Care Coordinator | South London and Maudsley NHS Foundation Trust

We have an exciting opportunity for two care coordinators to join an experienced and supportive multidisciplinary team at Croydon Older Adult CMHT. The CMHT has a key role in promoting metal wellbeing and engaging service users and carers to meet their mental health needs; avoiding the need for more restrictive treatment options such as inpatient care.

The team is well regarded by service users and carers with 100% of respondents on recent patient and carer experience questionnaires rating their experience of the service as 'very good'. The team reflects the diversity of the local community and team members are passionate in their desire to support each other to provide high quality patient care. As a care coordinator you will have opportunities to work both independently and as a core part of a team and the flexibility to structure your time according to the needs of your caseload.

We are committed to get the very best out of our staff and support staff in their career aspirations. We have career pathways available where you will be able to develop your skills and build on your experience to progress across different specialties. For this role, we offer career pathways to clinical specialist and team manager roles. In addition, we offer ongoing training and development, with staff across our CMHTs currently accessing training in dual diagnosis, family interventions in psychosis, structured clinical management, medication management, physical health and leadership.

You will promote and deliver evidence-based care for older adults with mental health problems living in the community. You will support a caseload of older adult clients across a full range of mental health needs, including people with dementia, mood disorders, schizophrenia and personality disorder. Some will have had ongoing contact with mental health services, whereas for others it may be their first presentation, so you will need to employ a range of strategies to engage with and support service users, their families and carers.

You will act as a care coordinator under the Care Programme Approach (CPA), working closely with other members of the MDT and other relevant teams and agencies. You will also carry out initial assessments for clients new to the service, and participate in shared team tasks such as duty and triage. The team has regular clinical meetings to support with care planning and risk management as well as forums to discuss service development and quality improvement.

You will have a genuine enthusiasm for working with older people, appreciating the richness of their life experiences and valuing each of your service users as an individual. You will be committed to exploring psycho-social models of care. We welcome applications from those looking to move from other mental health settings and specialisms and from people who can bring their values and enthusiasm to the role and demonstrate the transferability of their current skills and experience.

The team is made up of a number of experienced clinicians with a team manager, clinical nurse specialist and clinical specialist occupational therapist all on hand to offer supervision in your role. The team also includes three consultant psychiatrists, a number of care coordinators (community psychiatric nurses and occupational therapists), trainee CBT therapists, a mental health and wellbeing practitioner, and team administrators.

You will be based at Heavers Resource Centre which is located at 122 Selhurst Road, SE25 6LL; within walking distance of both Selhurst and Norwood Junction stations. As well as local public transport links, there is on-road parking nearby and access to a shared team pool car for carrying out patient visits. Heavers Resource Centre is a spacious team location, with office space for both the older adult CMHT and Croydon Memory Service, as well as council-run day services and a residential home for older people. Crystal Palace Football Ground and Croydon Town Centre shops are both within a few minutes' drive.

We would welcome informal conversations and visits to the team base from prospective applicants - please use the contact details below to arrange this.

Care Coordination and engagement

• To be personally responsible and professionally accountable for managing a designated caseload of service users as part of the community team and within the framework of the Care Programme Approach (CPA).


• To work collaboratively with service users focusing on a recovery approach and providing support and advice in relation to issues concerning them


• Assertively outreach difficult to engage clients and employ a range of strategies to assist with engagement and encourage participation in treatment delivery


• Meet service users regularly, within the timeframes required within their care plans, and follow through promptly on any actions agreed


• Ensure a flexible approach in care provision with a focus on social inclusion opportunities and supporting service users to make informed choices


Assessment and Intervention:

• To be responsible for the assessment of newly referred older adults with mental health difficulties, and the subsequent presentation of findings to the wider team


• To deliver evidence-based interventions appropriate to your own training, professional discipline and tailored to meet the needs of specific clients


• To participate in the team's duty system, carrying out triage of new referrals and responding to urgent situations and crises using the team's protocols


• To apply significant knowledge, awareness and understanding of legislation relevant to the community sector including the Care Programme Approach, Metal Health Act, Mental Capacity Act, Care Act and Community Treatment Orders


• To ensure that care provision is relevant to the needs of service users from a range of backgrounds and communities, including black and minority ethnic backgrounds, LGBTQI+ and service users with disabilities


Risk Assessment and Management

• To undertake risk assessments regularly, involving a range of other health professionals, agencies and others in a client's support network


• To ensure that risk assessments are regularly updated, are meaningful and are reflected in care plans


• To recognise and respond appropriately to self harm and suicide prevention regarding the risks in community settings, in line with Trust policies and training guidelines


• To understand and implement safeguarding procedures in the community setting, raising safeguarding alerts if you suspect that a service user and / or carer has been subject or harm or abuse


Families and Carers:

• To involve families and carers in treatment plans where appropriate and provide psychoeducation as needed


• To ensure that the needs of carers are assessed and care services are provided as necessary


• To sensitively manage situations where there may be conflicting needs and dynamics between the service user and their families / carers


MDT Working:

• To work in co-operation with members of the multi-disciplinary team and all other relevant health professionals to assess, develop, implement and evaluate high quality, client-centered care plans


• To form effective relationships with older adult inpatient services and home treatment teams to facilitate joined up care for service users whose care spans these pathways


• To participate in Mental Health Act Assessments of service users you are responsible for as appropriate, including providing relevant documentation for tribunals.


• To take part in clinical meetings as a representative as your professional discipline


Communication:

• To ensure effective verbal and written communication, adapting your communication style to suit a range of audiences and situations


• To display excellent interpersonal skills, an ability to listen to others' views and to respect and value individuals from a diverse range of backgrounds


• To maintain accurate clinical documentation, ensuring case notes are up to date as per Trust policy


• To liaise with other disciplines and organizations to ensure that all issues affecting service user care are managed and communicated to a high standard


Physical Health and Medication

• To recognise and address concerns about the physical health needs of service users with long-term conditions , escalating these concerns as necessary to appropriate members of the multi-disciplinary team


• Understand medication frequently used in a community setting and possible side effects.


• Monitor the side effects of medication and administer as relevant to your professional background - for registered nurses this includes giving IMI medication and ordering and appropriate storage of medication in the community setting


Personal Development

• To remain up to date with current / emerging good practice relating to community mental health services in general, and the care of older adults in particular


• To regularly meet with team manager / supervisor and actively participate in practice reflection in these sessions


• To take responsibility or be a 'champion' for particular areas of the team's functioning, as suits the team's needs and your own skills / interests


• To remain up to date with all mandatory training requirements


• To undertake continuous professional development as agreed with your line manager


• To provide supervision and support to junior team members and students and participate in the induction of new colleagues


• To participate in research, clinical audit and service development as required


Miscellaneous:

• To uphold all Trust policies and comply with the relevant professional codes of conduct in all areas of your work


• To report any serious or untoward incidents in line with Trust reporting policies and provide accurate record and reports relating to the incident


• Understand and implement duty of candour with regard to the particular issues in a community setting


• To understand and work within the boundaries of the Lone working policy and show an awareness of safety in the community setting


• To undertake other duties as requested by the team manager, clinical service lead or other management representatives


• To fulfill the physical requirements of the role, including visiting service users in their own homes, sometimes at short notice in response to changes in need


• To offer support flexibly to the Older Adult CMHTs in other boroughs in instances where this is required