24 April 2018 Andy Wright, IAPT Advisor, Heather Stonebank, Lead - - PowerPoint PPT Presentation

www.england.nhs.uk

• Andy Wright, IAPT Advisor, Heather Stonebank, Lead PWP Advisor and Sarah Boul,

Quality Improvement Manager

• andywright1@nhs.net, heather.stonebank@shsc.nhs.uk and sarah.boul@nhs.net
• Twitter: @YHSCN_MHDN #yhmentalhealth
• April 2018

Yorkshire and the Humber Mental Health Network

Senior PWP Network 24 April 2018

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@YHSCN_MHDN #yhmentalhealth

Housekeeping:

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Yorkshire and the Humber Senior PWP Network

Welcome, Introductions and Apologies

Andy Wright, IAPT Advisor, Yorkshire and the Humber Clinical Network

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Yorkshire and the Humber Senior PWP Network

Raising Self-Awareness and Wellbeing

All

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Raising Self-Awareness and Wellbeing

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Happiness

Life Approach Since January 2018 plot your emotional highs and lows – things, situations, people that had an impact. What was the situation? How did you feel at the time?

Raising Self-Awareness and Wellbeing

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• With the person next to you talk through your life

line.

• What did you learn from those experiences?
• Were there any patterns or themes?
• How are you going to take that learning positively

into the future?

Raising Self-Awareness and Wellbeing

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Choose your future! Challenges and difficulties will happen. It is about how you respond/react

Raising Self-Awareness and Wellbeing

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Yorkshire and the Humber

Senior PWP Network

Time for a break?

15 minutes only please!

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Yorkshire and the Humber Senior PWP Network

Provider Presentation:

York and Selby Improving Access to Psychological Therapies Service

Jasmine Turnbull and Lorraine Fourie, Senior PWPS, York and Selby IAPT

York and Selby IAPT Service

Jasmine Turnbull and Lorraine Fourie Senior PWPs

Who we are:

 Part of Tees, Esk and Wear Valleys NHS as of October 2015

We cover:

 York  Selby  Easingwold  Tadcaster  Pocklington Population upwards of 351,000 Commissioned by the Vale of York CCG

Vale of York

 Mainly rural aside from York city centre with small market towns  Generally affluent area  Small pockets of deprivation  Higher proportion of 20-24 year old due to the two universities  Higher percentage of the population than the national average is aged 50+

What happened in 2017

Lots of changes in the service:  Long waiting times for clients  Involvement of IST  Development of ‘Interim Pathway’ - combination of 1-1 sessions and psychoeducational course sessions for clients  Pathway in place for all modalities: PWP, CBT, Counselling New Pathway then developed:  Wellbeing Course first intervention to be offered for all clients aside from exceptions:

 PTSD, social anxiety, under 18’s, communication difficulties

Development of the Wellbeing Course in 2017

Lots of changes in the service  Previously 3 groups

 Stress Control (Jim White)  Improve your mood (BA group)  GAD (Dugas model) interactive group 2hrs in length

 All 6 weeks and lecture style format with some group involvement  Evaluated groups and decided to continue due to recovery and attendance rates  Problems: Staff sickness, annual leave and shortness of staff

Wellbeing Course 2017

 Rolling course - clients could start at any point  8 weeks in duration (Minimum of 6 to be attended)  Made it difficult to monitor attendance  Large course numbers (70)  Low rate of response for reviews  Clinicians felt improvements could be made & the course condensed – concerns about accessibility of an 8 week course for clients  No data due to incorrect tracking and PARIS input

Rapid Process Improvement Workshop (RPIW) November 2017

 Aims to improve the process of clients accessing the service  Focus on the Wellbeing Course as the main point of entry for most  Courses had a start and end date for monitoring purposes – although no gaps in delivery for 2 week target  Evening course provided to improve access  Course workbook developed  Feedback forms improved for effective monitoring  Risk management protocol discussed in detail  Clients at higher risk of suicide or self harm now an exception for the course

