Collaborative Care Team

Summary

The Collaborative Care Team is a health based intensive community rehabilitation team operating across the Southend, Castlepoint and Rochford area.

Service information

The team delivers high quality intensive rehabilitation to patients in their own homes on discharge from hospital or step down care from community bed based units. The team is therapy lead, treatment plans are patient centred and goal orientated, with the overall aim of re-educating and reskilling patients with all activities of daily living and to support regaining of independence. The team also signposts patients to EPUT community services to ensure a smooth and efficient rehabilitation pathway is experienced.

The team consists of a team of multidisciplinary professionals, including physiotherapists, occupational therapists, nurse, associate practitioners and rehabilitation staff.

The team also support with crisis intervention and step up to prevent unnecessary hospital admissions to any patient whom are in health crisis in the Southend, Castlepoint and Rochford area providing intensive rehabilitation in the patient’s own home.

The service is for patients aged 18 and over registered with a GP in Southend, Castlepoint and Rochford areas who require intensive rehabilitation following Stroke, a neurological event or un-stable fracture.

Referral information

Community Coordination Centre

Referral is via the Community Coordination Centre and while there is a referral form used primarily by the hospital and community bed based units, GP’s are able to refer direct over the phone.

Email: [email protected]
Telephone: 0333 015 3481

Crisis referrals

Crisis referrals can be made for people experiencing an episode of ill health that require short-term intervention to prevent and avoid unnecessary hospital admission.