lancashire care .therapist and team leader . ... • lancashire eis – laying the foundations •

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  • Children and Families

    Lancashire Care

    IAPT-SMI Demonstration

    Site 3/9/15

    James Kelly

    Senior Clinical Psychologist

    & IAPT-SMI

    Project Manager

  • LCFT Demonstration Site

    Lancashire EIS Laying the Foundations Why we were chosen as a Demonstration Site What we have done as a Demonstration Site Interim Findings 1/10/12 - 31/12/14 Learning Points

    Children and Families

  • LCFT Demonstration Site

    Lancashire EIS Laying the Foundations Why we were chosen as a demonstration site What we have done as a Demonstration Site Interim Findings 1/10/12 - 31/12/14 Learning Points

    Children and Families

  • EIS Shared Learning Conference

    Catchment area 1.5 million population caseload 727 ( actual 760)

  • EIS Shared Learning Conference

    Lancashire Care Overview Large Geographical area 1.5M population 3 local authorities Service caseload of 760

    Against target of 727 Average care co-ordinator caseload under twenty (but

    high teens) Approx. 260 accepted into service against 500 referrals

    assessed. 5.4 wte therapists across this area.

  • Laying the Foundations

    From inception, service has had Senior Management buy-in

    Commissioner Support Whole service commitment to psychosocial

    interventions 3 tier service model for PSI, CBT & FI. In-house training in PSI

    Outcome measurement Service User Involvement - ongoing

    Children and Families

  • LCFT Demonstration Site

    Lancashire EIS Laying the Foundations Why we were chosen as a Demonstration Site

    The 3 tiered matched approach - PSI Training - REACH - Research

    What we have done as a Demonstration Site Interim Findings 1/10/12 - 31/12/14 Learning Points

    Children and Families

  • A Matched-Care / Tiered Approach to Psychological Care

    Psycho-social interventions

    Case managers/

    ST&R

    Tier 2

    Tier 3

    Formal CBT or FI, Discrete Problems

    Staff with:

    Formal CBT training or COPE Msc

    (under supervision)

    Complex / multiple problems longer term CBT or FI

    Tier 1 Specific PSI

    Training Supervision/ Consultation

    Cognitive Therapists

    Clinical Psychologists

  • North Lancashire

    East Lancashire

    Central & West Lancashire

    Aligned Therapist Aligned Therapist Aligned Therapist

    Case Discussion and Formulation (Therapist and Case Manager)

    Core PSI Tier 1

    Formal CBT / FI (Tiers 2 and 3)

    Supervision, consultation & ongoing support from

    Therapist and Team Leader

    Review Outcome and Effectiveness

    Psychological Assessment including Case

    Manager

    Review Outcome

  • Tier 1

    Tier 3

    Engagement (MI skills) Normalising Approaches Maintenance Formulation Problem lists and Prioritisation SMART Goals & Agenda Setting Activity Scheduling Relapse Prevention (+ Manual) Recovery Approach Measuring Change

    Psycho-social interventions

    Case managers/

    ST&R

  • Tier 2

    Tier 3

    Staff with:

    Formal CBT training or COPE Msc

    (under supervision)

    Formal CBT or FI, Discrete Problems

  • Routine Enquiry about Adversity in Childhood

    (REACh) What is it? Process by which we routinely ask individuals about Adverse Childhood Experiences (ACEs) during assessment process The intent being to respond appropriately and plan interventions which reduce the impact on adult health and wellbeing

  • Research Active

    HELPER programme grant Three streams 1. Healthy living 2. Cannabis use FEP intervention 3. Cognitive remediation

    National EDEN SuperEDEN Benemine

  • NHS-E Goals for IAPT-SMI

    Increase choice by improving access to evidence based psychological therapies in existing services.

    Focus on barriers to implementation and how to overcome them (demonstration sites)

    Improve quality by specifying competenices to deliver therapies.

    National Training Syllabus for therapists and service leaders.

    Demonstrate impact of improved access to psychological therapies

    Outcome frameworks: service user experience at the core.

    Children and Families

  • Why we became a Demonstration Site Delivering evidence-based psychological

    therapies. Therapists with appropriate competencies. Have strategic approach Approach is replicable. Collecting outcome data routinely and

    effectively (access to historic data). Access to training & supervision Overcoming Barriers to Implementation: e.g.

    Senior management buy-in; & ring fenced time.

