EMHWD SCHOOL OF PSYCHIARTY (NORTH)
GENERAL ADULT PSYCHIATRY SPECIALITY TRAINING COMMITTEE
APPLICATION FORM FOR EDUCATIONAL APPROVAL OF A PLACEMENT FOR
SPECIALTY TRAINING
This continuing approval application form should be completed by the Clinical Supervisor/ Trainer and
submitted to the Training Programme Director for Approval by the Specialty Training Committee.
The following sections need to be completed:
1.
A job description for the post
2.
A weekly trainee timetable
This must include details of the arrangements for 1hr weekly supervision.
3.
A weekly Clinical Supervisor timetable
This must indicate overlap with the trainee timetable.
4.
Curriculum Vitae of Trainer (no more than 2 sides of A4) – to be submitted as a separate
document.
5.
Mapping of Intended Learning Outcomes to specific aspects of the posts – please use the list
of curriculum competencies for GA psychiatry on the RCPsych website and map each
competency relevant to your post to how the trainee will be expected to achieve these in the
next year (see attached document where I have used the competencies relevant to
rehabilitation psychiatry and mapped them to my post as an example).
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JOB DESCRIPTION FOR ST4/5/6
IN REHABILITATION PSYCHIATRY AND EARLY INTERVENTION AND ASSERTIVE
OUTREACH
CENTRAL NOTTINGHAMSHIRE
BASE
Millbrook Unit, Kings Mill Hospital, Sutton in Ashfield, Notts
Telephone 01623 784707.
Secretarial support is provided by Samantha Palmer, at Millbrook.
SECTORS/UNITS COVERED
Bracken House & Heather Close Recovery Units
Community clients of Rehabilitation and Recovery part of CMHT and Early Intervention teams in
Ashfield & Mansfield sectors.
MEDICAL STAFFING
Dr Jane Tarrant Substantive Consultant Psychiatrist Rehabilitation Units, CMHT and EI
ST4/5/6 Nottingham rotation (this post).
CT2/3 Nottingham rotation.
Dr Kopal Tandon, Consultant Psychiatrist (Part Time) AO
Junior doctors share a designated office at Millbrook
DESCRIPTION OF THE REHABILITATION SERVICE
1.
Heather Close Recovery Unit (Tel: 01623 421088)
Adjacent to Mansfield Community Hospital.
This site has a locked rehabilitation unit and open rehabilitation step down/recovery beds. There are
currently 18 beds for each unit. The unit is run on the philosophical principles of recovery and holistic,
multi-disciplinary care.
Residents are a mixture of those admitted from acute Inpatient wards at the Millbrook Unit, step down
from low secure care or from the community for a period of focus on independent living skills.
Currently there is a mixture of Forensic, EI/AO and CMHT clients who, following a period of
assessment and rehabilitation, are discharged to accommodation with Housing Support and a complex
package of care provided. All the patients on locked rehabilitation and small number of residents on
open rehabilitation are detained under the Mental Health Act.
Referrals come through from CCP (Trust Continuing Care Panel). There is a weekly multi-disciplinary
review meeting conducted with nursing staff, pharmacist and occupational therapist. There is currently
no psychology input, but one has been appointed and will be starting in April 2013.
Staff at Heather Close are able to provide short term follow up of clients discharged locally. They also
provide telephone support and a “drop in” service for some discharged clients.
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2.
Community
There are currently about 270 clients with the Ashfield & Mansfield CMHT living in their own or
supported homes provided either by the Local Authority or Housing Associations.
Most clients have a Care Co-coordinator from the CMHT based at Millfields, Millbrook (CPN, Social
Worker or OT) who organize regular reviews as per the Care Programme Approach (CPA). Additional
support is provided by Healthcare Assistants and Rehabilitation Support Workers. There are a few
clients who do not have a CCO and are reviewed regularly in out-patient clinic at regular intervals.
These clients are not on a CPA pathway.
A number of particularly difficult to engage clients who access similar facilities are looked after by the
Ashfield & Mansfield Assertive Outreach Team (70-90 clients) also located at Millfields, Millbrook.
The Early Intervention team is based at Millfields, Millbrook and provides a service for clients aged
14-35 with a first onset of psychosis. The team is multi professional including CPNs, a full time
psychologist, social workers and OT who work with clients through the first 5 years of the illness.
