wwwenglandnhsuk

bull Andy Wright IAPT Advisor Heather Stonebank Lead PWP Advisor and Sarah Boul Quality Improvement Manager

bull andywright1nhsnet heatherstonebankshscnhsuk and sarahboulnhsnet

bull Twitter YHSCN_MHDN yhmentalhealth

bull June 2019

Yorkshire and the Humber

Mental Health Network

Senior PWP Network

4 June 2019

wwwenglandnhsuk

YHSCN_MHDN

yhmentalhealth

Housekeeping

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Welcome Introductions Apologies

and Checking In

Andy Wright IAPT Advisor Yorkshire and the Humber

Clinical Network

wwwenglandnhsuk

How are you feeling today

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Compassionate Leadership

Wellbeing exercise presentation

and table top discussion

Andy Wright All

Compassionate Leadership

Who cares

Andy Wright

IAPT Adviser

Yorkshire amp Humber Senior PWP Network

4th June 2019

Introduction

How did I get here today

What have I noticed happening around me

Within my Trust

Within IAPT locally

Within IAPT in the Clinical Network

Would it be helpful to ground ourselves in a

leadership framework that is evidence based and

aligned to us

What could the barriers and benefits be of this

Disclaimer

Aims for our presentation

How Did I get Here

Fantastic achievement at the forefront of shaping future

MH services

IAPT high volume high turnover

Growing body of evidence highlighting concerns about

staff in the NHS amp Mental Health amp IAPT services

Aspiration to lsquodo no harmrsquo applies to us as well as

people we work with

There are also some other observations at all levels

Whats Happening In My Trust

Culture Profiling

The attitudes feelings values and behaviour that

characterise and inform society as a whole or any

social group within it

The general customs and beliefs of a particular group

of people at a particular time

Culture is the way we do things around here it is the

current in the river the hidden determinant of

organisational direction the manifestation of values

Climate control not command and control

Whats Happening In IAPT Locally

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Welcome Introductions Apologies

