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CLIPP Index <
 CLIPP
(Consultation and Liaison in Primary Care Psychiatry) Manual
Establishing a CLIPP Model Service
Introduction
If following need assessment the decision is taken to establish the CLIPP
Model in whole or in part then this structure provides steps for approaching
this. The framework may be adopted if only parts of the model are to be used,
and other techniques may be included to complement.
Management
General Principles
Careful consideration should be given to the management structure for the
establishment of the model. Experience suggests that the program requires
a degree of autonomy and designation of a circumscribed resource platform
to be successful. Conflicts of interest may arise with other sections of
a mental health service. There is a risk that without appropriate financial
management and accounting, resources may be diverted to more traditional
sites. Performance indicators should be tailored to the nature of the program.
Key Points
- The program may be best not subsumed within another element of the service
structure, rather given a direct line of accountability to a senior level
within a comprehensive community mental health service management structure.
- Protection of resources allocated to the program is critical to success.
- Periodic management review should incorporate formative and summative
evaluations against agreed performance criteria.
Recruiting GPs
General Principles
It is important that a strategic and tactical plan for the recruitment of
GPs be collaboratively developed between the AMHS and Division of General
Practice project teams. It should provide as far as possible equity of access
to involvement in the program for any GP in the area.
This process should facilitate the establishment of a shared idea of mutual
support between GPs and the AMHS. Each should come to be seen as supporting
the other in responding to needs for mental health care in the area.
There exists a wide variety of potential approaches, from pamphlets to presentations,
that could be used to recruit GPs. This is limited only by imagination and
resources. Therefore it is important to fully consider the unique characteristics
of the GPs and project staff when choosing a plan of action.
Key Points
Some key issues to consider in selecting a recruitment approach include:
- Being aware of the range of environmental pressures acting on GPs.
- Respecting the skills and resources of GPs in the area of mental health
practice.
- Being aware of available resources and budgets that can be allocated
to recruitment processes.
- Outlining realistic project aims and objectives.
- Gauging skills of workers and best ways to utilise them.
- Emphasising collaboration and exchange, of information, skills, and workload.
Specifics
In the two AMHSs currently implementing CLIPP as initially designed, the
procedure set out below has been followed:
- The Division of GP publicised the program through newsletters and meetings.
- The Division conducted an information evening for GPs.
- Through the Division the AMHS did a mailout to all GPs in the area inviting
involvement with fax-back forms facilitating easy response.
- All GPs expressing involvement were then contacted and offered involvement
in the program.
Assessing GP Practices
General Principles
It is important to form a clear picture of each practice that is considering
participation in the project. The following list outlines the key aspects
of GPs in their practices that should be considered prior to implementing
the CLIPP Program. This list is by no means exclusive and is merely to act
as a prompt or guide in formulating an understanding and rapport with practices
who agree to participate in the CLIPP program.
Key Points
- Each General Practice will have its own specific features.
- These will include its particular location, and particular variables
relating to accessibility.
- Each practice is a separate organisation which a unique practice culture,
and a particular set of organisational structures, declared and undeclared.
Specifics
There is no set protocol here, but important considerations when assessing
practices include the following:
Location
Is it close access to public transport, pharmacist, local shops, community
centre and or parks?
Practice Resources
Does the practice have a practice manager, nursing staff, allied health
services? If so how are their skills utilised and what is their availability?
How busy is the practice? Does it have a follow up procedure for missed appointments
and what is the waiting room environment like? Does the practice use fax/photocopy
machine/computers? Are there meeting rooms, is there wheelchair access, a
spare room, tea room and sufficient toilets?
Practice Constraints
Consider the practice appointment system, the billing policy, access
to out of hours or home visits. When are appropriate times for a psychiatrist
to visit the practice? When are the most appropriate times to contact GPs?
What is the most appropriate way to send any information to GPs?
The GPs
What is the personality mix of GPs in the practice? What are the team
dynamics? Who provides leadership within the practice? What is the practice
philosophy? What is the practice style and working hours of each GP?
The Patients
What seems to be the mix of diagnosed mental health problems currently
presenting and managed by GPs in the practice? What is known about patients'
knowledge and access to available mental health services?
