Encompass Specialist and Complex Services Pathways
Explore the Encompass Specialist and Complex Services Pathways designed to offer a range of support services for individuals in need, including rapid response, rehabilitation, recovery, and short-term enablement. With detailed referral pathways and crisis intervention processes, these pathways aim to provide comprehensive care and assistance to those requiring specialized support.
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Encompass Specialist and Complex Services Pathways
Referral Pathways Step 1 Care Act Assessment (Eligible) Commissioner Referral/ Self Referral to purchase Encompass Support 72 hours for assessment Rapid Response 3-5 working days for assessment Rehabilitation and Recovery 3 -5 working days for assessment Short Term Reablement Community and vocational 48 72 hours for assessment Community Outreach Medium term 3 12 months Short Term 6 12 weeks
Rapid Response Pathway - Crisis Intervention Assume own accommodation Person in crisis referred by CMHT/AOT/ASC Can person be supported at current accommodation? Risk Assessment completed in 24 hours Triage primary need- to identify appropriate support package YES Crisis Support Provided up to 24/7 Crisis Resolve in 72 Hours YES withdraw support CMHT/AOT decision NO Referrer decides next support route NO cannot accept referral Criminal Justice System Step Up Bed Different Agency Acute Setting
Rehab and Recovery Pathway - Accommodation Based Person in Acute Services ready for discharge Yes- Assess and support person whilst in acute setting Does the person have accommodation to return to? NO refer to Homelessness Team Draft Personalised Support package Discharge Plan to be developed and date set. Agree Purchase Order Person Discharged to Encompass Specialist Complex Services Rehab and Recovery 3 / 6 week review personalised support plan with circle of support, family, Social Worker CMHT and Encompass Team Yes- Support Continues 12 Week Review Does the person need to continue with the same level of support? 18 Week Review Yes complete episode of support Independent Rehab ends and Outreach step down begins No Outreach/Short Term Enablement Team
Short Term Enablement Pathway Community Outreach CMHT/AOT/ASC/Private referral to service CMHT/AOT/ASC/Private referral to service Meet person in home environment - Family / Person Centred Assessment strengths based approach - Risk Assessment and understand desired personal outcomes LIFESTYLE OUTCOMES: SOCIAL ACTIVITY COMMUNITY CONNECTION DAY TME OCCUPATION FRIENDSHIPS/FAMILY/RE LATIONSHIPS INDEPENDENCE OUTCOMES: HEALTH AND WELL-BEING PERSONAL CARE LIVING SKILLS NAVIGATING COMMUNITY VOCATIONAL OUTCOMES: WORK VOLUTEERING MICRO ENTERPRISE CO-PRODUCED PERSONALISED SUPPORT PLAN AGREEMENT 3 / 6 MONTH REVIEW CIRCLE OF SUPPORT & MDT RE-ASSESSMENT CONTINUE SUPPORT STEP COMMUNITY OUTREACH DOWN FROM PROGRESSING - REVIEW SUPPORT PLAN 12 MONTH REVIEW 3 5