and Checking In

Andy Wright IAPT Advisor Yorkshire and the Humber

Clinical Network

wwwenglandnhsuk

How are you feeling today

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Compassionate Leadership

Wellbeing exercise presentation

and table top discussion

Andy Wright All

Compassionate Leadership

Who cares

Andy Wright

IAPT Adviser

Yorkshire amp Humber Senior PWP Network

4th June 2019

Introduction

How did I get here today

What have I noticed happening around me

Within my Trust

Within IAPT locally

Within IAPT in the Clinical Network

Would it be helpful to ground ourselves in a

leadership framework that is evidence based and

aligned to us

What could the barriers and benefits be of this

Disclaimer

Aims for our presentation

How Did I get Here

Fantastic achievement at the forefront of shaping future

MH services

IAPT high volume high turnover

Growing body of evidence highlighting concerns about

staff in the NHS amp Mental Health amp IAPT services

Aspiration to lsquodo no harmrsquo applies to us as well as

people we work with

There are also some other observations at all levels

Whats Happening In My Trust

Culture Profiling

The attitudes feelings values and behaviour that

characterise and inform society as a whole or any

social group within it

The general customs and beliefs of a particular group

of people at a particular time

Culture is the way we do things around here it is the

current in the river the hidden determinant of

organisational direction the manifestation of values

Climate control not command and control

Whats Happening In IAPT Locally

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

wwwenglandnhsuk

How are you feeling today

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Compassionate Leadership

Wellbeing exercise presentation

and table top discussion

Andy Wright All

Compassionate Leadership

Who cares

Andy Wright

IAPT Adviser

Yorkshire amp Humber Senior PWP Network

4th June 2019

Introduction

How did I get here today

What have I noticed happening around me

Within my Trust

Within IAPT locally

Within IAPT in the Clinical Network

Would it be helpful to ground ourselves in a

leadership framework that is evidence based and

aligned to us

What could the barriers and benefits be of this

Disclaimer

Aims for our presentation

How Did I get Here

Fantastic achievement at the forefront of shaping future

MH services

IAPT high volume high turnover

Growing body of evidence highlighting concerns about

staff in the NHS amp Mental Health amp IAPT services

Aspiration to lsquodo no harmrsquo applies to us as well as

people we work with

There are also some other observations at all levels

Whats Happening In My Trust

Culture Profiling

The attitudes feelings values and behaviour that

characterise and inform society as a whole or any

social group within it

The general customs and beliefs of a particular group

of people at a particular time

Culture is the way we do things around here it is the

current in the river the hidden determinant of

organisational direction the manifestation of values

Climate control not command and control

Whats Happening In IAPT Locally

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Compassionate Leadership

Wellbeing exercise presentation

and table top discussion

Andy Wright All

Compassionate Leadership

Who cares

Andy Wright

IAPT Adviser

Yorkshire amp Humber Senior PWP Network

4th June 2019

Introduction

How did I get here today

What have I noticed happening around me

Within my Trust

Within IAPT locally

Within IAPT in the Clinical Network

Would it be helpful to ground ourselves in a

leadership framework that is evidence based and

aligned to us

What could the barriers and benefits be of this

Disclaimer

Aims for our presentation

How Did I get Here

Fantastic achievement at the forefront of shaping future

MH services

IAPT high volume high turnover

Growing body of evidence highlighting concerns about

staff in the NHS amp Mental Health amp IAPT services

Aspiration to lsquodo no harmrsquo applies to us as well as

people we work with

There are also some other observations at all levels

Whats Happening In My Trust

Culture Profiling

The attitudes feelings values and behaviour that

characterise and inform society as a whole or any

social group within it

The general customs and beliefs of a particular group

of people at a particular time

Culture is the way we do things around here it is the

current in the river the hidden determinant of

organisational direction the manifestation of values

Climate control not command and control

Whats Happening In IAPT Locally

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Compassionate Leadership

Who cares

Andy Wright

IAPT Adviser

Yorkshire amp Humber Senior PWP Network

4th June 2019

Introduction

How did I get here today

What have I noticed happening around me

Within my Trust

Within IAPT locally

Within IAPT in the Clinical Network

Would it be helpful to ground ourselves in a

leadership framework that is evidence based and

aligned to us

What could the barriers and benefits be of this

Disclaimer

Aims for our presentation

How Did I get Here

Fantastic achievement at the forefront of shaping future

MH services

IAPT high volume high turnover

Growing body of evidence highlighting concerns about

staff in the NHS amp Mental Health amp IAPT services

Aspiration to lsquodo no harmrsquo applies to us as well as

people we work with

There are also some other observations at all levels

Whats Happening In My Trust

Culture Profiling

The attitudes feelings values and behaviour that

characterise and inform society as a whole or any

social group within it

The general customs and beliefs of a particular group

of people at a particular time

Culture is the way we do things around here it is the

current in the river the hidden determinant of

organisational direction the manifestation of values

Climate control not command and control

Whats Happening In IAPT Locally

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Introduction

How did I get here today

What have I noticed happening around me

Within my Trust

Within IAPT locally

Within IAPT in the Clinical Network

Would it be helpful to ground ourselves in a

leadership framework that is evidence based and

aligned to us

What could the barriers and benefits be of this

Disclaimer

Aims for our presentation

How Did I get Here

Fantastic achievement at the forefront of shaping future

MH services

IAPT high volume high turnover

Growing body of evidence highlighting concerns about

staff in the NHS amp Mental Health amp IAPT services

Aspiration to lsquodo no harmrsquo applies to us as well as

people we work with

There are also some other observations at all levels

Whats Happening In My Trust

Culture Profiling

The attitudes feelings values and behaviour that

characterise and inform society as a whole or any

social group within it

The general customs and beliefs of a particular group

of people at a particular time

Culture is the way we do things around here it is the

current in the river the hidden determinant of

organisational direction the manifestation of values

Climate control not command and control

Whats Happening In IAPT Locally

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Disclaimer

Aims for our presentation

How Did I get Here

Fantastic achievement at the forefront of shaping future

MH services

IAPT high volume high turnover

Growing body of evidence highlighting concerns about

staff in the NHS amp Mental Health amp IAPT services

Aspiration to lsquodo no harmrsquo applies to us as well as

people we work with

There are also some other observations at all levels

Whats Happening In My Trust

Culture Profiling

