............................................................................................................................

.............................................................................................................................

Ethnicity................................................................................................................

Religion................................................................................................................

Sexual orientation.................................................................................................

Ex-British forces....................................................................................................

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Your needsPlease use the diagram below to tell us more about your current needs

For example ‘I need help with managing my mood’.

Feel free to add as many additional lines as you may need.

Your needs

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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.......................................................

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Can you identify why you use this substance/s?....................................................

............................................................................................................................

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Are you engaged with any services to help with this and, if so, who is your keyworker?

............................................................................................................................

Page 8: NHS Foundation Trust Dual Diagnosis Street Team A5... · Dual Diagnosis Street Team DDST The Bridge, 154 Mill Road, Cambridge CB1 3LP This is not an emergency service and therefore

Alcohol useTo help us identify your alcohol use, please complete the following AUDITC form:

Scoring: total of 5+ indicates increasing or higher risk drinking.An overall total score of 5 or above is AUDIT-C positive

Department of Health 2009

How often do youhave a drink containing alcohol?

How many units ofalcohol do youdrink on a typicalday when you aredrinking?

How often haveyou had 6 or moreunits if female, or8 or more if male,on a single occasion in the last year?

Questions Scoring system Your score

0 1 2 3 4

Never

Never Lessthanmonthly

Monthly Weekly Dailyoralmostdaily

0-2 3-4 5-6 7-9 10+

Monthlyor less

2-4times amonth

2-3times aweek

4+times aweek

Score

Page 9: NHS Foundation Trust Dual Diagnosis Street Team A5... · Dual Diagnosis Street Team DDST The Bridge, 154 Mill Road, Cambridge CB1 3LP This is not an emergency service and therefore

What DDST will doTreat 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 aremade to make your journey as smooth as possible.

Page 10: NHS Foundation Trust Dual Diagnosis Street Team A5... · Dual Diagnosis Street Team DDST The Bridge, 154 Mill Road, Cambridge CB1 3LP This is not an emergency service and therefore

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 unlessit relates to significant risk to others, is in the public interest, you lack capacity orthere is a requirement under the law for information to be shared.

I …………………………………………………………………consent to share information held by Cambridgeshire and Peterborough NHS Foundation Trustwith the following:

Yes / No with my GPYes / No with my family (please specify) ……………………………………………

…………………...............................................................................................….

Yes / No with the Multi Agency Protection Arrangements (MAPPA) panel.Yes / No with probation or approved premises staffYes / No with other mental health services (for example in prison mental health

team, community mental health team or hospital settings)Yes / No with housing providersYes / No with PoliceYes / No with Drugs and Alcohol ServicesYes / No with my solicitor (please specify)…………………………………………

…………………………………………………………………………………………

Yes / No with prison staff( for purposes of ACCT / Reviews)Yes / No Other Organisations - Please specify……………………………………

…………………………………………………………………………………………

Consent to share information for Dual Diagnosis

Page 11: NHS Foundation Trust Dual Diagnosis Street Team A5... · Dual Diagnosis Street Team DDST The Bridge, 154 Mill Road, Cambridge CB1 3LP This is not an emergency service and therefore

The DDST is a pilot project and as such will be collecting anonymized data tohelp identify the service outcomes. In order for us to do this we need to gainyour consent. If you give permission for us to share your information in this manner, please tick this box to confirm:

I do not want information on the following shared:

I understand that I have the right at any time to change my mind about who I in-formation is shared with at any time and will inform my link worker. I under-stand that this may impact on the effective dual working with otherorganisations involved in their care.

Signed……………………………...……………………………………………………

Date……………………........................................................………………………

Please specify any restrictions to information sharing:

.........................................................................................................................

.........................................................................................................................

.........................................................................................................................

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Patient Advice and Liaison Service (PALS)

If you have any concerns about any of CPFT's services, or wouldlike more information please contact: Patient Advice and LiaisonService (PALS) on freephone 0800 376 0775 or [email protected]

Out-of-hours’ service for CPFT service users Contact Lifeline on 0808 808 21217pm-11pm365 days a year

Leaflet updated December 2017Leaflet review date: December 2018

For more information

en Elizabeth House, Fulbourn Hospital, Cambridge CB21 5EF.q 01223 726789c 01480 398501

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Contact usDual Diagnosis Street Team DDSTThe Bridge,154 Mill Road,CambridgeCB1 3LP

This is not an emergency service and therefore we are not able to offercrisis support out of hours, or respond to a crisis immediately. If you are ina mental health crisis please call the First Response Service on 111, Option 2, 24 hours a day.

Other useful servicesSamaritans 0845 790 90 90Saneline 0845 767 8000Shelterline 0808 800 44 44

E-mail: [email protected] T: 01223 271011


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