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REST H&F Outreach Nurse

Job Description

The aim of the REST Outreach Team is to embed into the gap between mental health and addictions services working within the Hammersmith & Fulham hostel setting. The team will assertively link between different providers to deliver effective close liaison and joint working. They will be working collaboratively with West London NHS Trust and substance use services to help clients engage in structured services.

The REST Outreach Nurses will work as a dual diagnosis community liaison team. Based in the hostels, they will act as an interface between hostel staff, mental health and addictions services. They will work alongside existing services and GPs in the borough to support residents with co-occurring substance use and mental health needs by facilitating engagement and referrals. They will increase expertise and morale among hostel staff, building resilience through training and support in managing addiction and substance use presentations in hostels.

Main Responsibilities:

• Rapid identification of clients with co-occurring substance use and mental health disorders, followed by a comprehensive joint assessment of addiction and mental health needs
• Supporting providers to establish robust care plan formulation and treatment recommendations
• Liaison with community addictions and mental health services
• Establishing direct referral routes into mental health care with agreement from West London NHS Trust
• Facilitated referrals/joint assessments to develop fast-track pathways into substance use treatment
• Input into case discussions including clinical advice and support
• Providing specialist substance use advice and support to other colleagues within the health care setting and to other agencies concerned with substance use.
• Close liaison with inpatient wards prior to discharge back to hostel settings
• Delivery of psychosocial interventions e.g. motivational interviewing, to support change behaviour and encourage engagement with appropriate treatment programmes
• Providing training and development opportunities for mental health and hostel staff in identifying and managing dual diagnosis presentations and enhancing engagement with residents presenting with these needs
• To develop and provide a training package for those that work within the hostels on providing brief interventions and dealing with out of hours support.
• To use agreed and established Outcome Monitoring Tools (TOP) and any other relevant quality measures.

• Rapid identification of clients with co-occurring substance use and mental health disorders, followed by a comprehensive joint assessment of addiction and mental health needs
• Supporting providers to establish robust care plan formulation and treatment recommendations
• Liaison with community addictions and mental health services
• Establishing direct referral routes into mental health care with agreement from West London NHS Trust
• Facilitated referrals/joint assessments to develop fast-track pathways into substance use treatment
• Input into case discussions including clinical advice and support
• Providing specialist substance use advice and support to other colleagues within the health care setting and to other agencies concerned with substance use.
• Close liaison with inpatient wards prior to discharge back to hostel settings
• Delivery of psychosocial interventions e.g. motivational interviewing, to support change behaviour and encourage engagement with appropriate treatment programmes
• Facilitating engagement with mutual aid programmes (such as AA, NA, SMART) and practical support to engage with relevant social care agencies
• Providing training and development opportunities for mental health and hostel staff in identifying and managing dual diagnosis presentations and enhancing engagement with residents presenting with these needs
• Identification and onward referral of additional needs (e.g. BBVs, COPD, smoking cessation, physical health issues, dentistry, sexual health, podiatry)
• Organising GP appointments and communicating assessment recommendations
• To develop and maintain pathways into specialist services to ensure the health and well-being of residents is met, including primary care services
• To promote engagement in Primary Care services and facilitate access to organised health care for residences.
• To sign post service users to the appropriate health care settings to meet their needs.
• To develop and provide a training package for those that work within the hostels on providing brief interventions and dealing with out of hours support.
• To use agreed and established Outcome Monitoring Tools (TOP) and any other relevant quality measures.

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