The attitudes feelings values and behaviour that

characterise and inform society as a whole or any

social group within it

The general customs and beliefs of a particular group

of people at a particular time

Culture is the way we do things around here it is the

current in the river the hidden determinant of

organisational direction the manifestation of values

Climate control not command and control

Whats Happening In IAPT Locally

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Aims for our presentation

How Did I get Here

Fantastic achievement at the forefront of shaping future

MH services

IAPT high volume high turnover

Growing body of evidence highlighting concerns about

staff in the NHS amp Mental Health amp IAPT services

Aspiration to lsquodo no harmrsquo applies to us as well as

people we work with

There are also some other observations at all levels

Whats Happening In My Trust

Culture Profiling

The attitudes feelings values and behaviour that

characterise and inform society as a whole or any

social group within it

The general customs and beliefs of a particular group

of people at a particular time

Culture is the way we do things around here it is the

current in the river the hidden determinant of

organisational direction the manifestation of values

Climate control not command and control

Whats Happening In IAPT Locally

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

How Did I get Here

Fantastic achievement at the forefront of shaping future

MH services

IAPT high volume high turnover

Growing body of evidence highlighting concerns about

staff in the NHS amp Mental Health amp IAPT services

Aspiration to lsquodo no harmrsquo applies to us as well as

people we work with

There are also some other observations at all levels

Whats Happening In My Trust

Culture Profiling

The attitudes feelings values and behaviour that

characterise and inform society as a whole or any

social group within it

The general customs and beliefs of a particular group

of people at a particular time

Culture is the way we do things around here it is the

current in the river the hidden determinant of

organisational direction the manifestation of values

Climate control not command and control

Whats Happening In IAPT Locally

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Whats Happening In My Trust

Culture Profiling

The attitudes feelings values and behaviour that

characterise and inform society as a whole or any

social group within it

The general customs and beliefs of a particular group

of people at a particular time

Culture is the way we do things around here it is the

current in the river the hidden determinant of

organisational direction the manifestation of values

Climate control not command and control

Whats Happening In IAPT Locally

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Culture Profiling

The attitudes feelings values and behaviour that

characterise and inform society as a whole or any

social group within it

The general customs and beliefs of a particular group

of people at a particular time

Culture is the way we do things around here it is the

current in the river the hidden determinant of

organisational direction the manifestation of values

Climate control not command and control

Whats Happening In IAPT Locally

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Whats Happening In IAPT Locally

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Buthellip

Nationally IAPT is an example of how setting targets

has improved patientsrsquo access to psychological

therapy

Targets could be blamed for distorting clinical priorities

(Kingrsquos Fund)

Mid-Staffordshire is an example of what happens when

the target is hit but the point is missed (Frances

Report)

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Spinning Plates

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Action Plans

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

ldquoPeople need a period of stability otherwise they may

actively resist beneficial changerdquo

raquo G Kinman Jan 2018

Potential conflict when we work within an organisation

which has at itrsquos core the principle of continuous

improvement if this becomes perceived as continual

change

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Living In The Moment

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

We know what to do but hellip

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

So it was about climate (cultural) change

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Professor Michael West

Senior Fellow NHS Leadership Academy

httpsyoutube0RXthT32vcY

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Dr Paul Gilbert emotional regulation systems

Drive SystemTo motivate us

towards resources

Feelings wanting

pursuing achieving

Soothing SystemTo manage distress and promote

connecting

Feelings content safe connected

trust

Threat SystemTo detect and protect

against threats

Feelings anxiety anger

disgust

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

How might the balance of the systems look

DRIVE

SOOTHING

THREAT

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Blocks to compassion

Drive and

Achievement Soothing and

Connection

Threat and

Protection

Audience Participation

Question OneIn what ways can

work contribute to our

or staffrsquos ill health

How do we currently

acknowledge our

own and staffrsquos

compassionate

behaviour at work

Question Two Paying attention and being

present

Understanding the causes

of distress

Empathic response

Helping taking intelligent

action

How do we currently model

the components of

compassionate leadership

What are the barriers (internal

and external)

Question

Three

Clear vision and purpose (the

narrative)

Agree objectives and goals that

are clear aligned and not

overwhelming for staff

Ensure enlightened people

management Positive

authentic supportive interactions

with staff Appreciative of staff

contributions

An environment of continual

learning improvement and

innovation

Effective (inter) team working

How could we support each

other to lead more

compassionately

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Provider Presentation Bradford IAPT

Sharon Edwards and Simon White Bradford

IAPT

MyWellbeing College

Overview

bull Large diverse demographic

bull Standalone psychological therapy service

bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)

bull Mental Health Clustering Tool ndash 1-4

bull Stepped care model

Stepped Care Model

Common mental health disorders

bull Depression

bull Recurrent depression

bull Generalised anxiety disorder

bull Panic disorder (with or without Agoraphobia)

bull Health anxiety

bull Social anxiety

bull Obsessive-compulsive disorder

bull Post-traumatic stress disorder

bull Specific phobia

bull Binge eating and bulimia (mild)

Assessment (Enrolment Team)

bull MyWellbeing Check

bull Peer Support Workers

In progress

bull New app design for the Wellbeing Check

bull Step 2 automatic online enrol

Treatment interventions

bull Step 2

bull Guided self- help ndash Low intensity

bull Course

bull Individual face to face or telephone based

bull Online

bull 6 treatment (review) sessions

bull Wellbeing promotion

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Question OneIn what ways can

work contribute to our

or staffrsquos ill health

How do we currently

acknowledge our

own and staffrsquos

compassionate

behaviour at work

Question Two Paying attention and being

present

Understanding the causes

of distress

Empathic response

Helping taking intelligent

action

How do we currently model

the components of

compassionate leadership

What are the barriers (internal

and external)