Engagement of GPs in Particular Practices
General Principles
The ability to establish rapport with both practices as cultural identities
and with individuals within a practice is crucial to the program's long term
success. The importance of meeting with GPs and practice staff, coming to
an understanding of their knowledge, communication styles and needs, can
not be overemphasised throughout the process of engagement and beyond.
Key Points
- Communication is the key to engagement and is a two way process between
all CLIPP staff and each GP engaged in the CLIPP program.
- Emphasise the accountability of the visiting psychiatrist to the General
Practitioners and the importance of the development of effective working
relationships.
- Establish the consultation and liaison relationships the transfer from
AMHS into shared care come later.
Specifics
Sharing Information About the Project
Meetings should be arranged where possible at the practices concerned and
in line with availability of the GPs. Lunchtimes are a suitable time for
meetings in many practices. A good starting point in establishing a working
relationship at the GP practices involved is to share information about the
project, how it is funded, how it is structured, and the transactions involved.
The consultation liaison aspect is offered and described first. Also suggest
that if GPs will accept an appropriately supported shared care role with
people with psychotic disorders, then the AMHS is more likely to be able
to spare resources to help them with depression, anxiety and similar problems.
Describe the educational components of the project and recognition of the
model by the RACGP. The accountability of the psychiatrist and their role
in the practice should also be explained. The GP should be encouraged to
insist that the advice provided by the visiting psychiatrist is concise,
appropriately targeted and practical. Discuss the use of specific Medicare
items to remunerate some of the activities in the program.
Encouraging Feedback
Explore what it is like for the participants as a GP trying to manage mental
health problems and disorders, and gather initial feelings about the project.
Respond to the feedback validating the GP's experience.
Respect, Validate and Seek to Empower
Highlight the importance of the GP as a primary mental health care provider.
Be mindful that GPs all have developed their particular, often very sophisticated
and effective strategies for working in this area, and innovation should
be introduced without devaluing these skills. Seek to provide access, support
and assistance for GP's in their primary care role.
Engaging and Providing Guidance for Non-Medical
Staff in the Practices
Receptionists
General Principles
The role of the receptionist should be understood and valued. It is extremely
helpful if the senior medical staff within the general practice clearly articulate
that the mission of the general practice involves the care of individuals
with mental disorder including some with long term mental illness.
The structure of the practice may vary considerably, but adequate supervision
of practice management staff by practice manager certainly helps. Conditional
to these wider attitudinal issues there are a number of specific tasks which
complement the model and fall to the reception staff.
Key Points
- The receptionist is the first point of contact for anyone with a mental
health problem coming to a practice.
- The active involvement of reception staff will greatly smooth every aspect
of the program.
Specifics
Appointment Making
This will vary from practice to practice, and practices have different levels
of computerised appointment systems. Hence details of these need to be worked
out in any one particular setting. However reception staff should generally
be aware that the usual layout of a CLIPP psychiatrist attachment will be:
- Two long appointments available for assessment of cases referred from
GPs
- Two short appointments available either for transfers of clients from
the AMHS or for reviews.
Reception staff should also be aware that often the format for a transfer
will comprise a quarter of an hour appointment with the psychiatrist followed
by a quarter of an hour appointment with the GP, longer if possible. Both
of these will also to be attended by the CLIPP liaison clinician.
Practice Management Staff
General Principles
Practice managers where they are employed as such by practices are influential
in determining the success or otherwise of establishing CLIPP in that practice.
It is important at an early juncture that practice managers are contacted,
inducted into the model, and the specific requirements of implementation
in that practice are set out. Practice managers will often have a lot of
influence over accommodation and will need to be aware that an appropriately
lit, well ventilated room with enough space to carry out interviews which
may on occasions involve 4 or 5 people represents the ideal accommodation
for a CLIPP psychiatrist attachment.
Key Points
Practice management staff are important to have involved in the establishment
and continuing of the process, as they must be sufficiently involved and
committed to provide support and motivation to reception staff. Also their
advocacy and tolerance for the program is important for the furthering of
goodwill with the GPs.
Specifics
Practice management staff can advise on the alternating rosters of various
doctors who may be attending the particular clinic and assist in the timing
of CLIPP attachments such that opportunities for contact with the various
doctors involved are maximised.
The psychiatrist and the CLIPP liaison clinician should provide phone and
fax numbers. They should also arrange periodic contact, probably at least
once every three months, with the practice manager and review how the CLIPP
service is perceived within the practice. |
