Centre for Anxiety Disorders & TraumaAnnual Report 2017/2018

INDEX

ContentsEXECUTIVE SUMMARY...........................................................................................................................1

1. WHO ARE WE?...............................................................................................................................2

1.0 Clinical Care.................................................................................................................................2

1.1 Education and Training................................................................................................................2

1.2 Research......................................................................................................................................2

1.3 Aims and Objectives....................................................................................................................3

2. WAIT TIMES 2017-2018.................................................................................................................3

3. RECOVERY AND OUTCOMES..........................................................................................................6

4. CARING SERVICES..........................................................................................................................8

5. SUPERVISION AND TEACHING.....................................................................................................10

6. RESEARCH AT CADAT...................................................................................................................14

6.1 General Anxiety Disorder Research...........................................................................................14

6.2 Depression.................................................................................................................................14

6.3 Perinatal Mental Health.............................................................................................................14

6.4 Hoarding Research.....................................................................................................................14

6.5 Global Mental Health.................................................................................................................14

6.6 Research Supervision.................................................................................................................15

7. LEADING NEW DEVELOPMENTS AT CADAT.................................................................................15

7.0 The Psychological Outreach Screen and Support Service..........................................................15

7.1 Patient Choice............................................................................................................................17

7.2 Southwark Council Hoarding Work............................................................................................17

7.3 Evening Clinic.............................................................................................................................18

8. SUMMARY...................................................................................................................................18

9. APPENDICES.................................................................................................................................19

Comparison of Waiting Times..........................................................................................................19

Comparison of average waiting times from referral to assessment in 2017-18 and 2016-17.........20

Comparison of average waiting times from referral to treatment in 2017-18 and 2016-17............21

IAPT DEFINTIONS.................................................................................................................................22

Effect Sizes...........................................................................................................................................24

EXECUTIVE SUMMARYThis report provides an outline of CADAT’s activity for the year April 2017 to March 2018. It includes the clinical activity and outcomes, the training and supervision provided and the research activity and outputs – the tripartite mission of Kings Health Partners (KHP).

We continued to provide high intensity Cognitive Behaviour Therapy (CBT) for people with anxiety disorders.

We continued to develop our activities with local and national service user groups. We are 22 substantive SLaM staff, 15.1 FTE (full time equivalent). We span primary, secondary and tertiary care. We have 9 clinical service streams and an

additional training and supervision stream. The clinical activity includes national services, the Improving Access to Psychological Therapies (IAPT) services and Integrated Psychological Therapies Teams (IPTT) in Lambeth, Southwark and Lewisham.

We received 631 referrals. The most common referrals were for Obsessive Compulsive Disorder (225), Posttraumatic Stress Disorder (146) and Social Anxiety Disorder (55).

The most common care cluster is 4 and the majority of clients are in clusters 3 to 7. Depending on service stream, the average wait for assessment is between 7 and 39 weeks,

and the wait for treatment is between 17 and 51 weeks. For all disorders across all service streams treated at CADAT, pre and post measures showed

a large positive effect size on disorder specific measures, showing improvement in symptomology (as measured by patient self-report measures), except for Specific Phobias, which showed a medium effect size.

Applying IAPT recovery criteria across the whole clinic (including secondary and tertiary care) 47.28% achieved recovery. For those patients seen within IAPT service streams, the recovery rate was 54.3%.

For the Patient Experience Data Information Centre (PEDIC) questionnaires, 98% of the 165 respondents said they would be likely or extremely likely to recommend our service.

We hosted 20 therapists on placement. Overall, the total number of clinicians supervised by CADAT staff, either at CADAT or

elsewhere, was over 100. CADAT staff presented multiple lectures and workshops.

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1. WHO ARE WE?CADAT was established by Professors David Clark, Anke Ehlers and Paul Salkovskis in 2000. The current joint clinical leads are Professor David Veale and Dr Blake Stobie. At CADAT, we treat people whose main problem is an anxiety disorder, especially Obsessive Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), Social Anxiety Disorder (SAD), Health Anxiety and Posttraumatic Stress Disorder (PTSD). The clinic is based on the Maudsley Hospital site and forms part of South London and Maudsley NHS Foundation Trust (SLaM), which provides mental health services to South London and specialist services nationwide.