Currently about 90 clients are with this service.
Clients in crisis can be referred to the Home Treatment / Crisis Resolution Service, Millbrook Unit to
prevent hospital admission.
3.
Acute Admission Wards
Dr Hos Abed, Dr Gbenga Odeyemi, Dr D Maldovsky and Dr C Innes provide acute care for clients.
DUTIES
1.
To attend the weekly team meetings as appropriate.
2.
To take primary medical responsibility for allocated and limited number of clients
community in conjunction with Care Coordinators and staff of other agencies.
3.
To attend multidisciplinary review meetings held at Bracken House and Heather Close as required
and to provide psychiatric assessment where requested by the nursing staff.
4.
To attend Discharge Planning and Section 117 meetings as appropriate on the acute wards and at
Heather Close.
5.
To attend/chair/ and occasionally minute CPA reviews together with all staff and agencies
involved in care provision.
6.
To provide psychiatric assessment when requested to do so by a client’s care co-coordinator.
7.
To establish good liaison systems with all relevant GPs.
8.
To be involved in the assessment of new referrals to the services as required.
living in the
ROTA AND ON CALL REQUIREMENTS
There is a second On Call rota for evenings and weekends. Approximately 1 in 7 duties include
advising the junior and completing Mental Health Act assessments (often at Mansfield Police Station)
out of hours i.e. 5pm to 9am when on call. There is no requirement to cover the day time rota.
TEACHING AND TRAINING
The trainee will be expected to take part in undergraduate teaching on an individual and group basis
and in undergraduate examination. They will take part in weekly educational meetings and will have
opportunities to assess and appraise core trainees.
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REHABILITATION COMPETENCIES/CURRICULUM MATCHING
1) To be able to perform specialist assessment of patients and document relevant history and
examination on culturally diverse patients.
The trainee will have the opportunity to assess new referrals to the Rehabilitation, Early Intervention
and Assertive Outreach Teams as well as referrals for specialist rehabilitation in-patient settings both
locked and open. This will include basic psychiatric history taking skills, case and historical review of
notes, as well as thorough assessments using appropriate tools over time of particular complex cases
e.g. resistant symptoms, medication side effects, cognitive disabilities, social functioning or dual
diagnosis issues alongside other professionals.
This will be assessed by ongoing supervision and WPBAs including ACE and CbD
2) To construct Formulations of patient’s problems that includes appropriate differential
diagnoses.
The trainee will formulate cases holistically. There will be opportunity to do this jointly with other
members of the multi-disciplinary team and specific psychological formulations will be made on some
clients under the supervision of the psychologist. These formulations will be fed back to team meetings
and will be used to construct care.
This will be assessed by CbD and the submission of anonymised formulations in the portfolio.
3) To be able to comprehensively assess risks and develop a risk management plan for both the
short and longer term
The trainee will learn about the context of risk, using past and static factors as well as current
environmental, social and psychiatric issues to formulate all aspects of risk to a person or others
including children, self neglect, financial abuse etc.. Opportunities will be given to look at and compare
the use of specific risk tools within acute and forensic services, in versus out-patient environments.
Comprehensive risk management plans will be routinely used and made for clients in each of the AO,
R+R, EI and recovery in-patient teams with the trainee working with both client and team to reduce or
manage risks over time and in crisis situations.
This will be assessed by ongoing supervision and case presentations alongside CbD and ACE or MiniACE.
4) To have the ability to conduct therapeutic interviews and demonstrate the ability to conduct a
range of individual, group and family therapies, integrating them into everyday treatment.
The trainee will have a limited case load of clients to engage and work therapeutically with over the
year from each of the community teams and the in-patient unit. This will give a wide range of
opportunity to employ and tackle focused individual work and/or family work e.g. in EI settings.
Supervision from other practitioners in each setting e.g. psychologist or family interventions worker
will be available for complex cases.
This will be assessed by supervision and CbD.
5) To be able to demonstrate the effective management of patients with severe and enduring
mental illness.
The trainee will gain experience in a wide variety of care settings in the community and in partnership
or private organizations within the area. They will gain experience in the use of the mental health act
for instance renewal of sections or rationale for supervised community treatment. They will assess
patients’ capacity and gain experience of the mental capacity act. They will be involved in the delivery
of complex care packages in the community alongside the community teams and work with clients
towards recovery based goals.