Wellbeing course 2018

 6 week course 3 groups run simultaneously (One evening and two day - 2 week’s apart) 1 hour sessions

 Introduction to CBT and Goal setting  Understanding Anxiety and Lifestyle Factors  How our Behaviours Affect our Wellbeing  Thought Challenging and Worry Management  Relaxation and Sleep  Maintaining Progress and Review

 Clients offered a review of therapy after session 6

Data from group

 Day groups

 Average 48 people on register before start and 38 attending  31.5% recovery rate  59% reliable improvement

 Evening groups

 65 people on the register before start and 44 people attending  38% recovery rate  62% reliable improvement

Data from group

 Similarities of groups

 20-25% drop out/cancelled before sessions started  70-75% completion rate  25-28% drop out rate during the group  25-30% of people accepted reviews after course  Of those people 20-30% were stepped up for further treatment  77% of attendees scored Moderate – Severe for GAD 7 at start of group  51% of attendees scored Moderate – Severe for PHQ 9 at start of group

Data from group

 Positives:

 Drop out rate low  Feedback from clients consistent with Data for attendance rates  Completed treatment rate high and people being stepped up is low  Positive changes can be made from data

 Negatives:

 Inconsistent data capture  Reason for discharge  Lack of admin support  Missing data values  No current theme or significant correlation between groups

Feedback from service users

 It conceptualised my situation, put it into words and made me feel less alone/isolated  Really grateful for this course and being able to get on it so quickly when I was in a very dark place  The course has been really well presented and I’ve looked forward to attending. All of the presenters are very knowledgeable and empathetic  Still think it’s such a shame that our ideas are not shared in the session. I feel talking and sharing is so important in mental health but I understand that some people would be uncomfortable to share! Loved today’s session though, very

• useful. I will definitely be challenging my thoughts from now on!

 Informative but overwhelming

SWOT Analysis

Strengths

Reasonably quick access for clients Evening course for those who work full time Amazing team New senior management Retaining staff Trainee placements New groups (Step 2 and 3) Treatment choices Same building as other services

Weaknesses

Recruitment – difficult location and university doesn’t

• ffer training in York

PARIS Backlog pathway and transition to new pathway

Opportunities

New pathways (LTC, perinatal, students) Development of groups Self-referral platform Website

Threats

Newly qualified staff team Access rates Agency staff (remote working and training needs)

Thank you for listening! Any Questions?

 http://www.valeofyorkccg.nhs.uk/about-us/about-the-ccg/  http://www.valeofyorkccg.nhs.uk/about-us/about-the-vale-of-york/

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Yorkshire and the Humber

Senior PWP Network

Time for some lunch?

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Yorkshire and the Humber Senior PWP Network

IAPT LTC Service Presentation

Liz Ruth, Senior PWP, Sheffield IAPT

Sheffield’s Integrated IAPT Team

Sheffield – a diverse city

• pop: 575,400 (2016)
• 19% BME communities – Caribbean,

Indian, Bangladeshi, Somali, Yemeni, Eritrean and Chinese

• ‘City of sanctuary’
• Student population
• Variation in depravation
• NHS in Sheffield

IAPT in Sheffield

• Established in 2008
• Working in GP practices and community

venues

• Across 4 sector teams
• Achieves 18% access target – rising to 23%

in 2018

• Front line interventions
• Improving Wellbeing Sessions
• Stress Control
• cCBT (Silvercloud)

Five Year Forward View for Mental Health

IAPT Expansion

National Top-up training curriculum underway for PWPs and CBT – for LTC/MUS

Top-up training

By 2020/21 1.5 million people entering treatment in IAPT

1.5 million people

2/3rds of this expansion – integrating physical and mental health: development of Integrated IAPT

Integration

Maintaining integrity to the key characteristics of IAPT and implementing national guidance