SLaM itself forms part of King’s Health Partners (KHP) Academic Health Sciences Centre, which brings together King’s College London and three NHS foundation trusts (SlaM, King’s College hospital and Guy’s and St Thomas’ hospitals) in an initiative to bring together world-class research, education and clinical practice for the benefit of patients. CADAT is part of SLaM’s Psychological Medicine and Older Adults Directorate.

During 2017-2018, CADAT staff consisted of certified clinicians, trainees, and administrative staff. Of the certified clinicians, the following were accredited with the British Association for Behavioural and Cognitive Psychotherapies: 3 had provisional accreditation as therapists, 8 were fully accredited as therapists, 6 were accredited as both therapists & supervisors and 3 were accredited as therapists, supervisors & trainers.

1.0 Clinical CareCADAT is a unique service in that it provides a clinical service across primary, secondary and tertiary care. CADAT forms a small part of each of Lambeth, Southwark and Lewisham’s (LSL) primary care Improving Access to Psychological Therapies (IAPT) services and each borough’s secondary care Integrated Psychological Therapies Teams (IPTT). CADAT also holds a Highly Specialised Service (HSS) contract with NHS England to provide treatment for people with OCD and BDD for whom numerous previous treatments have been unsuccessful (tertiary). CADAT can also receive referrals nationally, where funding is provided by the local Clinical Commissioning Group, and via Patient Choice (tertiary).

1.1 Education and TrainingCADAT provides training and supervision within SLaM and other local services. Our staff contributes to KCL established training courses, especially the Postgraduate Diploma in CBT, and the Doctorate in Clinical Psychology, both based at the Institute of Psychiatry, Psychology and Neuroscience. We also regularly host placements for British and international undergraduates and trainees.

1.2 ResearchMany of the treatments we offer have been developed by our own teams, have been very effective in randomised-controlled trials, and are subject to high levels of quality control. Our centre is a leader in both research and clinical treatment of anxiety in the UK.

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1.3 Aims and ObjectivesAt CADAT we aim to provide the best possible treatment, training, and research on anxiety disorders. We are proactive about gathering and acting on feedback from service users and have a commitment to dissemination and public engagement.

We strive to uphold the SlaM ‘Five Commitments’ in order to build mutual and respectful relationships with each other and service users:

1. Be caring, kind and polite

2. Be prompt and value your time

3. Take time to listen to you

4. Be honest and direct with you

5. Do what I say I am going to do.

2. WAIT TIMES 2017-2018Data presented here is for people seen within the year 1st April 2017 to 31st March 2018. Referrals to CADAT are allocated internally within the IAPT and IPTT services. CADAT does not take direct referrals for Lambeth, Southwark and Lewisham residents. Referrals for National / Tertiary Care and HSS service users come from local CMHTs. Service users are assessed and then allocated to most suitable therapist (including training status, gender, specific expertise etc.). Wait times include any delays due to service user cancellations, DNAs, and request for delay

Table 1 - Overall Clinic Activity DataTotal

referredTotal

assessedEntered

Treatment*Total

discharged from

treatment**

Completed Treatment ** Dropped out

t**

Total number of referrals to CADAT 644 497 386 372 303 68

IAPT Lewisham 79 65 49 48 38 10

IAPT Lambeth 163 141 128 122 101 21

IAPT Southwark 112 113 106 108 89 19

IPTT Lewisham 1 1 0 1 1 0

IPTT Lambeth 1 1 2 2 2 0

IPTT Southwark 4 0 4 5 4 1

HSS 60 51 25 27 21 5

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National 119 44 23 20 14 6

Patient Choice 89 73 46 38 32 6

Table 1 - Overall Clinic Activity Data. This table illustrates our clinic activity in 2017-2018.