This will be assessed by supervision, CbD and summaries of CPA and management summaries in
portfolio.
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6) To work effectively with colleagues, including team working.
All areas that the trainee will work in are founded on strong multi-disciplinary working. All teams
share and help with problem solving, meeting on a weekly basis. Assessments and CPAs are always
conducted jointly and liaison with other specialties both within psychiatry and in acute medical care is
needed.
This will be assessed by mini-PAT assessments and general feedback.
7) Developing appropriate leadership skills
The trainee will be participating and sharing chairing of team meetings or journal clubs and be
involved in clinical development. They will work towards leading some small development changes
and lead individual clinical care such as CPAs and ward reviews/discharge planning meetings as
appropriate.
This will be assessed by clinical supervision, mini-PAT and DONCS.
8) Developing the ability to teach, assess and appraise
The trainee will participate in the individual and group teaching for medical students. They will be
involved in undergraduate examinations and in the assessment and appraisal of of junior trainees.
They will contribute and chair case conferences and educational meetings.
This will be assessed by clinical supervision, Mini-PAT and DONCS.
SUPERVISION
Weekly clinical supervision sessions with the Consultant.
ACCOUNTABLE TO
Dr Jane Tarrant
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WEEKLY TIMETABLE FOR TRAINEE AND SUPERVISOR
(which should show an overlapping pattern of clinical work.)
a.
b.
c.
d.
e.
Two sessions for research/special interest (preferably on the same day).
Details of clinical supervision.
Opportunities for attendance at journal clubs/ case conferences.
Attendance at an appropriate academic programme.
Details of on-call work (including nature of duties and arrangements for clinical
supervision.
2.1
Trainee Timetable
Please complete the proposed timetable for the trainee. This timetable must indicate the arrangements
for Clinical Supervision (1 hour per week).
am
Monday
Tuesday
Wednesday
Thursday
Friday
Client reviews
CMHT EIP
9.00 Urgent cases
meeting EIP
EIP client reviews
Bracken House Ward
Review
9.30am – 10.30am
Assertive Outreach
Handover meeting and
Client reviews
9.30am to 10.30 am
CMHT meeting
10.30am to 11.30 am
supervision
pm
13.00pm to2pm
Academic programme
at Millbrook
Client reviews
Assertive Outreach
2pm to 5pm
Ward round and
reviews at the Heather
Close Recovery Unit
Special
interest/research
AO Client reviews
Special
interest/research
Administraion
Urgent Slot as
necessary
2.2
Trainer timetable
Please complete the timetable for each clinical supervisor/ trainer. This should show:
a.
regular scheduled consultant supervision of one hour per week.
b.
a substantial overlap with that of the trainee.
am
Monday
Tuesday
Wednesday
Thursday
Client Reviews
CMHT EIP
9.00 EIP Meeting
9.30-10.30 Team
Meeting, R+R
Client Reviews
CMHT EIP
Bracken House Ward
Review
1-2pm Academic
Programme. Millbrook
Unit.
Friday
Medical student
teaching
10.30-11.30
Supervision of SpR.
Bracken House
referral meeting
11.30-12.30
Supervision of SHO
Consultants Forum,
supervision, leadership
group etc.
6
pm
Client Reviews
CMHT EIP
Reviews at Heather
Close Recovery Unit
Not at Work
2.00pm EIP Team
meeting
Urgent Clinical slot
Lead Consultant work
CPD
3.30 pm
Client Reviews
CMHT EIP
3.
Brief Curriculum Vitae of Clinical Supervisor/Trainer
(no more than 2 sides of A4)
This needs to include the following details:
a.
Date of appointment to current consultant post.
b.
Date and specialty of CCT or specialty on the Specialist Register including any endorsements.
c.
Previous consultant posts (if relevant).
d.
Details of the trainer’s own higher training, including qualifications.
e.
Confirmation that the trainer is registered with the College and in good standing for CPD.
f.
Details and dates of relevant training eg: clinical supervision/ educational supervision/appraisal/
WPBAs.
