IAPT Providers Network 2 May 2018 Andy Wright, IAPT Clinical - - PowerPoint PPT Presentation
Yorkshire and the Humber Mental Health Network IAPT Providers Network 2 May 2018 Andy Wright, IAPT Clinical Advisor and Sarah Boul, Quality Improvement Manager andywright1@nhs.net and sarah.boul@nhs.net Twitter: @YHSCN_MHDN
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Yorkshire and the Humber Mental Health Network
IAPT Providers Network 2 May 2018
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@YHSCN_MHDN #yhmentalhealth
Housekeeping:
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Yorkshire and the Humber IAPT Providers Network
Andy Wright, IAPT Advisor, Yorkshire and the Humber Clinical Networks
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Yorkshire and the Humber IAPT Providers Network
Minutes from Last Meeting (07.02.18) and Matters Arising
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Actions from Meeting 07.02.18
Owner
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Regarding CASPER Plus training places a small number of additional places are
All/Sarah Boul
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Sarah Boul to collate the Senior PWP table top discussion notes for distribution. Sarah Boul
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Sarah Boul to collate the IAPT Data table top discussion notes for distribution. Sarah Boul
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Sarah Boul to share a link to the planning guidance for 2018/19. Sarah Boul
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Clinical Network to consider developing a shared dialogue/narrative to support services in working with their commissioners to discuss a trajectory around what could be achieved with available funding. Andy Wright/Sarah Boul
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All Providers’ to review the Older Adults toolkit and send feedback to gthrippleton@nhs.net. All
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Georgie Thrippleton to include the CCG information in the quality premium spreadsheet by STP/ACS footprint. Georgie Thrippleton
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Sarah Boul to share the draft spreadsheet with the Network to ensure services know which CCGs are signed up. Sarah Boul
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Sarah Boul to ask services to submit their issues around clustering and submit this to the NHS England DCO team to raise with NHS Digital. All/Sarah Boul
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Any suggestions on subjects or issues that could be covered at the IAPT Providers’ Network to be emailed to sarah.boul@nhs.net All
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If anyone has strong views on a formalisation process of access to IAPT for IAPT staff please email sarah.boul@nhs.net. All
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Yorkshire and the Humber IAPT Providers Network
HEI Update
Steve Kellett, IAPT Programme Director, University of Sheffield
Stephen Kellett Consultant Clinical Psychologist and Psychotherapist, Sheffield H & SC NHS Trust IAPT Programme Director, University of Sheffield
Objectives for the talk
are training
planning for future LTC/MUS cohorts
key timelines for the 2018-19 cohorts and the next two years following
course content
BABCP
excellence in 2013-14
PWP and CBT work – research integrated into teaching
PWPs and HIT – 2 courses have been developed, two cohorts completed and an evaluation report delivered to the commissioner
plan
commissioning trainee places
trainees – target of 4,500 additions in Primary Care
2018/19 2019/20 2020/21 PWP 92 92 84 HIPI 90 90 79 Proposed figures for Yorkshire & Humber recruitment from the HEE commissioner. These include baseline (replacement) figures of 50 PWPs and 15 HIPIs. Sheffield will continue to cover this demand for training with an October and March cohort. With respect to the proposed numbers we have agreed to take maximum
support for secondments
way out (given it May already!)
us …
Flow chart and timeline for guiding the demand assessment and commissioning of IAPT programmes within the North of England
commissioner in terms of your proposed training places
11th May 2018 – this covers routine IAPT and also LTC/MUS plans
intensity assessment and treatment competencies
sessions from routine practice
Practice Portfolio
measures of the therapeutic alliance in the case studies within the Practice Portfolio
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Yorkshire and the Humber IAPT Providers Network
IAPT PRN Research Projects and Findings Update
Jaime Delgadillo, Clinical Psychology Unit University of Sheffield
Jaime Delgadillo, PhD
Clinical Psychology Unit University of Sheffield
Meta-analyses of trials show NNT = 2.6
(e.g. Cuijpers et al, 2013; Hofmann & Smits, 2008)
(http://www.content.digital.nhs.uk/catalogue/PUB23831)
(Lambert & Ogles, 2004)
How good are therapists at assessing their patients’ prognosis?
