Other Issues CHILD AND ADOLESCENT PSYCHIATRY SERVICES

44 Psychiatric And Mental Health Services Operational Policy after assessment, taking into account the reason for the visits, the interventions needed and patients’ and families’ response to intervention. o Frequency of visits should be determined by specialist in charge. o Ideally, patients on acute home care should be seen 1-3 times per week, patients on Level 1 2 follow up seen 1-2 times per month and assertive care patients should be seen at least once a week. o The results of intervention after each visit should be made known to specialist and home care team after as regularly as possible. o A key worker or case manager should be assigned for each patient on home care. o This named worker will provide direct services to the patient at home. These include: assessing symptoms and side effects, giving medication, providing education to patient and family, crisis help etc. o There should be a limited number of patients assigned to each case manager key worker. • INTERVENTIONAL ACTIVITIES AT PATIENTS’ HOME: o Education to patients on aspects of illness, medication adherence, ADL, early warning signs etc. o Family education. o Help with getting jobs may liaise with job placement services of hospital. o Collaborate with key local igures e.g. village leaders etc. e Inclusion criteria • Severe mental illness schizophrenia, mood disorders, dementias. • History of non adherence to treatment and non engagement to services. • Frequent crises. • Frequent readmissions. • Prolonged psychotic episode. • Co morbid substance use. 45 Psychiatric And Mental Health Services Operational Policy f Exclusion criteria • Personality disorders, such as antisocial personality. • Homelessness. • high risk behaviors such as suicidality and homicidality. g Regular reviews on need for further follow up • Acute home care: done after crisis is over usually in 3 weeks. • Level 1 2 patients: at least 2 years of stable follow up before care can be transferred. • Assertive care: at least two years of stable follow up before care can be step down. Usually assertive care patients will require indeinite follow up. 6.4.1.2 Assertive Community Team a Should have 4 of 5 criterias o Low staff : patient ratio 1:12 or less. o Psychiatrist. o at least one staff nurse and one assistant medical oficer. o at least 2 meetings in a week. o after hours services eg; weekends. b Members of the team provide a comprehensive, accessible and continuous care for patients who were recently discharged from the ward to their residence in the team area of coverage. c Patient’s inclusion criteria are o Psychotic disorder: schizophrenia and mood disorder. o history of no adherence to treatment. o frequent crisis, admissions and prolonged psychotic episode. o co morbid substance abuse. d Patient’s exclusion criteria are o personality disorder such as antisocial personality. o homelessness.