    Children and Families

  • LCFT Demonstration Site

    Lancashire EIS Laying the Foundations Why we were chosen as a Demonstration site What we have done as a Demonstration Site Interim Findings 1/10/12 - 31/12/14 Learning Points

    Children and Families

  • IAPT-SMI Dataset Sessional Data:

    CHOICE Short Form

    Start/Middle/End EQ-5D Warwick & Edinburgh Well-Being Scale

    (WEMWBS) Work and Social Adjustment Scale (WSAS) Psychosis Rating Scale (PSYRATS) Patient Experience Questionnaire Friends & Family

    Children and Families

  • PROMS

    Data Collected in-session

    Developed mobile application for use on Samsung Galaxy tablets

    Feedback table for outcomes

    Children and Families

  • Service Users

    Therapists Informatics Technical Solutions

    Person Centeredness Standardised measures Imposing reality Use of the data Choice and ambivalence

    Displaying the scores Accessibility

    Data protection

    Displaying the data What needs to happen next?

    Delivering the IAPT Data Mobility and efficiency

  • Desktop App

    Children and Families

  • 66 - 10 9 30

    60 - - - -

    66 70 - - -

    70 - 12 - -

    70 - - - -

    - - - - -

    60 - 10 - -

    - - - - -

    Session one

    Session Two

    Session Three

    Session Four

    Session Five

    Session Six

    Session Seven

    Session Eight

    Choice

    WEM WBS

    WSAS

    EQ 5D

    PSYRATS

    PROMS Paired Outcomes % Improved % Deteriorated

  • Outcomes Aims to contextualise data from individual Demonstration Sites whilst testing feasibility of measuring data across the following domains: Service & Population Workforce Activity Completion: Patterns of treatment and outcome:

    PROMS Health Utilisation Children and Families

  • Consent Form

    Children and Families

  • Consent Form

    Children and Families

  • LCFT Demonstration Site

    Lancashire EIS Laying the Foundations Why we were chosen as a Demonstration Site What we have done as a Demonstration Site Interim Findings 1/10/12 - 31/12/14 Learning Points

    Children and Families

  • Activity

    Children and Families

    1st October12 to 31st December 14 215 people referred 151.2 offered treatment Context:

    referrals come after lots of informal work. 107 started and completed therapy in this

    period (85.6 per year) 54 had 5 or more sessions (43.2) 53 had 1 to 4 sessions. (42.4)

    45 of completers had paired outcomes (83%)

  • CHOICE Scores

    Children and Families

    0

    10

    20

    30

    40

    50

    60

    70

    earliest latest

    Mean = 46.61 S.D.= 19.12

    Mean = 58.59 S.D.= 24.32

    Completers with 5 sessions or more

    Data collected between 1/11/12 and 31/12/14

    Earliest measure and latest measure

    Significant improvement (P

  • EIS Shared Learning Conference

    Sessional Measurement Advantages

    Allowed therapist and client to see progression and alter therapy accordingly.

    Positive change was viewed as very rewarding

    A drop in scores provided focus for session Could serve to ground clients when

    unwell/distressed.

  • EIS Shared Learning Conference

    Sessional Measurement Disadvantages

    Not always suitable when client unwell/distressed

    Clients did not always feel measurement was relevant

    Measurement as part of therapy: reduced time to speak about issues concerning client.

    Sometimes led to reduction of use of specific measures, e.g. BDI-II, BAI, ISS, HAPPI, Padau Inventory for OCD.

    Culture change

  • 0

    0.1

    0.2

    0.3

    0.4

    0.5

    0.6

    pre-treatment(n=54)

    duringtreatment

    (n=54)

    Follow up(n=9)

    Contacts with CRHTT Completers (5 or more) Contacts with

    crisis/home treatment teams per month per patient

    Data collected between 1/11/12 and 31/12/14

  • 0

    0.005

    0.01

    0.015

    0.02

    0.025

    0.03

    0.035

    0.04

    pre-treatment(n=54) during treatment(n=54)

    follow up (n=9)

    People with more than 5 sessions

    MH acute admissions per month per patient for total cohort

    Data collected between 1/11/12 and 31/12/14

    Mental Health Acute Admissions

  • 0

    0.2

    0.4

    0.6

    0.8

    1

    1.2

    1.4

    1.6

    1.8

    pre-treatment(n=54) during treatment(n=54)

    follow up (n=9)

    Mental Health Acute Bed Days

    People with more than 5 sessions.

    Data collected between 1/11/12 and 31/12/14

  • Service User Feedback [Therapist]s the only one I can be 100% open wi

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