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BRIEF CV - CATHARINE JANE TARRANT
PSYCHIATRY TRAINING POSTS
TRENT SHO ROTATION 1993-1995
TRENT REGISTRAR ROTATION 1995-1997
TRENT SPECIALST REGISTRAR ROTATION 1999-2002
CCST and Specialist Register Registration for General Adult and Rehabilitation Psychiatry attained September 2002.
PREVIOUS CONSULTANT POST
Consultant Psychiatrist In General Adult Psychiatry, Derby City Hospital, Uttoxeter Road, Derby.
May 28th 2003 to 31st October 2005.
This post covered a large rural geographical area covering the Derbyshire Dales with a catchment population of 40 000 for both
general adult and rehabilitation clients. I was working with a multi disciplinary community team for general adult clients and an
assertive outreach team. In addition I provided general psychiatry input to HMP Foston Hall, a Category C womens prison.
During the post I also led the development and the expansion of medical students clinical placements in psychiatry with the
Derby Medical School allied to Nottingham University. This involved helping to develop pilot and teach a new curriculum, the
coordination of funding, recruitment of teaching staff and the building of a new facility at the Derby Psychiatric Unit to teach the
medical students.
CURRENT CONSULTANT POST
Consultant Psychiatrist in Rehabilitation and Recovery and Early Intervention, Millbrook Unit Kings Mill Hospital, Sutton in
Ashfield, Notts
November 2005 to date.
This post covers 2 sectors of Ashfield and Mansfield (total population 150 000) for rehabilitation and recovery and early
intervention. Both specialist teams are based in the community. A rehabilitation unit for 36 clients provides the inpatient facility.
Duties involve the assessment, review and treatment and management of those of both those with first onset psychosis and those
with severe and enduring illness requiring rehabilitation in conjunction with the multi-disciplinary teams. Clinical supervision is
provided to the SHO, SpR and other duties include relevant undergraduate teaching, Lead consultant and associated clinical
governance duties, management of a CPD peer group and involvement in developments and changes to the services.
I am registered for CPD, am part of a peer review group and have a personal development plan. I have been appraised on
a yearly basis and have also taken part in yearly job planning.
PREVIOUS RESEARCH POST
Principal clinical researcher for the MRC multicentre AESOP study (Aetiology and Ethnicity in Schizophrenia and Other
Psychoses) Nottingham site involving the recruitment and collection of data from over 130 cases.
Professor Peter Jones. University of Nottingham, Division of Psychiatry, June 1997-September 1999.
PUBLICATIONS
Non- Animal Alternative Toxicity Tests for Detergents, Genuine Replacements or Mere Pre- Screens?
Michael Balls, Sandra Reader, Jane Tarrant and Richard Clothier.
Journal of Chem. Technol. Biotechnol. 1991. Vol 50, No. 3, 423-433.
Antecedents of Functional Psychosis.
Peter B. Jones, C. Jane Tarrant.
ZNS Journal, August 1998, 4-15.
The specificity of developmental precursors of schizophrenia and affective disorders.
C Jane Tarrant, Peter B Jones.
Psychiatric Annals, 1999:29:137-144.
Precursors to Schizophrenia: Do biological markers have specificity?
Jane Tarrant, Peter B Jones.
Canadian Journal of Psychiatry, 1999:44: 335-349.
Specificity of developmental precursors to schizophrenia and affective disorders.
Peter B Jones, C Jane Tarrant.
Schizophrenia Research 1999:39:121-125
Biological Markers as Precursors to Schizophrenia: Specificity, Predictive Ability and Aetiological Significance.
C. Jane Tarrant, Peter B. Jones.
Childhood onset of adult psychopathology, clinical and research advances.
American Psychological Association, Edited by Judith Rappaport. American Psychiatric Press, 2000 p 65-102.
Developmental precursors and biological markers for schizophrenia and affective disorders: Specificity and public health
implications.
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PB Jones, CJ Tarrant.
European Archives of Psychiatry and Clinical Neuroscience. 2000:250:286-291.
Childhood development and later schizophrenia: evidence from genetic high risk and birth cohort studies.
Mary Cannon, C. Jane Tarrant, Matti O Huttunen and Peter Jones.
The Epidemiology Of Schizophrenia, Edited by Robin M Murray, Peter B Jones, Ezra Susser, Jim van Os and Mary
Cannon. Cambridge University Press, 2003 p100-124.