Question

Three

Clear vision and purpose (the

narrative)

Agree objectives and goals that

are clear aligned and not

overwhelming for staff

Ensure enlightened people

management Positive

authentic supportive interactions

with staff Appreciative of staff

contributions

An environment of continual

learning improvement and

innovation

Effective (inter) team working

How could we support each

other to lead more

compassionately

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Provider Presentation Bradford IAPT

Sharon Edwards and Simon White Bradford

IAPT

MyWellbeing College

Overview

bull Large diverse demographic

bull Standalone psychological therapy service

bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)

bull Mental Health Clustering Tool ndash 1-4

bull Stepped care model

Stepped Care Model

Common mental health disorders

bull Depression

bull Recurrent depression

bull Generalised anxiety disorder

bull Panic disorder (with or without Agoraphobia)

bull Health anxiety

bull Social anxiety

bull Obsessive-compulsive disorder

bull Post-traumatic stress disorder

bull Specific phobia

bull Binge eating and bulimia (mild)

Assessment (Enrolment Team)

bull MyWellbeing Check

bull Peer Support Workers

In progress

bull New app design for the Wellbeing Check

bull Step 2 automatic online enrol

Treatment interventions

bull Step 2

bull Guided self- help ndash Low intensity

bull Course

bull Individual face to face or telephone based

bull Online

bull 6 treatment (review) sessions

bull Wellbeing promotion

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Question Two Paying attention and being

present

Understanding the causes

of distress

Empathic response

Helping taking intelligent

action

How do we currently model

the components of

compassionate leadership

What are the barriers (internal

and external)

Question

Three

Clear vision and purpose (the

narrative)

Agree objectives and goals that

are clear aligned and not

overwhelming for staff

Ensure enlightened people

management Positive

authentic supportive interactions

with staff Appreciative of staff

contributions

An environment of continual

learning improvement and

innovation

Effective (inter) team working

How could we support each

other to lead more

compassionately

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Provider Presentation Bradford IAPT

Sharon Edwards and Simon White Bradford

IAPT

MyWellbeing College

Overview

bull Large diverse demographic

bull Standalone psychological therapy service

bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)

bull Mental Health Clustering Tool ndash 1-4

bull Stepped care model

Stepped Care Model

Common mental health disorders

bull Depression

bull Recurrent depression

bull Generalised anxiety disorder

bull Panic disorder (with or without Agoraphobia)

bull Health anxiety

bull Social anxiety

bull Obsessive-compulsive disorder

bull Post-traumatic stress disorder

bull Specific phobia

bull Binge eating and bulimia (mild)

Assessment (Enrolment Team)

bull MyWellbeing Check

bull Peer Support Workers

In progress

bull New app design for the Wellbeing Check

bull Step 2 automatic online enrol

Treatment interventions

bull Step 2

bull Guided self- help ndash Low intensity

bull Course

bull Individual face to face or telephone based

bull Online

bull 6 treatment (review) sessions

bull Wellbeing promotion

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Question

Three

Clear vision and purpose (the

narrative)

Agree objectives and goals that

are clear aligned and not

overwhelming for staff

Ensure enlightened people

management Positive

authentic supportive interactions

with staff Appreciative of staff

contributions

An environment of continual

learning improvement and

innovation

Effective (inter) team working

How could we support each

other to lead more

compassionately

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Provider Presentation Bradford IAPT

Sharon Edwards and Simon White Bradford

IAPT

MyWellbeing College

Overview

bull Large diverse demographic

bull Standalone psychological therapy service

bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)

bull Mental Health Clustering Tool ndash 1-4

bull Stepped care model

Stepped Care Model

Common mental health disorders

bull Depression

bull Recurrent depression

bull Generalised anxiety disorder

bull Panic disorder (with or without Agoraphobia)

bull Health anxiety

bull Social anxiety

bull Obsessive-compulsive disorder

bull Post-traumatic stress disorder

bull Specific phobia

bull Binge eating and bulimia (mild)

Assessment (Enrolment Team)

bull MyWellbeing Check

bull Peer Support Workers

In progress

bull New app design for the Wellbeing Check

bull Step 2 automatic online enrol

Treatment interventions

bull Step 2

bull Guided self- help ndash Low intensity

bull Course

bull Individual face to face or telephone based

bull Online

bull 6 treatment (review) sessions

bull Wellbeing promotion

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Provider Presentation Bradford IAPT