Evidence-base

Early Implementer Wave 2 Site

Sheffield IAPT-LTC

NHSE investment & CCG commitment to recurrent funding

Building on Pathfinder with additional investment

Ambitious and transformati

• nal bid to

create systemic change

Ambitious bid

Establishment of a Health and Wellbeing Service: integrating with primary care health and medical psychology

Establish new service

Whole pathway approach to LTC/MUS from Step1-Step 4:

Pathway approach

Context

• LTC spending accounts for ~ 70% total NHS

budget1

• At least 30% of people with a LTC also have a

co-morbid MH problem2

• Comorbid MH problems interact with and

exacerbate physical health problems - raising health care costs by at least 45%3

1. DoH, 2010, in Centre for MH Report 2. Cimpean and Drake, 2011, cited in IAPT Building the Business Case 3. Naylor et al, Kings Fund, 2012

The reality … is that we are seeing more and more people with two or more long term conditions at a time… I suggest it is this expansion of multi morbidity, both in terms of

• verall numbers and at earlier ages, that is not
• nly impacting on healthy life expectancy but

is also the key factor in driving the increase in the demand for health and social care services. Director of Public Health Report for Sheffield 2017

Sheffield

• Almost 40% population have at

least one LTC

• 94,110 people have 2 or more LTCs
• Multi-morbidity – increasing and

key factor driving increased health and social care demand

• 18% least deprived people in

Sheffield have developed a LTC by their 50s cf 40% most deprived Director of Public Health Report, 2017

Sheffield’s Integrated IAPT Team

• Clinical lead
• Operations manager
• Lead CBT and Lead Clinical Psychologist
• 3 Psychologists working at Step 4 – pathway leads
• 2 psychologists and 11 CBT therapists at Step 3
• 3f/t Senior PWP (4 staff)
• 9 PWP
• Evaluation lead

Key Principles

Mental health promotion Increase identification of anxiety and depression in physical health settings enhanced by joint training Integration greater parity of esteem- part of the multidisciplinary teams within and across the pathways Partnership working work with CCG, primary care and ‘neighbourhoods’ to understand local populations/ key priorities. Developing further partnerships with STH, specialist services & third sector Close to home Deliver psychological therapy at ‘Neighbourhood’ level Whole pathway approach Integrate Step 1 to 4 psychological interventions within condition specific pathways

Health and Wellbeing Service

Step 1

Joint Training Screening/ Identification Psycho- education/ Self-Help

Information Leaflets

Health and Wellbeing Online booking/ patient portal in development Self-Help and Training Resources Adapted Stress Control A range of ‘living well with’ groups for LTC/PPS Silvercloud: LTC cCBT Condition- specific Guided Self- Help Condition- specific Group Interventions (Co-delivery) Condition- specific CBT 1:1 Condition- specific CBT Groups eg CBT for Health Anxiety Transdiagnostic Group Interventions eg MBSR pilot, MBCT, ACT Psychological Assessment, Formulation, Intervention Consultation, Case Review Care Planning MDT assessment & intervention

Step 2 ‘First Line’ Step 2 PWP Step 3 CBT Step 4 Psychology Specialist MDTs

Stepped Interventions for LTC/MUS

10 Condition Pathways

1 Pain/MSK 2 COPD 3 CHD (including non cardiac chest pain) 4 IBS 5 CSF/ME 6 Generic Long Term Conditions (including dermatology) 7 Health anxiety 8 Diabetes (Type 1 and 2) 9 Generic MUS/PPS Cancer (following successful treatment) 10

The PWP role

The Bio-Psycho-Social Model

Biological factors (disease & other bodily changes) Social factors (family, relationships, support) Psychological factors (thoughts feelings & behaviours) The experience

• f illness

Living well after cancer treatment – psycho education course

To book a place: Website: www.iaptsheffield.shsc.nhs.uk Telephone: 0114 271 6568

Case study

• GR – female, 34 years old
• 10 year history of depression
• 1 year history back pain – herniated disk
• Managed with medication and awaiting surgery
• Unable to work 9 months
• Living well with back pain course (co-facilitated

with physioworks)