Hannan et al 2005, J Clin Psychol 61: 1-9
Finch et al 2001, Clin Psychol Psychother 8: 231-242
anxiety (GAD-7) symptoms
Kendrick et al, 2016, Cochrane Library: C0D11119
Design
using MLM, controlling for therapist effects
Total Sample: 2233 patients within 77 therapists
Strengths
Limitations
Conclusions
identify and to address obstacles to improvement
deterioration in cases that are prone to poor response to treatment
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Yorkshire and the Humber IAPT Providers Network
15 minutes only please!
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Yorkshire and the Humber IAPT Providers Network
Training IAPT Staff to Deliver Mindfulness Based Cognitive Therapy
Dr Paul Bernard, Consultant Psychiatrist, TEWV Trust Mindfulness Lead, Associate Oxford Mindfulness Centre
MBCT Teacher Training for IAPT Services 2018-2019
Yorkshire and the Humber IAPT Providers’ Network Dr Paul Bernard, Consultant Psychiatrist, Trust Mindfulness Lead, Associate Oxford Mindfulness Centre
– Development – Evidence
Aaron Beck
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John Teasdale, Zindel Segal & Mark Williams
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Marsha Linehan
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Jon Kabat-Zinn
50
Segal, Williams & Teasdale, 2002
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From MBSR
From cognitive science
depression
elements of programme
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Develop greater levels of meta-awareness and move towards observing thoughts as transient mental phenomena, rather than as facts or accurate descriptions of reality Bring a less judgemental and more compassionate attitude to the flow of thoughts, feelings and sensations that are experienced
Increasingly recognise habitual maladaptive cognitive processes, such as depressive rumination Become more skilled at disengaging from these unhelpful processes, for example by re- directing attention to present moment experience
– Practices – Discussion – CBT elements
Lancet, 2016 Effectiveness and Cost-effectiveness of Mindfulness-Based Cognitive Therapy compared with maintenance anti-depressant treatment in the prevention of depressive relapse.
Kuyken et al (2016). Efficacy and moderators of mindfulness-based cognitive therapy (MBCT) in prevention of depressive relapse: An individual patient data meta-analysis from randomized trials. JAMA Psychiatry.
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(892 patients; 385 relapses)
Hazard Ratio = 0.79 (0.64 – 0.97)
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Van Aalderen et al (2012) The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: a randomized controlled
Van Aalderen et al (2015) Long-Term Outcome Of Mindfulness- Based Cognitive Therapy In Recurrently Depressed Patients With And Without A Depressive Episode At Baseline. Depression and Anxiety.
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MBCT can effectively reduce depressive symptoms Even when people are within an episode at baseline Stable during f/u period
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Van Aalderen et al (2012)
Geschwind et al (2012). Efficacy of mindfulness-based cognitive therapy in relation to prior history of depression: randomised controlled trial. British Journal of Psychiatry.
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MBCT – significant reduction (~ 35%) of depressive symptoms No significant difference between those with 1- 2 episodes and those with ≥ 3 episodes TAU reduction ~ 10%
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Severity Response Remission
– Eg during pregnancy
– eg health anxiety, medically unexplained symptoms
– eg adolescents
– eg cancer, diabetes
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"Even if a psychosocial intervention has compelling aims, has been shown to work, has a clear theory-driven mechanism of action, is cost-effective and is recommended by a government advisory body, its value is determined by how widely available it is in the health service."