Determining the chronology and components of psychosis onset: the Nottingham Onset Schedule (NOS).
Swaran P Singh, John E Cooper, Helen L Fisher, C Jane Tarrant, Tuhina Lloyd, Jumi Banjo, Sarah Corfe, Peter
Jones.Schizophrenia Research. 2005: 80:117-130
Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: Findings from the three-Center Aesop Study.
James B Kirkbride, Paul Fearon, Craig Morgan, Paola Dazzan, Kevin Morgan, Jane Tarrant, Tuhina Lloyd, John
Holloway, Gerard Hutchinson, JullianP Leff, Rosemarie M Mallet, Glynn L Harrison, Robin M Murray, Peter B Jones.
Archives of General Psychiatry. 2006:63:250-258
Physical monitoring in patients prescribed atypical antipsychotics. An audit of blood glucose testing for adult psychiatric patients
in primary and secondary care
C. Jane Tarrant
Psychiatric Bulletin. 2006:30:286-288
Incidence of schizophrenia and other psychosis in ethnic minority groups. Results from the MRC Aesop study.
Fearon P, Kirkbride JB Morgan C, Dazzan P, Morgan K, Lloyd T, Hutchinson G, Tarrant J et al.
Psychological Medicine 2006, 36, 1541-50
Minor physical anomalies in patients with first-episode psychoses: their frequency and diagnostic specificity.
Lloyd T Dazzan P, Dean K Park SBG, Fearon P, Doody GA, Tarrant J et al.
Psychological Medicine 2008, 38,71-8.
Educational Supervision Appropriate for Psychiatry Trainees needs?
Rele K, Tarrant J.
Academic Psychiatry 2010,34, 229-232
ABSTRACTS AND POSTER/ORAL PRESENTATIONS
Palate shape in first onset psychoses
CJ Tarrant, SJ Window, P Williams, PB Jones.
Schizophrenia Research 2000:41:p84
Presented at Tenth Biennial Winter Workshop on Schizophrenia, Davos, Switzerland, Feb.2000.
Affective symptoms in the prodrome of first onset psychoses.
CJ Tarrant, P Williams, SJ Window, SP Singh, PB Jones.
Schizophrenia Research 2000:41:p180
Presented at Tenth Biennial Winter Workshop on Schizophrenia, Davos, Switzerland, Feb.2000.
Measuring onset in first episode psychosis: The Nottingham Onset Schedule (NOS).
SP Singh, J Cooper, CJ Tarrant, H Bagalkote, PB Jones.
Schizophrenia Research 2000:41:p180
Presented at Tenth Biennial Winter Workshop on Schizophrenia, Davos, Switzerland, Feb.2000.
The prodrome of first onset psychoses: are affective symptoms specific to diagnosis?
CJ Tarrant, SP Singh, JE Cooper, T Lloyd, PB Jones.
European Psychiatry 2000:15 p284
Presented at the Tenth Congress of the Association of European Psychiatrists, Prague, October 2000.
Interactions between ethnicity and minor physical anomalies (MPAs) as risk factors for schizophrenia: proximal vs. remote
causes.
H. Bagalkote, T Lloyd, J Tarrant, G Doody, P Jones.
Presented at the International Congress on Schizophrenia research, Whistler, April 2001.
Negative symptoms in first onset schizophrenia: Associations with age of onset and prodrome length.
CJ Tarrant, T Lloyd, PB Jones, Aesop Study Team.
Schizophrenia Research 2002:53 p47-48.
Presented at Eleventh Biennial Winter Workshop on Schizophrenia, Davos, Switzerland, Feb.2002.
Poor insight, diagnosis, symptoms and mode of admission in the Aesop first-onset psychosis study.
KD Morgan, CJ Tarrant, P Dazzan et al.
Schizophrenia Research 2002:53 p48.
Presented at Eleventh Biennial Winter Workshop on Schizophrenia, Davos, Switzerland, Feb.2002.
Psychometric properties of the Nottingham Onset Schedule.
SP Singh, J Tarrant, J Banjo, T Kewley, H Fisher, J Cooper.
Presented at The European Network for Mental Health Service Evaluation, Sofia Bulgaria, May 2002.
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Prescribing patterns of antipsychotic medication in rehabilitation inpatient facilities: an audit using a subjective side-effect rating
scale Lunsers.