*This number refers to the number of people who entered treatment in the financial year 2017-18, meaning some may have been referred and/or assessed in the previous financial year. Some may also have finished treatment in the following financial year.

** This number refers to the number of people who finished treatment in the financial year 2017-18, meaning some may have been referred and/or assessed in the previous financial year.

Figure 2 - Average waiting time from referral to assessment in 2017-18 (weeks)

Figure 1 - Average Waiting Time from Referral to Assessment in Weeks. This figure illustrates the average number of weeks patients in each service stream had to wait to be assessed.

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Figure 3 - Average waiting time from referral to treatment in 2017-18 (weeks)*

Figure 2 - Average Waiting Time from Referral to treatment in Weeks. This figure illustrates the average number of weeks patients had to wait to be treated for each service stream.

Overall, the average waiting time from referral to assessment in 2017/2018 was 15 weeks. The average waiting time from referral to treatment was 24 weeks. Comparisons of waiting times to previous years can be found in the appendix.

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3. RECOVERY AND OUTCOMES3.0 DiagnosisThe largest number of referrals this year were for OCD, PTSD and Social Anxiety. The figures below show a comparison of the numbers of referrals we’ve received, and patients that have entered into treatment over the last three years, according to disorder.

Figure 3 - Comparison of number of referrals made for separate diagnoses

BDD GAD Health Anxiety Hoarding DisorderOCD Panic Disorder PTSD SADSpecific Phobia SPOV Other

These trends are similar to last year, as seen in the figure below.

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Figure 4 - Number of people who entered treatment 2-year comparison

BDDGAD

Health Anxie

ty

Hoarding D

isord

erOCD

Panic D

isorder

PTSD

SAD

Speci

fic Phobia

SPOV

0

20

40

60

80

100

120

140

Entered Treatment 2016-17Entered Treatment 2017-18

3.1 Recovery- IAPT ServicesIAPT DATA

Terms relating to outcome measure are defined in the appendix.

Recovery and Reliable Improvement:

Recovered Realiable improvement Caseness Reliable Deterioration0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

0.543

61.38%

45.48%

5.30%

35.96%32.58%

3.75%

IAPT Patients Treated at CADAT 2017-2018

All Patients Anxiety Depression

Category of patient scores at the end of therapy (in accordance with IAPT definitions)

Perc

enta

ge o

f pati

ents

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3.2 Recovery- All Clinic

Recovered Realiable improvement Caseness Reliable Deterioration0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

0.4728

56.16%

39.26%

6.02%

37.25%

29.80%

4.30%

All Patients Treated at CADAT 2017-2018

All Patients Anxiety Depression

Category of patient scores at the end of therapy (in accordance with IAPT definitions)

Perc

enta

ge o

f pati

ents

Treatment effect size:

For all disorders across all service streams treated at CADAT, pre and post measures showed a large positive effect size on disorder specific measures, showing improvement in symptomology (as measured by patient self-report measures), except for Specific Phobias, which showed a medium effect size*.

4. CARING SERVICES CADAT collects feedback from patients on a regular basis through the use of Patient Experience Data Information Centre (PEDIC) questionnaires. The results of these can highlight areas requiring improvement and identify what we are doing well.

CADAT values patient feedback and so we have tried to make accessing the PEDIC questionnaires as easy as possible, for example, by designing our own advertising posters to promote feedback and including a weblink in staff email signatures. We invite all patients to complete a PEDIC questionnaire on paper or online.

CADAT consistently performs well in PEDIC reports, with 98% of the 165 respondents from April 2017 to end of March 2018 said they would be likely or extremely likely to recommend our service to family and friends if needed.

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Don't Know

Extremely likely

Likely

Neither likely nor unlikely

0 20 40 60 80 100 120 140

How likely are you to recommend our service to your friends and family if they needed similar care or treatment?

