30. Know current best practice

Do you have all the evidence based guidance such as NICE or SIGN at your finger tips?

Have you collected other evidence based practice together?

Have you discussed this guidance and evidence as a team?

Have you come to a consensus as a team about how this guidance may be applied to the realities of the families you see?

Do you know what evidence is out there?

Rationale

You need to start by knowing what the evidence, and the limitations of it, is! You also need to know where there is no evidence yet. Interventions set in the Care Bundle are informed by standards set by any available evidence and clinicians’ views.

Ideas for Action

  • Identify groups that could benefit from Care Bundles e.g. ADHD, depression, conduct disorders.
  • Identify the elements of care based on best practice standards (such as NICE guidance).
  • Example
  • A Care bundle for anorexia nervosa could involve input from a dietician, an individual therapist (CBT based) and systemic therapy.

 

31. Local Agreement on Care Bundle

Have you agreed as a team which approaches and interventions are best for types of problems for which there is a dearth of evidence?

Have you consulted with users and incorporated their views about what works into the Care Bundle?

This means the whole team agreeing what should be done

Rationale

If evidence is not available (and this is often true for the complex families we see in CAMHS) then the beauty of Care Bundles is that you can agree the elements as a team, based on your clinical experience. Added Bonus: a written care bundle can be informed by user views as to what they find works and may involve choice from a range of interventions. Care becomes explicit to families and referrers. This process of deciding a Care Bundle in the team can be challenging depending on the range of therapies and views available!

Ideas for Action

  • If there are no evidence based standards then decide as a team, based on clinical experience.
  • Start with severe or common problems.
  • Making ingredients of the care bundle explicit and evidenced based improves the reliability of care