Sharon Edwards and Simon White Bradford

IAPT

MyWellbeing College

Overview

bull Large diverse demographic

bull Standalone psychological therapy service

bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)

bull Mental Health Clustering Tool ndash 1-4

bull Stepped care model

Stepped Care Model

Common mental health disorders

bull Depression

bull Recurrent depression

bull Generalised anxiety disorder

bull Panic disorder (with or without Agoraphobia)

bull Health anxiety

bull Social anxiety

bull Obsessive-compulsive disorder

bull Post-traumatic stress disorder

bull Specific phobia

bull Binge eating and bulimia (mild)

Assessment (Enrolment Team)

bull MyWellbeing Check

bull Peer Support Workers

In progress

bull New app design for the Wellbeing Check

bull Step 2 automatic online enrol

Treatment interventions

bull Step 2

bull Guided self- help ndash Low intensity

bull Course

bull Individual face to face or telephone based

bull Online

bull 6 treatment (review) sessions

bull Wellbeing promotion

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Provider Presentation Bradford IAPT

Sharon Edwards and Simon White Bradford

IAPT

MyWellbeing College

Overview

bull Large diverse demographic

bull Standalone psychological therapy service

bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)

bull Mental Health Clustering Tool ndash 1-4

bull Stepped care model

Stepped Care Model

Common mental health disorders

bull Depression

bull Recurrent depression

bull Generalised anxiety disorder

bull Panic disorder (with or without Agoraphobia)

bull Health anxiety

bull Social anxiety

bull Obsessive-compulsive disorder

bull Post-traumatic stress disorder

bull Specific phobia

bull Binge eating and bulimia (mild)

Assessment (Enrolment Team)

bull MyWellbeing Check

bull Peer Support Workers

In progress

bull New app design for the Wellbeing Check

bull Step 2 automatic online enrol

Treatment interventions

bull Step 2

bull Guided self- help ndash Low intensity

bull Course

bull Individual face to face or telephone based

bull Online

bull 6 treatment (review) sessions

bull Wellbeing promotion

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

MyWellbeing College

Overview

bull Large diverse demographic

bull Standalone psychological therapy service

bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)

bull Mental Health Clustering Tool ndash 1-4

bull Stepped care model

Stepped Care Model

Common mental health disorders

bull Depression

bull Recurrent depression

bull Generalised anxiety disorder

bull Panic disorder (with or without Agoraphobia)

bull Health anxiety

bull Social anxiety

bull Obsessive-compulsive disorder

bull Post-traumatic stress disorder

bull Specific phobia

bull Binge eating and bulimia (mild)

Assessment (Enrolment Team)

bull MyWellbeing Check

bull Peer Support Workers

In progress

bull New app design for the Wellbeing Check

bull Step 2 automatic online enrol

Treatment interventions

bull Step 2

bull Guided self- help ndash Low intensity

bull Course

bull Individual face to face or telephone based

bull Online

bull 6 treatment (review) sessions

bull Wellbeing promotion

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Overview

bull Large diverse demographic

bull Standalone psychological therapy service

bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)

bull Mental Health Clustering Tool ndash 1-4

bull Stepped care model

Stepped Care Model

Common mental health disorders

bull Depression

bull Recurrent depression

bull Generalised anxiety disorder

bull Panic disorder (with or without Agoraphobia)

bull Health anxiety

bull Social anxiety

bull Obsessive-compulsive disorder

bull Post-traumatic stress disorder

bull Specific phobia

bull Binge eating and bulimia (mild)

Assessment (Enrolment Team)

bull MyWellbeing Check

bull Peer Support Workers

In progress

bull New app design for the Wellbeing Check

bull Step 2 automatic online enrol

Treatment interventions

bull Step 2

bull Guided self- help ndash Low intensity

bull Course

bull Individual face to face or telephone based

bull Online

bull 6 treatment (review) sessions

bull Wellbeing promotion

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Stepped Care Model

Common mental health disorders

bull Depression

bull Recurrent depression

bull Generalised anxiety disorder

bull Panic disorder (with or without Agoraphobia)

bull Health anxiety

bull Social anxiety

bull Obsessive-compulsive disorder

bull Post-traumatic stress disorder

bull Specific phobia

bull Binge eating and bulimia (mild)