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PEDIC reports also allow patients to give comments:

CADAT strives to take service user feedback and implement changes based on areas where we need improvement:

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5. SUPERVISION AND TEACHINGCADAT staff teach on a wide variety of CBT courses locally and nationally. We have particularly close links with the IoPPN CBT Postgraduate Certificate and Diploma (PG Cert and Dip). The course director, Sheena Liness, is a member of CADAT staff; and the deputy course director, Suzanne Byrne, also does her clinical work at CADAT. Alongside teaching, CADAT is a major supervision resource for the IoPPN doctorate in clinical psychology and PgDip in CBT courses, and for Specialist Trainees on psychiatry rotation. We also provide Continuing Professional Development (CPD) placements for more experienced staff from both local SLaM services and further afield.

5.0 Clinical Placements at CADAT

We hosted and supervised 27 therapists on placement at CADAT, usually for 6 months each. DClinPsy and IAPT trainees are at CADAT 3 days per week. CPD placements are here usually one day per week.

Supervisees No. Where supervisees are from

DClinPsy Trainees 4 IOPPN and Canterbury Christ Church University, Salomons Centre

IAPT High Intensity CBT Trainees 12 Southwark IAPT, Lewisham IAPT & Lambeth IAPT

Psychiatry Trainees 2 ST6

SLaM CPD attachments 2 Lambeth IAPT, Southwark IAPT

Non-SLaM CPD attachments 6 University of Reading, Umeå University, University of Münster

We hosted 3 IoPPN MSc Mental Health studies placements, and 1 BSc student from University of Bath. CADAT also hosted 1 international fee-paying placement to a psychology student from Umeå University (4 months). This included providing clinical work under supervision.

5.1 SupervisionSupervision is provided at CADAT to trainees on placement, qualified staff on attachment from within SLaM for specialist CPD, and qualified staff from outside of SLaM.

Supervision is also available to therapists not doing placements at CADAT. Weekly sessions are offered at local locations for Lambeth, Southwark and Lewisham IAPT services. The supervision provided can include both supervision of clinical work and supervision of other therapists’ supervision

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The following represents supervision in the London area:

Overall, the number of clinicians supervised by CADAT staff, either at CADAT or elsewhere was over 100.

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5.2 Teaching

The following graphic shows a selection of topics taught by CADAT staff during 2017-18:

In total, CADAT staff delivered more than 30 learning opportunities on a broad variety of topics.

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The image below illustrates the universities, conferences and institutes that CADAT staff taught at during 2017/2018. It also shows a selection of courses that were contributed to.

CADAT staff most frequently taught at King’s College in London. Courses most commonly taught at were DClinPsy courses at various universities and the PGDip at King’s College London.

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6. RESEARCH AT CADATCADAT is a leader in UK research of anxiety and cognitive behavioural therapy. Several of our therapists are involved in cutting edge research furthering our knowledge of the applications of cognitive theory to the alleviation of mental health conditions.

6.1 General Anxiety Disorder Research CADAT collaborates with Dr Colette Hirsch at the IoPPN (Institute of Psychiatry, Psychology and Neuroscience). Dr Hirsch has proposed a new CBT model for worry, together with new developments in clinical strategies to target this hard to treat disorder. The treatment outcomes have been very encouraging and she has been disseminating the protocol in workshops she has run for clinicians locally and nationally.

6.2 Depression As well as working with anxiety disorders, CADAT therapists contribute to the understanding of CBT for depression. Dr Stirling Moorey has constructed a Massive Online Open Course entitled ‘An Introduction to CBT for Psychiatrists’ with assistance from Suzanne Byrne and other CADAT therapists. This has been accessed by over 5000 participants.

6.3 Perinatal Mental HealthCADAT is involved in research and treatment of perinatal anxiety disorders. CADAT is committed to developing and providing quality services to parents in the perinatal period. One of our Clinical Psychologists, Dr Fiona Challacombe, has gained an NIHR clinical lectureship to run a case series and feasibility RCT in treatment of antenatal anxiety disorders.

6.4 Hoarding Research CADAT proudly promotes the understanding and treatment of Hoarding Disorder. This year, Dr Helena Drury, Dr Victoria Bream, Dr Alice Kerr and Ms Caroline Harrison have been involved in conducting research to examine the feasibility and effectiveness of a group CBT intervention for Hoarding Disorder in routine clinical practice. This research will continue into 2018/2019.

