Figure 1
The Complex Case and Recovery Management Framework (The CCaRM) in user friendly language [32]: Adapted and reproduced with permission of the authors.
Figure 2
Co-platforming care over time, from case review to case review.
| VALUE THEME | DESCRIPTION |
|---|---|
| 1. Identifying the best possible circle of support | Map all the network of key people involved with the service-user in their care project. This draws on three sources: i. The service-user’s own network of family, friends and supporters. ii. The care coordinator and the network of clinicians involved. iii. Commissioners and other wider stakeholders as may be relevant. Explore what strengths and contributions each might bring, and has anyone been overlooked? What further development might be useful and how that can be achieved? |
| 2. About Me: Developing a shared understanding | What is the care predicament, and to what extent is there a shared understanding? This might consider: i. Progress with engagement ii Progress with an agreed working theory or formulation iii Progress with an agreed process of further inquiry Explore where and how shared understanding is being built, and where and how it could be improved. Consider what useful tools or models might help deepen understanding. |
| 3. My Problem Toolkits | How many distinct problem areas are there (mental or physical) that are having a key functional impact? How well are these areas supported? Consider: i What is the most useful way to all of presenting each problem area (for example as a diagnostic problem or a problem description). ii What is the right balance between capturing problem areas as interlinked, and capturing them as distinct? For each problem area, what is already in hand by way of assessing care planning and making progress? Consider what guidelines might be available. What further initiatives are needed to build a more rounded toolkit? |
| 4. Joining In and Living a Good Life | What opportunities might there be for doing meaningful things, joining in activities and managing daily concerns? Consider: i. Communication: what works in supporting personal interactions (including verbal and non-verbal language, maturity and preferred style)? ii. The role of day-to-day structure (including daily routines, need for prompts and self-organisational skills) iii. Opportunities, personal interests, range of skills iv. What does it mean to “live a good life” [1]? Explore what progress has been made in exploring each of these areas. Consider what useful tools or models might help deepen understanding. Consider what further initiatives might help. |
| 5. Keeping People Safe and Well | This involves the broad area of avoiding harm, either unintended or not. This includes thinking about risks arising from behaviour, and also issues of protection, promoting good health and supporting autonomy and personal reputation. Consider: i Risk behaviour (eg harm to self or others, deterioration in coping, vulnerability, offending concerns). ii Medication management needs iii Maintaining and promoting good physical and mental health iv Managing capacity, dignity and consent issues For each area, consider the progress made in developing collaborative assessments and care plans. Consider what further initiatives might be needed. Consider what tools, models, legal and rights frameworks might help. |
| 6. What Progress Am I Making? | Considers how people will know that progress is being made as the care journey unfolds. There are three elements to this: i Agreement and review of relevant, available progress monitoring tools. ii Agreement and review of the case management process iii Democratic outcomes: That is, the quality of collaborative discussion, leading to a shared description and judgement. Also, definitive agreement on whether progress has been made or not against each value theme following a case management review [2]. Explore each element to identify what evaluation practices are already in place, and what further improvements could be made. |