The care programme approach

The care programme approach (CPA) aims to improve delivery of services to psychiatric patients. After a formal assessment of their medical and social needs, patients and carers are invited to take part in drawing up written, individual care plans. These might include statements about the frequency of outpatient reviews, medication, home visits by the CPN, and/or social work interventions with the family. The resulting document is signed by those responsible. Regular review meetings follow. Although several members of the multidisciplinary team are likely to be involved, the plan must specify a named 'key worker' to coordinate the care and be the first point of contact in a crisis.

Two 'tiers' of the CPA exist, enhanced - in which the patient typically will have both a psychiatrist and a care coordinator, typically a social worker or CPN - and standard, in which the patient just sees one professional; typically, they just attend psychiatric outpatients. Enhanced cases are more complex and severe; the care coordinator may have approximately 20 at any one time. There are written risk assessments and regular CPA review meetings with care coordinator, consultant psychiatrist, patient, family, and other involved parties. Standard cases are less severe, and their care is less complex. No special paperwork is required, as the risk assessment is held to be implicit in the standard notes and letters.

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