6.5 Global Mental HealthDr Melanie Abas, Reader in Global Mental Health at IoPPN and Honorary Consultant Psychiatrist at CADAT was awarded a research grant valued $3.8 million from the US National Institute for Mental Health for a clinical trial to demonstrate how a cognitive behavioural intervention for depression in people living with HIV can improve physical health, HIV viral suppression, and quality of life. This award was featured in the KCL magazine Spotlight https://www.kcl.ac.uk/news/spotlight-article?id=0f3bd264-152f-4aa4-a2e7-0104e271096d . Dr Abas is part of team which won a Comic Relief grant in 2018 to expand the Friendship Bench intervention for depression and anxiety to rural Zimbabwe https://www.friendshipbenchzimbabwe.org/. Her research to “de-bunk the myth” that depression and anxiety do not occur in poor countries was written about in the Wellcome Trust Mosaic science magazine https://mosaicscience.com/story/friendship-bench-zimbabwe-mental-health-dixon-chibanda-depression/.

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6.6 Research SupervisionCADAT therapists regularly supervise research conducted by doctoral students.

Dr Challacombe supervised Grace Child’s completed clinical doctorate examining the development of obsessional beliefs and behaviours in parents of a baby in the NICU. She also supervised Jolyon Poole’s completed clinical doctorate examining the experiences of partners of mothers with perinatal OCD.

Dr Blake Stobie and Professor David Veale supervised Francesca Muccio’s doctorate thesis on ‘Comparing the impact of exposure without safety behaviours to exposure with safety’ which passed with good feedback and no revisions.

7. LEADING NEW DEVELOPMENTS AT CADATCADAT constantly strives to develop and improve services in order to reduce wait times and increase public access to the clinic. The following are some developments that CADAT undertook in 2017/2018.

7.0 The Psychological Outreach Screen and Support ServiceThe Psychological Trauma Outreach, Screen and Support Service for the London Terrorist incidents was founded by NHS England and CADAT following the terrorist attack in London Bridge. The service started in October 2017 and is responsible for addressing the mental health needs of people affected by the London terrorist Incidents in 2017; Westminster Bridge, London Bridge, Finsbury Park and Parsons Green. The service is provided in collaboration with Camden and Islington Mental Health Trust.

Through a proactive outreach and screen approach the service ensures that people who were injured, bereaved or witnessed the attacks including first responders, are screened, clinically assessed, referred and treated by appropriate services to support their mental health recovery.

The service provides ongoing follow up to monitor referrals’ wellbeing, engagement with treatment and progress. The service offers support to its users around the time of the anniversaries and inquests. Written psychoeducational materials were developed to help people affected prepare for the anniversary and the inquest. The service has been taking part in multi-agency liaisons with stakeholders to coordinate support.

Referrals

Data presented here is for 491 referrals during the period of 1st October 2017 to 31st March 2018. The service received contact details from the Metropolitan Police, Victim Support, NHS services as well as direct referrals.

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Figure 1 – Breakdown of referral source 2017-2018

ReferralsPolice

Victim Support

NHS

Self-Referral

Other

Care Pathway

The service provides repeated screening for risk, PTSD, depression, anxiety and substance misuse following direct exposure to terror or related bereavement. Positive screens are followed up by assessment and referral to treatment by local services. The service ensures engagement in timely and evidence-based treatment with local services (including IAPT, secondary care, third party organisations etc.). A limited number of service users are treated by the service when local services are not able to offer appropriate or timely treatment. The Psychological Trauma Outreach and Screen for London Terror Incidents has also provided regular follow up contact with referrals and contact around the anniversary to the attack and the court hearing and inquests. The table below provides a summary of referrals that were seen by the service between 0ctober 2017- March 2018. The majority of these clients completed their treatment in the following financial year.