• 3x PWP appointments – sleep
• PHQ-9: 19-9 GAD-7: 10-7

Brief Pain inventory: 21/59 -12/29

Outcome Measurement

• Mental health outcomes: session by session outcome measures will be completed as usual
• Perception of physical health: it is important to measure service users’ perceptions of their LTC as the

therapy progresses in order to ensure that treatment focuses on the whole person

• Healthcare utilisation: it is expected that the treatment of mental health problems will reduce a person’s

use of other health service resources. Documenting this effect will be important for sustaining IAPT- LTC

• services. The Client Service Receipt Inventory (CSRI) will help to document reduction in health care
• costs. In the longer term, this self-report measure will be complemented by linking the national IAPT

database with other National NHS datasets

• Patient-reported experience measures (PREM): will measure the quality of a person’s experience of

the service.

Integrated IAPT - Ambitious programme

Contributions to:

• Ensuring parity of esteem between MN

and PH by 2020; increased access to talking treatments (FYFW)

• Effective management of long term

conditions and personalised care (FYFW)

• Challenging organisational and

conceptual division between mental and physical health, as a barrier to improvement in health care (Annual Report of CMO, 2013; Kings Fund)

• Educating and training physical health

practitioners in mental health (Closing the Gap, 2013)

Outcomes so far

• Small numbers so far
• Outcomes from ‘Living Well with…’ are

Comparable with Stress Control

• Ongoing evaluation

Qualitative feedback

• ‘Yes the cancer’s gone, but I’m not alright...[this course]

makes it more normal to be feeling like this.’

• ‘The emotional side of your treatment plan is as important

as radiotherapy and surgery, this course is fantastic’.

• ‘What you’ve described [about the impact of Living after

cancer treatment] is true…this is what it’s like.

• ‘I’m learning more about myself and what I can do’
• ‘You explain it [how I feel] in a way that I can relate to…so

that I can understand and work through it.’

• ‘If I wasn’t here I would be sat wallowing at home. I’ll be sad

when it ends…talking and listening to other people helps.’

• ‘I start to understand what the problems are and some

strategies

The future: opportunities and challenges

• Access targets
• Data collection
• BME access
• Small PWP rescource
• Integration with physical health teams
• Patient awareness

Thank you for your time Any questions?

Kerry.montgomery@shsc.nhs.uk Ian.mitchell@shsc.nhs.uk Sian.wray@shsc.nhs.uk Elizabeth.ruth@shsc.nhs.uk

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Yorkshire and the Humber

Senior PWP Network

Time for a break?

15 minutes only please!

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Yorkshire and the Humber Senior PWP Network

Promoting Resilience and Self-Reflection

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Aim of the Session To understand more about resilience and look at how to use different strategies to be resilient and self-reflective in the Senior PWP role.

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What is resilience?

Resilience is the ability to bounce back from difficult situations and to see problems as opportunities for learning and growth.

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What is self-reflection?

Self reflection is like looking into a mirror and describing what you see. It is a way of assessing yourself and your ways of working.

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Why is resilience and self-reflection important in the Senior PWP role?

Resilience helps us to be:

• Happier
• Healthier
• Adaptable
• Able to achieve what we want to achieve

Self reflection is an is an important part of learning. Spending time thinking about your own skills can help you identify changes you might need to make.

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Resilience and Self-Reflection Discussion: Consider the following questions, in the context of your role as a Senior PWP, and capture your thoughts on the template provided on the table:

• 1. On a scale of 1-10 (1 low; 10 high), how resilient

are you?

• 2. In what situation do you find it most difficult to be

resilient?

• 3. How could you become more resilient?

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Courage does not always roar. Sometimes courage is the quiet voice at the end of the day saying, “I will try again tomorrow”.

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Yorkshire and the Humber Senior PWP Network

Feedback from the IAPT Providers’ Network

Heather Stonebank, Lead PWP Advisor, Yorkshire and the Humber Clinical Networks

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Questions for discussion

• Are you getting the most out of your SPWP’s for

example they are really interested in the data

• How are you encouraging the integration of learning

from the SPWP network in your service?

