Swydd-ddisgrifiad a phrif gyfrifoldebau manwl

To undertake the full range of activities required to deliver ongoing comprehensive mental health assessment for service users with severe and enduring mental health needs living in the community and in a range of settings.

This will include: 
a. The use of standardised assessment tools, i.e. the Cluster Allocation Support Tool (CAST), KGV. 
b. Recovery Star. 
c. History, strengths and aspirations. 
d. Mental state. 
e. Impact of culture and diversity. 
f. Functional needs. 
g. The needs of family and carer. 
h. Evaluation of risk. 
i. Physical health. 
j. Complicating factors. 
k. The interventions and treatments required to enable positive change. 
l. Social care needs. 
m. Safeguarding and public protection. 
n. Capacity under the Mental Capacity Act. 

To be responsible for developing delivering and reviewing comprehensive and complex treatment programmes using appropriate frameworks in line with evidence–based practice, including strategies to manage risk for service users with complex needs and carers, bringing in other resources as required. 

To act as care coordinator for service users with the most complex needs, also providing defined interventions to individuals on other workers caseloads. 

To plan, deliver and evaluate defined, specialist therapeutic interventions as indicated in the assessment process, in line with personal recovery plans, including to service users who maybe on other caseloads.

This might include: 
a. Individual or group therapeutic intervention. 
b. Psychological treatments such as CBT, DBT approaches, family interventions. 
c. Psychosocial interventions. 
d. Motivational and coping enhancement strategies. 
e. Medication management. 
f. Interventions under the Mental Health Act, 

To deliver a range of defined activities/interventions to improve the carers 'ability to support the service user and to enable them in their relationship with the service user. 

To develop and maintain good partnership working with other services throughout all treatment episodes, including regular liaison within Primary Health Care Team, inpatient and intensive services, day services, voluntary sector and with nominated carers/advocates. 

In collaboration with service users and carers, to be responsible for facilitating the development of complex comprehensive crisis plans, rapid access plans, advance statements etc, involving other agencies such as primary care etc where appropriate. 

To personally build and lead others to build, hope inspiring relationships with service users, which acknowledge the personal journey of each person, and focus on strengths and aspirations to allow the creation of meaningful personal recovery plans. 

To be responsible for maintaining own workload, as well as planning the workload of others, on a day-to-day basis, ensuring that time is prioritised effectively, utilising of electronic resources such as diaries/scheduling. 

To be responsible for the protection of individuals from abuse and harm in line with local safeguarding policies and procedures, including working with others in the planning development and review of protection plans, ensuring the appropriate sharing of information. 

Coordinating and undertaking protective interventions which may be required in the protection of others, as outlined in the protection plan, taking individual action where indicated. 

Personally, and leading others to collaboratively and sensitively work with individuals, with a range of mental health needs to develop skills to manage their own health, in accordance with their personal recovery plan, by actively promoting and using approaches which are affirming, build on strengths, identify past positive experiences and success, and use small steps to move towards the person's goal. 

Undertake active clinical leadership and supervision within the team, covering for the manager and colleagues as required. 

To maintain the single health and social care record, ensuring both paper and electronic records are kept up to date in accordance with professional and organisational standards. 

Report and record within agreed timeframes, all activity relating to information reporting and performance requirements. 

To participate in management, caseload and clinical supervision in accordance with trust policy. 

To provide mentoring/training for others in relevant practice areas, according to professional requirements, taking a collaborative approach to practice development and evidence-based care. Specifically this means providing a safe and effective learning environment for the mentoring and supervising of students, participating in their learning objectives and assessments.

Demonstrate responsibility for developing own practice in line with professional qualifications and for contributing to the development of others, by making use of and providing, effective feedback, supervision, coaching and appraisal. 

Monitor and maintain health, safety and security of self and others, undertaking assessments and taking appropriate action where required. 

Develop own knowledge and practice, and contribute to the development of others, making use of available feedback, supervision and appraisal to identify appropriate areas of development for this work role, taking responsibility for accessing identified learning and training opportunities. 

Lead, maintain and participate in practices which enable effective team working. 

To participate in on call rotas as required. 

To participate in local arrangements in order to ensure consistent care to service users across the local geography.