Table 1 - Overall Activity Data October 2017-March 2018

  Total Westminster London Bridge Finsbury Park Parsons Green

Referrals 495 167 234 19 75

Screens returned 125 36 53 31 5

Assessment completed

67 16 36 1 14

Number needing treatment

58 11 34 1 12

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Number DNA’d* 6 3 2 1 0

Brief interventionby Outreach and screen

6 3 3 0 0

Service users under 18

4 1 3 0 0

Caseness*:

69% of referrals met the PTSD criteria for caseness, 6% met the criteria for anxiety and 3 % for depression, 12% presented with other difficulties and 10% of those assessed did not require treatment.

*Terms relating to outcome measure are defined in the appendix.

7.1 Patient ChoiceAs of April 2014, adults with mental health problems have had the legal right to choose the provider of their treatment. This means that patients that live outside of the SLaM catchment area can choose to be referred to CADAT directly by their GP, although CCG funding still needs to be sought. CADAT has actively supported service users trying to exercise their legal rights under patient choice, including helping to ensure that suitable structures are in place in SLaM to facilitate this.

7.2 Southwark Council Hoarding WorkSince 2016, CADAT have provided Psychological Input for Southwark Multi Agency Working Team (MAWT), specifically in relation to Hoarding Disorder. Funding from Southwark Council allows CADAT staff to provide expert supervision and treatment of Southwark residents with significant hoarding problems. Dr Victoria Bream and Ms Caroline Harrison have led this work and have made significant progress in 2017/2018.

By bringing psychological therapists into the MAWT, clients can be assessed by mental health specialists quickly and in their homes if required, and either receive therapy within the team or be signposted onto more appropriate services. Given that the waiting time for assessment in NHS psychological services currently can be up to 4 months with a further 6 months wait following assessment for treatment, having psychological therapists within the MAWT could prevent residents mental health from deteriorating which is far better for their wellbeing and could save the council money in the long term.

Based at the Council for 2.5 days a week, Dr Bream and Ms Harrison work in conjunction with the Council to provide psychological treatments to people with hoarding problems and comorbidity. They sit on a hoarding panel monthly and advise on how to work on hoarding problems and other mental health problems. They have provided tailored training for the MAWT in hoarding disorder, covering diagnosis, clinical features and an outline of cognitive behaviour therapy.

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Dr Bream and Ms Harrison run a drop-in hoarding support group open to all at Dockhead Fire Station on Thursday afternoons. So far, this group has attracted people who would not come to the attention of services until far later in their hoarding disorder trajectory, indicating that early intervention is possible. The same evidence based content is offered as in individual and group treatment programmes, but with more flexibility and time to cover topics in depth. Most of the attendees would have to wait up to a year for therapy from psychiatric services and may not meet the threshold for treatment. They have built a core base of regular members who support and hold each other accountable to declutter between sessions. Group members report that holding the group in the fire station takes away the stigma of attending psychiatric clinics, they feel more comfortable about having fire safety checks having met fire fighters at the group, and they have requested a fire safety session for a group in the near future.

The working relationship between CADAT and Southwark MAWT continues to run successfully.

7.3 Evening ClinicWe have introduced an evening clinic in order to increase appointment availability and decrease wait times. The evening clinic operates 2 evenings a week, with 5 therapists and 2 assistant psychologists. We intend to expand on this service in the coming months and further increase availability of therapy in the evenings.

8. SUMMARYThis report has detailed how CADAT continues to contribute in clinical activity, training and education, and research – KHPs tripartite mission. CADAT particularly offers other SlaM services expertise in CBT provision, training and supervision. We have existing close relationships with local SlaM IAPT and IPTT services, as well as other SlaM services.

We have been active in education and training, supervising a large number of therapists. Over the next year we will aim for further improvements in 2018-2019. We will also seek to reduce waiting times. We will look to develop training placements further, including internationally.

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9.APPENDICES

Comparison of Waiting TimesTable 2 - This table compares waiting times for 2016-17 and 2017-18. Waiting times are listed in mean weeks with standard deviations noted in the parentheses.