Assessment (Enrolment Team)

bull MyWellbeing Check

bull Peer Support Workers

In progress

bull New app design for the Wellbeing Check

bull Step 2 automatic online enrol

Treatment interventions

bull Step 2

bull Guided self- help ndash Low intensity

bull Course

bull Individual face to face or telephone based

bull Online

bull 6 treatment (review) sessions

bull Wellbeing promotion

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Common mental health disorders

bull Depression

bull Recurrent depression

bull Generalised anxiety disorder

bull Panic disorder (with or without Agoraphobia)

bull Health anxiety

bull Social anxiety

bull Obsessive-compulsive disorder

bull Post-traumatic stress disorder

bull Specific phobia

bull Binge eating and bulimia (mild)

Assessment (Enrolment Team)

bull MyWellbeing Check

bull Peer Support Workers

In progress

bull New app design for the Wellbeing Check

bull Step 2 automatic online enrol

Treatment interventions

bull Step 2

bull Guided self- help ndash Low intensity

bull Course

bull Individual face to face or telephone based

bull Online

bull 6 treatment (review) sessions

bull Wellbeing promotion

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Assessment (Enrolment Team)

bull MyWellbeing Check

bull Peer Support Workers

In progress

bull New app design for the Wellbeing Check

bull Step 2 automatic online enrol

Treatment interventions

bull Step 2

bull Guided self- help ndash Low intensity

bull Course

bull Individual face to face or telephone based

bull Online

bull 6 treatment (review) sessions

bull Wellbeing promotion

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Treatment interventions

bull Step 2

bull Guided self- help ndash Low intensity

bull Course

bull Individual face to face or telephone based

bull Online

bull 6 treatment (review) sessions

bull Wellbeing promotion

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Recovery data using GSH workbooks

Month LI service recovery Recovery with use of a workbook

February 60 67

March 55 61

April 59 64

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Treatment interventionsbull Step 3

bull Personalised formulation driven therapy

bull Cognitive behavioural therapy

bull Eye movement desensitisationreprocessing therapy (EMDR)

bull Counselling for Depression

bull Interpersonal Psychotherapy

bull Disorder specific model informed therapy

bull Duration dependent on NICE recommendations

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Targets

bull Access rates

bull Commissioned to deliver 163 (with Cellar Trust telehealth)

bull Achieving 15 (Telehealth delayed implementation)

bull National target is 19 and 22 from 1st April ndash awaiting CCG

bull Waiting times

bull Above target for both 6 weeks and 18 week targets

bull Recovery

bull Improving within City CCG area (now above 40)

bull Business Intelligence team discovered error in reporting should show improvement from January published data

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Research projects

EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone

TTRR - Talking Therapies Research Resource

My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell

An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Service developments and projects

bull Telehealth service

bull Digital platform

Disorder specific workbooks

bull Robust supervision including reflective practice and recording of therapy sessions

bull Structured CPD approach linked to outcomes

bull Disorder specific (skills based) refresher training

Continuing Professional

Development

bull Self Management After Therapy

bull Care for Screen Positive Elders

SMArT

CASPER Trial

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Service developments and projects

bull Priority treatmentsBlue light pathway

bull Priority treatmentsMaternal

mental health

bull 45 minute sessions

bull Generate referrals via VCS organisations

Wellbeing promotion

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Long term conditions

Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions

bull Chronic Fatigue Syndrome (ME)

bull Diabetes

bull COPD Respiratory

This project will include a focus on increasing access joint working with other services LTC training for staff

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

bull Low access rates for South Asian Community

bull Poor recovery rate within City demographic

bull Stigma of mental health issues

bull Education around mental health

bull Recovery Rates

bull Increasing promotion of services within schools and community services that work directly with the South Asian population

bull Working less with interpreters and using staff language skills

bull Staff focus groups concentrating on delivering treatment in other languages

bull CPD linked directly with working cross-culturally

bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City

Challenges Work in progress

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

bull Multiple trauma

bull Negative view nationally of IAPT impact on staff wellbeing

bull Working with Trust Communications team to develop appropriate promotional materials

bull Holding assessment clinics within City GP practices

bull Long Term Conditions work

bull Using telephone interpreting service to organise appointments

bull Promoting services where singular trauma might be present

bull Stopped presenting team targets moved to individual performance management

bull Introduced wellbeing action plans for each staff member

Challenges Work progress

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for some lunch

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Clinical Skills ndash Psychoed Courses