• How can we develop SPWPs leadership potential?
• What key messages does the provider forum want to

send to the SPWP network?

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Are you getting the most out of your SPWP’s for example they are really interested in the data

• Acknowledgement that it is important to share

recovery rate data with Senior PWPs and PWPs

• Data needs to be shared with Senior PWPs and

PWPs in the form of key messages

• The narrative of data needs to be shared with PWPs

to demonstrate and help understanding of the links to the wider picture and service change

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How are you encouraging the integration of learning from the SPWP network in your service?

• Clinical leads and managers really value the network and your

attendance and feedback

• Services need to implement a feedback process/meeting to and

from the Senior PWPs

• Feedback key messages to PWPs
• Service managers and clinical leads need to invest in the

Network, encourage people to attend and then ensure the learning is spread through the service

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Key message

• Service managers and clinical leads value your

attendance and keen to integrate learning from the network into service What next… Five W’s and How

• who, what, why, when, where and how

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How can we develop SPWPs leadership potential?

• How can people access leadership training courses?
• Ensure career path is clear and create room for ambition
• Enabling SPWPs to build on experience e.g. project

management

• Mentoring in place for those taking the step up from PWP
• Create opportunities for Senior PWPs to be involved in

recruitment

• Recognition the PWP role should be recognised as a core

profession

• Invite and include in senior forum meetings

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Key message

• Service managers and clinical lead keen to support

leadership and development in the role What next…

• Reflection, what are you already doing, what are the
• pportunities
• PDR/LDR - future leadership development
• pportunities

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What key messages does the provider forum want to send to the SPWP network?

• Senior PWPs are doing a great job
• It’s can be a challenging role, you work really hard and we really

appreciate you

• Recognition of the importance of the Senior PWP role as a role

model for others and brilliant support for PWPs

• Seniors should be part of the decision making process
• Senior PWPs to work closely with data analysts
• We want the network to continue and grow
• We will continue to support/encourage Senior PWPs to attend.
• Senior PWPs are important in developing quality of step 2
• How do we retain Senior PWPs? What do you need in terms of

development?

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Reflection

Feedback

• How do you feedback learning from the network?
• Have you integrated any learning which has improved your

practice/service? Data

• Are you having conversations about data?
• What’s working well?

Leadership

• What are you already doing?
• What are the leadership development opportunities?
• What do you need in terms of development?

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Yorkshire and the Humber Senior PWP Network

Thank you for listening!

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Yorkshire and the Humber Senior PWP Network

Any Other Business Video Selfies Feedback from the National Team (BIT, Yammer & NHS Choices) CASPER Plus Training cCBT Update

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Yorkshire and the Humber Senior PWP Network

Promoting the PWP Role: Video Selfies!

Sarah Boul, Quality Improvement Manager, Yorkshire and the Humber Clinical Networks

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The National IAPT Programme have concluded that:

PWPs are an invaluable part of IAPT services and the mental health workforce.

The PWP Role: National Recognition

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Apparently not! As a relatively new role, we hear that healthcare professionals outside IAPT, and the general public, often don’t know what a PWP is or what wonderful work you do.

The PWP Role: But does everyone know what you do?

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That’s right – video selfies – 60-90 seconds long covering:

• Your name
• Role
• Where you work (you could give us a little tour)
• The type of work you do and the patients you see
• What a typical day looks like
• An example of a piece of clinical work you’ve done or a

group you’ve run (whilst maintaining patient confidentiality)

• How you work with GPs and other healthcare

professionals.

The PWP Role: How can we raise awareness?

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And there’s more! The national team would also like – video selfies – 60-90 seconds long covering:

• PWPs who are working in specialist areas or

leading innovative projects. For example, this might include PWPs working in LTC teams, with BAME communities, in prisons, in management roles or with older adults.

The PWP Role: How can we raise awareness?