*Standard deviation not applicable as only person came through this service stream**IPTT Lambeth not included as no patients from this service stream received treatment*** No data available

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Service stream 2017-18 Wait referral to assessment: mean weeks (SD)

2016-17 wait referral to assessment: mean weeks (SD)

2017-18 Wait referral to treatment: mean weeks (SD)

2016-17 wait referral to treatment: mean weeks (SD)

IAPT Southwark 18 (14.28) 16.08 (12.58) 28 (15.62) 30.05 (20.37)

IAPT Lambeth 10 (8.11) 9.10 (8.20) 17 (11.59) 19.51 (15.15)

IAPT Lewisham 19 (12.17) 16.07 (8.47) 23 (12.76) 20.73 (12.72)

IPTT Southwark 39 (N/A*) 15.34 (12.19) 51 (N/A*) 28.62 (27.75)

IPTT Lambeth 12 (N/A*) 17.07 (7.41) N/A** 47.71 (7.67)

IPTT Lewisham 13 (N/A*) 24.00 (17.86) 29 (N/A*) 49.22 (13.64)

National/Tertiary 14 (9.17) 19.53 (15.85) 32 (16.11) 40.85 (19.99)

Patient's Choice 12 (6.87) N/A*** 30 (12.69) N/A***

HSS 7 (4.57) 12.63 (14.97) 24 (14.35) 40.55 (29.71)

Comparison of average waiting times from referral to assessment in 2017-18 and 2016-17

Figure 4 - Comparison of average waiting times from referral to assessment in 2017-18 and 2016-17. This figure illustrates the difference in average waiting times from referral to assessment. No data available for Patient’s Choice.

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Comparison of average waiting times from referral to treatment in 2017-18 and 2016-17

Figure 5 - Comparison of average waiting times from referral to treatment in 2017-18 and 2016-17. This figure illustrates the difference in average waiting times from referral to treatment. Missing numbers for IPTT Lambeth and Patient’s Choice are due to no patients receiving treatment and missing data, respectively.

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IAPT DEFINTIONS Definitions obtained from NHS Digital (2018), Psychological Therapies: a guide to IAPT data and publications.

Term Definition

Reliable recovery A referral has reliably recovered if they meet the criteria for both the recovery and reliable improvement measures. That is, they have moved from being a clinical case at the start of treatment to not being a clinical case at the end of treatment, and there has also been a clinically significant improvement in their condition.

Caseness Recovery in IAPT is measured in terms of ‘caseness’ – a term which means a referral has severe enough symptoms of anxiety or depression to be regarded as a clinical case of that condition. A referral has moved to recovery if they were defined as a clinical case at the start of their treatment (‘at caseness’) and not as a clinical case at the end of their treatment, measured by scores from patient questionnaires tailored to their specific condition.

Reliable Deterioration This is defined as a count of the number of referrals that ended in the period having finished a course of treatment, and where the following is true:

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there are two or more PHQ-9 scores and two or more ADSM scores (known as ‘paired scores’);

where there is an increase from the first to the last score on either the PHQ-9 measure or the ADSM measure, or both, that is greater than the reliable change threshold for that measure;

neither the PHQ-9 measure nor the ADSM measure has a decrease from the first to the last score that is greater than the reliable change threshold for that measure.

Reliable improvement A referral has shown reliable improvement if there is a clinically significant improvement in their condition following a course of treatment, measured by the difference between their first and last scores on patient questionnaires tailored to their specific condition.

No Reliable Change This is defined as a count of the number of referrals that ended in the period having finished a course of treatment, and where the following is true:

• There are two or more PHQ-9 scores and two or more ADSM scores (known as ‘paired scores’) either: o There is

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an increase from the first to the last score on either the PHQ-9 measure or the ADSM measure that is greater than the reliable change threshold for that measure, and the other has a decrease from the first to the last score that is greater than the reliable change threshold for that measure;

Neither measure has a change (neither an increase nor decrease) from the first to the last score that is greater than the reliable change threshold for that measure.

Effect SizesCohen’s d Effect

Size

0.8 Large

0.5 Medium

0.2 Small

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