Lottie Hutton Tyra Sutton Poppy Danahay and

James Walton North Yorkshire IAPT

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

North Yorkshire IAPT Service ndash

Psychoeducational Course

Improvement

Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton

-

Senior PWPs

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Main Themes

What have we been doing and what are we doing

now

Measuring changes in recovery from courses

Drop-out management

Direct observation of courses and key learning points

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

But firsthelliphellip Group Exercise

A little fun to create some new groups in order to

complete a group exercise

CHANGE CHAIRShelliphellip

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Change Chairs

Read out a statement

Change chairs with someone else in the room that also

gets up in response to the statement

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Change chairs ifhellip

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Change chairs ifhellip

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Change chairs ifhellip

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Change Chairs ifhellip

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Group Exercise

What courses do you run

How many sessions is it

What is the recovery rate for your course

How do you manage DNA Drop out

Have you considered best practice

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

What we were doinghellip

North Yorkshire IAPT service ndash 3 localities

2 Psychoeducational Courses

Stress Control ndash 6 sessions

Healthy Minds ndash 4 sessions

Mixture of daytime and evening sessions

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

What we foundhellip

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Implicationshellip

4 session Healthy Minds Course

60 recovery rate ndash good

Buthellip

6 session Stress Control Course

72 recovery rate

Offering 4 sessions only missing out on a further 12

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Other Considerationshellip

Recovery Rate different across localities

Local variations

Confidence in course and offering at assessment

Amendments to slides

Greeting Clients

Music No Music

Refreshments No Refreshments

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

What we didhellip

6 session Healthy Minds Course

Senior PWPrsquos developed course

Cascaded out to PWPrsquos ndash feedback

Roll out

Amendments

Observations

Standard delivery across localities

Best Practice Tool

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

What we foundhellip (after assessment)

Therapist confidence in course grew

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Recovery Rates

Treatment Type Number of patients

attended (in total)

Of which calculated

recovery rate

Course 979 5619

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Where we go from herehellip

Recovery rates ndash how to improve (we know we can

reach 72)

DNA Drop-Out management

Observations ndash development of a Best Practice Tool

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Drop-out Management -

Observations

Courses tend to have high levels of DNACNA

Courses tend to have good recovery rates overall

Patients who attend courses tend to be the most truly

ldquomild-moderaterdquo and therefore evidence would suggest

that these are most likely to recover

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

What does this mean

Are patients dropping out of treatment because they

are recovered

Or because itrsquos the wrong treatment for them and the

format of the course makes it difficult for this to be

identified

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

What did we do (1)

Improve provisional diagnosis from routine assessment

using a provisional diagnosis ldquoquick guiderdquo

This was visible to all PWPs at assessment

Identify correct presenting problem in order to inform

which treatment most appropriate

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

What did we do (2)

Develop an evidence-based decision making tool

Using statistics on diagnosis age severity of scores

specific to our service

To offer an ldquoevidence-basedrdquo choice rather than a

ldquomenu of choice

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Course Drop-Out Management (1)

Patients who do not attend 2 or more sessions of a

course without prior notice

Previously would have resulted in automatic discharge

in line with attendance policy with ldquoget in touchrdquo

deadline of 2 weeks

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Course Drop-Out Management (2)

Responsibility shared throughout team

Flagged by admin when entering MDS

Attempt to contact patient or send out a letter offering a

review appointment in 1 week

Review reasons for drop-out with patient and agree to

discharge move to next course (only once) or offer

alternative treatment

If they do not attend the review offer 1 week to get in

touch or discharge as normal ndash does not extend time

in service

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Statistics

Trialled initially on a Stress Control course with 64

patients

Responsibility for drop out management shared

between staff

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Without Drop-Out Management

21

16

1

4

11 11

0

5

10

15

20

25

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

With Drop-Out Management

26

5

1

5

16

11

0

5

10

15

20

25

30

Recovered ampDischarged

Not Recovered ampDischarged

Non-Caseness DNAd (No SessionsAttended) ampDischarged

Stepped (Next Courseor Reviewed and

Stepped)

Awaiting Follow-up

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Within Drop-Out Management

5

2

4

1

4

0

1

2

3

4

5

6

Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Conclusions

Drop-out management means that patients who would

have been discharged are able to be offered a

treatment that may be more appropriate for them rather

than being discharged re-referred etc

Drop-out management means we are able to capture

recovery from patients who drop out because theyrsquove

recovered

Patients were not staying in the service any longer than

before due to the 1 week deadlines (for managing

risk)

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Staff Feedback

Staff found that due to sharing it out as a team it did

not require a lot of extra work

Patients who were stepped elsewhere tended to be

ones who had not understood what the course

entailed was not what they expected or was not the

right treatment

Some patients had not felt comfortable to call up and

tell us it was the wrong treatment

One patient had attended felt too anxious to come in

and not come back

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Direct observations

Template Observation Proforma

Pre-course check list

Couse Opening

Application of Communication Skills

Professionalism

Use of Volunteers

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Direct Observations

3 offices - Harrogate with one venue

-Hambleton with 2 venues

- SWR with 3 venues

Stress Control and Healthy Minds run at all

locations

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Ensure appropriate temperature and lighting