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These videos will showcase the breadth of PWP roles and skills to:

• Commissioners,
• Service leads and
• Other PWPs to encourage their career

development.

The PWP Role: But why video selfies?

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• You read the: “Quick guide to filming with a

camera phone or small camera”;

• You complete a consent form, which will enable us

to use your PWP video-selfie for NHS England communication purposes;

• You get filming for 60-90 seconds;
• You email your completed video selfie to

kevin.smith6@nhs.net via wetransfer.com;

And then you will be…

The PWP Role: So how do I make a video selfie?

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• NHS England is collaborating with Behavioural Insights Team (BIT)

and the Equality and Human Rights Commission (EHRC) to examine how behavioural insights could be used to increase access IAPT services for underrepresented groups.

• The project will explore inequalities in access to IAPT, particularly by

age, gender and race.

• BIT will conduct a review of the behavioural literature, undertake

qualitative research for 2 identified population groups, and use the findings to consider how best to increase IAPT usage in the identified groups. A final report will summarise the findings, providing suggestions for behaviourally-informed interventions and how these could be evaluated. We hope that, if feasible, this project will lead to a rigorous trial of one or more of our suggested behavioural interventions to test their effectiveness.

• BIT and the EHRC have agreed the project will focus on BAME

groups and older adults.

• BIT are currently in the explore phase and would like to interview

staff working in IAPT and service users from the two focus groups. If you want to be involved in this project please email: victoria.fussey@bi.team

Feedback from the National Team - BIT

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• We have been experiencing some technical difficulties on Yammer

due to the move from the nhs.net server. Some members with an @nhs.net email address were no longer able to access Yammer. This has included members of the IAPT national team and the only solution for this problem is to be re-approved using an email address

• ther than x@nhs.net. If you have experienced this problem please

let us know by contacting england.mentalheath@nhs.net.

• In order to re-access Yammer, you will need to be added with an

alternate email address to an @nhs.net account. For NHS England colleagues the @england.nhs.uk can be used, or for provider colleagues an @[trust].nhs.uk email address will suffice. Please email england.mentalhealth@nhs.net with the new email address to receive a new invite to join the IAPT Yammer network.

• So in short, the IAPT Yammer network is still in use. We apologise

for any inconvenience and we hope for the issue to be resolved soon.

Feedback from the National Team - Yammer

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• The National IAPT Programme are working with Ros Hewitt

who is the product manager for the mental health project focussing on improving IAPT self-referral on NHS Choices / NHS.UK.

• The work is currently underway and is set to run for 8 weeks

during which there will be redesign work, updating content and a “beta” testing of the web pages.

• Ros is looking for a few providers (clinical leads, clinicians,

data leads or admin) who would be interested in reviewing and testing the pages.

• Would you like to be involved and is your service

information correct?

Feedback from the National Team – NHS Choices

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• 3x full day CASPER Plus training sessions held

across Yorkshire and the Humber – 90 PWPs/Senior PWPs trained in:

• Collaborative Care (CC)
• Behavioural activation (BA) - working with long

term health conditions & older adults

• Functional Equivalence
• Using Functional Equivalence to accommodate

long term conditions and role changes

• Staying well

Follow up work with the University of York is also being undertaken – watch this space!

CASPER Plus Training

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cCBT Workshop: Enhancing Treatment with Digital Technologies

• The Yorkshire and the Humber Clinical Network, in

conjunction with SilverCloud, is delighted to be hosting an event focussing on the use of cCBT within IAPT services.

• The event intends to enable attendees to develop their

understanding of digital technologies; hear first-hand how SilverCloud has been implemented in a local service, learn how to manage the cultural shift required for cCBT and learn how to utilise data to model an optimised service.

• The event will be held: Wednesday 16 May 2018,

09:30-15:30, Novotel, Leeds. (Currently fully booked)

cCBT Training Day 16.05.18

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Yorkshire and the Humber Senior PWP Network

Thank you for Attending! Please remember to fill out your evaluation forms!