One training site per HEE Region. TEWV = site for Northern Region In collaboration with Oxford Mindfulness Centre and Bangor Centre for Mindfulness Research and Practice
Training for:
year post-qualification experience
personal practice
Bassetlaw Insight - Joanne Blackpool Bradford Calderdale Insight - Kelly Cheshire & Wirral Partnership Gateshead Halton Hartlepool and East Durham MIND Leeds – Ross & Lorraine Manchester – Graham and Pete Middlesbrough Insight - Sam Navigo (Grimsby) Newcastle - Naomi TEWV (North Yorkshire) Northumberland - Linda Pennine Care - Sophie Salford South Tyneside - Rob Trafford Tyne & Wear Insight Wigan - Pip TEWV (York & Selby) 34 (22) 12 (10)
Training outline – 10 days in Leeds
theory
practices and enquiries etc
Oxford for MBI-TAC assessment
paul.bernard@nhs.net
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Yorkshire and the Humber IAPT Providers Network
A Strategic Vision for Workforce Wellbeing in IAPT Services: Table Top Discussion
All
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On your tables please spend 25 minutes discussing the following questions. Please use the templates provided to write down the key points discussed.
your services?
managers and senior clinicians?
staff?
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Time for some lunch?
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Yorkshire and the Humber IAPT Providers Network
Provider Presentation: Kirklees and Calderdale IAPT
John Butler, Laura Firth and Nichola Hartshorne, Kirklees IAPT
John Butler, Team Manager Step 2 Laura Firth, Data Quality Lead, Nichola Hartshorne, Clinical Lead We make up part of the leadership team
Kirklees IAPT is funded by a block contract Calderdale is funded by an AQP
arrangement.
Both services sit under the umbrella of the
South West Yorkshire Partnership NHS Foundation Trust, under the community arm
predominantly secondary care mental health.
For the purposes of this presentation we will
focus on Kirklees IAPT.
Kirklees IAPT reports to two CCG’s
We report separately and then add the two
together to achieve an overall figure
Greater Huddersfield
North Kirklees
Kirklees (combined) 50,823 and 712 a month
I joined the service in September 2016, my
role was to manage the HI therapists.
Currently already in service was John who was
employed part-time and was responsible for managing step 2 and another service within the organisation.
2 senior PWP’s, 1 was on maternity leave and
the other was part time.
Previous to this there had been no consistent
management structure.
We also had a clinical system that didn’t really
work for us as an IAPT service
It was difficult to use clinically Getting data reports were very difficult We were working blind without up-to-date
data
Except for our Access target…….
0.86% 1.19% 1.20% 1.30% 1.16% 1.00% 1.59% 1.47% 1.01% 1.50% 1.24% 1.04% 0.60% 0.80% 1.00% 1.20% 1.40% 1.60% 1.80% Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Kirklee lees s IAP APT - % Prevalence valence
% Target % Prevalence / Access
Handing leaflets out in supermarkets, as well
as all the usual places. G.P’s surgeries, chemists, leaflets included in bounty packs
Talking to local business’s Providing workshops for local business’s Attending team meetings with colleagues in
the Trust
Designed a new website Assessing some of the referrals that came
into our secondary mental health Team (SPA)
This target became our world, We had by this time increased the leadership
team to include:
The general manager of the BDU and her
deputy were enlisted to help!
The team met weekly to scrutinise the
figures,
We increased the number of PWP Assessment
appointments we offered
We had been chosen as part of the wave 1
LTC project, we worked with our colleagues in physical health to promote mental health
It was at this point the Intensive support team
contacted the Trust and asked permission to became involved in order to support us to
People had different responses to this offer
I think it’s safe to say the three of us
welcomed the idea
And work began on providing detailed
information on figures, narratives, case studies etc.etc
All of this was done before the visit
A meeting was held with the providers, the
CCG and the IST, where more questions were asked and more information provided.
It felt for us as a service a very validating and
supportive experience
The outcome in terms of our access target,
revealed we didn’t have the required number
…..so we are in the process of looking at this
with the CCG and working out how best to proceed.
The moral of the story for me, is that it’s
imperative the CCG understands the service and works with providers.