Presented at The Royal College of Psychiatrists, Rehabilitation and Social Psychiatry Section Conference, Bournemouth,
November 2002.
Adolescent Attitudes to Mental Health: The Impact of a Mental Health Awareness Day.
Presented at The Royal College of Psychiatrists Annual Conference, Edinburgh, June 2007.
AUDIT
1) The rationale for prescription and treatment with antipsychotic medication according to best practice and guidelines in
residents of rehabilitation in-patient units in central Nottinghamshire – 2002-2003. This led to the systematic documentation at
multi-disciplinary meetings of the medical rational of treatment, the systematic use of side-effect scales and the review and
prescription of clozapine or other antipsychotic on some clients.
2) Monitoring of blood glucose indices over a year for those prescribed atypical antipsychotics in a general adult sector in
Derbyshire - 2004-2005. Recommendations implemented were local guidelines, junior doctor awareness, discussion with local
GPs with consideration to their targets, and computer access to pathology results.
3) Management of clients on Risperdal Consta over a 1 year period - 2006-2007. Lessons learnt were increasing the time that oral
risperidone was prescribed alongside the depot to around 4 weeks, considering starting at 37.5mg if patient on 4mg or more as a
daily dose and ensuring if changing from another depot that last dose is given 1 week before starting Consta.
4) ECG and physical health monitoring in in-patient recovery services – 2006-2008. Full audit and reaudit cycle over 2 years.
Multi-disciplinary recommendations with wholescale changes in nursing activity, available medical equipment, junior doctors
role and expectations, monitoring via CPA, computer access to pathology results on site, culture shift in cooking and diet on site,
increase in money per patient for food, healthy eating encouragement and an increase in physical activity with OT involvement.
5) Effect of training and change management on culture and philosophy, patient outcomes and staff morale at an in-patient
recovery unit – 2008 – ongoing.
6) Supervision of junior medical staff on several audits including; use of crisis beds at the recovery unit instead of acute
provision, physical health in community patients with enduring mental health needs, junior doctors supervision, oral health and
access to dental services for patients in in-patient recovery unit.
TEACHING AND ASSESSING
Currently I teach and assess medical students on their clinical attachment and examine in undergraduate examinations. I am
medical student lead in central Notts. I supervise my Core Trainee and Specialist Trainee . I also take part and have presented at
meetings and conferences for both the Trust and PCT, facilitated GP special interest groups and conducted seminars for
voluntary groups and carers.
I helped with the change in curriculum for undergraduates and implemented and taught this in Derby.
I last undertook clinical supervisor training in 2009.
MANAGEMENT & SERVICE DEVELOPMENT
Throughout my training I sought out opportunities to be involved in and learn about service development for instance in the set
up of Early Intervention Teams. During my consultant post in Derby I was involved in a wide reaching service review
commissioned by the PCTs across primary care, voluntary provision, social services, supporting people and mental health
services of the Derbyshire rehabilitation services. This required working with the differing agencies on organising and presenting
at stakeholder days, reviewing and providing medical/clinical reviews of the evidence base, developing a service model,
philosophy, care pathway, and setting up strategy for change across the county.
I organized the development of the psychiatric undergraduate training in Derby for the increase in medical students from July
2005. This included participating in a project to fund and organise a new build attached to the current in-patient unit, helping to
develop and write the business plans, working on and piloting the new curriculum with Nottingham, writing new job descriptions
for consultant teaching posts and recruiting to these posts and facilitating the changes at the psychiatric unit.
In starting current post I set up an overarching Rehab and Recovery scoping meeting to review current services and pursue
development of the clients pathway of care through the inpatient and community rehabilitation services. This has expanded in its
remit and led to further focus groups on assessment and outcome measures and a wholescale project to develop the in-patient
services. A leadership group has been managing the action plans for improvement with changes in culture and philosophy along
with training to provide a recovery focus for a wider remit of clients. This has lead further to the development to a locked
recovery unit which is currently under way.
I have instigated the set up of a physical health forum on the back of research and a partial failure to make physical health care a
concern within the community team for clients. This forum is now chaired by a service manager and has developed and grown
supported by a more widespread national and Trust agenda, coordinating and spreading good practice initiatives through-out the
county.
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