Use safety behaviour chairs and ensure chairs are

spaced apart

Ensure screen size is good and projection clear

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Course Observations

Best Practice

Play music appropriate volume and Type

Service wide guidance re music type

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Greet participants individually with individual and

genuine interactions eg The journey nice to see you

again the weather

Where there are two facilitators andor volunteer one

individual to greet at the door one to move round the

room to give further opportunities for questions

Consider if booklets pens and MDS should be placed

on the chairs or given at the door

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Introduce self (and colleague volunteers) and role

Smile in a warm and genuine manner give good eye

contact to all participants

Thank participants for attending and reinforce the value

and attending each week

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Revisit all areas when appropriate slide is shown

Suggest that it is fine to visit the toilet during the

session or to stand up at the backtake time out if

needed

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Give a rationale for use of MDS

Encourage participants to speak to a facilitator if they score

1 or more on PHQ 9 Q9 or if they have any concerns re

safety

Normalise thoughts of suicide in Depression and encourage

help seeking behaviour

Have resources re MH helplineSamaritans number etc

Offer opportunity to review MDS scores with facilitators

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Instil hope using dose recovery slide

Encourage use of in-between session work and link to

recovery

Normalise impact of Depression on motivation and invite

participants to discuss with facilitators if concerned

Encourage participants to attend further sessions and

complete the intervention

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Listen well with attentive manner open body posture

and good eye contact

Summarise what the participant has asked

Provide a clear answer where you are able if you are

unsure advise the participant you will find out and get

back to them

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Allow appropriate pacing of speech for participants to

process new information

Ensure a break is always given

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Speak in a clear and audible manner ndash check with

participants that facilitator can be heard

Speak with a warm and genuine tone being respectful

and professional in manner

Use humour in a careful and appropriate manner

Add variation in tone and volume during presentation

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Stand and move appropriate during the presentation

Use warm friendly approach

Connect with all areas of the room ensuring good eye

contact

Use gestures to enhance points

Be attentive and towards fellow presenters smiling and

nodding in a genuine manner to reinforce points

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Take a warm and empathic stance

Engage with the whole room ensuring good eye

contact with all participants

Use inclusive and collaborative language (ldquoI can see

from some of your reactionshelliprdquo etc)

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Promote a sense of team work with smooth transitions

Ensure attentive NVC when other facilitator speaking

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Ensure a smooth ending summarising the content covered

and introducing the content of the next session

Thank participants for coming and encourage attendance at

next session

Promote in between session work and link to recovery

Provide opportunity for individual questions

Ensure that someone is at the door giving warm and

genuine individual farewells

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Wear NHS badge

Remain professional throughout the session

Demonstrate leadership throughout the session

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Collated Observations

Best Practice

Welcome volunteers warmly

and genuinely

Ensure that the volunteer

has a clear understanding of

their role allowing

opportunity for questions or

concerns to be raised by

volunteer if necessary

Thank volunteer for their

contribution

Monitor volunteerrsquos role

during the evening

Flag up any concerns re the

volunteer stepping outside

their role with your team

manager

Thank volunteer give helpful

feedback on their

contribution

Give opportunities for

volunteer to ask questions

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Additional Observations to consider

Ensure each slide is explained well providing

participants time to process the information

Consider use of appropriate self-disclosure metaphors

or stories to illustrate points

Pay attention to the therapeutic alliance utilising

opportunities to build good alliances with participants

Use open body posture and be available for

participants to approach facilitators for questions at the

break and at the end of the session

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Further suggestions by observers

Use a questions box and answers the questions the

following week

Have resources available on exercise alcohol etc on

a side table for participants to pick up

Peer feedback and skill development ndash possibly

develop a specific

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Suggestions for the course books

Rationale for courses and importance of the

intervention including data

Overview of both courses

Normalising of anxiety self soothing and presentation

techniques including the danger of over preparing

Application and communication

Ending

Role of volunteers

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

Q amp A time

Any questions

Any thoughts or reflections

Does this fit with what your service does

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

wwwenglandnhsuk

Yorkshire and the Humber Senior PWP Network

Time for a break

15 minutes only please

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Materialsstrategy for adjustments

made to treatengage diverse

patients - Discussion

Heather Stonebank All

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

wwwenglandnhsuk

Discussion

Points for discussion

bull What are the challenges

bull What are the solutions

bull What adaptations do you make

bull What self-help materials do you use

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms

wwwenglandnhsuk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending

Please remember to fill out

your evaluation forms