Recovery figures
We’ve worked hard as a service on our
recovery target.
My experience coming in to the service was
some clinicians didn’t reall lly understand this target and weren’t always working in a recovery focused way.
We organised a CPD event around recovery
and the use of the MDS where there were a few light bulb moments for staff.
We tried to set the context for the recovery
target
Explored ways in which to incorporate the
MDS into sessions, not something to be filled in and not looked at again.
We delivered further in house clinical training,
to support staff to work in a more recovery focused way with more psychologically complex clients
There is still more work to do around this, in
around the Five Year forward view
But we’re getting there…
In our push to hit our access target our
waiting times obviously grew
By increasing our staffing we hope this will
really help with our waits
Everyone on the HI waiting list has been
written to and offered group work or silver cloud.
We’ve developed our offer of groups at Step 3
and are in the process of developing the
The counsellors are offering: Confidence building – 6 weeks Mindfulness - 6 weeks Living with loss – 6 weeks
CBT are offering an introduction to CBT
course
Which comprises of a 4 week workshop
looking at what is CBT , Depression, Anxiety and stress people can attend all 4 sessions
We also offer a 12 week skills group which
is based on CBT principles but offers a variety
interpersonal therapy mindfulness and ACT.
A GAD (General Anxiety Disorder) group A managing emotions group 6 weeks
By attending groups it open’s up choices for
people
People feel less isolated though peer support
and understand ‘they are not going mad.’
Can put their difficulties in perspective We reduce the need for 1:1 for everyone, may
reduce the number of sessions clients entering 1:1 therapy may need.
Data Analyst, Clinical Lead, Step 2 Team
Manager, 2 senior PWP’s, CBT lead, Counselling Lead, LTC team manager, Admin lead
And we are just about to go PCMIS….
15 PWPs (8 of which are trainees) CBT – 2 therapists in training 11 qualified Counselling 4 qualified therapists
Now Laura has a life other than access targets Staff have monthly access to their
contribution to the KPI’s
So they receive their individual data around ,
contacts offered, contacts seen, DNA’s, CNA’s, recovery rate based on how many discharges they have had.
This is discussed in monthly line
management
Staff wellbeing is something John and I are
passionate about
And yet there is a real tension in IAPT
because of the focus on outcome measures:
As we mentioned earlier we have tried to
bring a context to the outcome measures, rather than people seeing them as just numbers!
Team Culture
Team objectives explored and agreed Individual appraisal objectives linked to team
Improved information sharing Influx of new staff
New office / Agile working Buddy system Team away days
Improved communication Joint decision making Understanding of team goals Commitment to achieving team goals Listening and responding to staff concerns
Explain rationale for changes
Offered increased support and leadership
Developed a culture of collaboration
Addressing this became a major team
Recent Team Away day focused on wellbeing Individual wellbeing pledges Increased peer support
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Yorkshire and the Humber IAPT Providers Network
15 minutes only please!
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Yorkshire and the Humber IAPT Providers Network
Senior PWP Network Update
Heather Stonebank, Lead PWP Advisor, Yorkshire and the Humber Clinical Network
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Access to Psychological Therapies
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York and Selby service presentation by Jasmine Turnbull and Lorraine Fourie
Key messages – good team work, service improvement - enthusiastic SPWPs committed to quality improvement
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Sheffield IAPT - LTC presentation by Liz Ruth
site
Key messages – passion and enthusiastic SPWP, committed to supporting patients, sharing best practice and improving services
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Feedback from IAPT Providers Network
SPWP network into services
networks
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Next steps
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role
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today :-)
good practice.
thank you!
establishing similar network in the West Midlands.
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Yorkshire and the Humber Senior PWP Network
Thank you for listening!
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Yorkshire and the Humber IAPT Providers Network
Feedback from CASPER Plus Training and Improving Access for Older Adults: Table Top Discussion
Sarah Boul, Quality Improvement Manager, Yorkshire and the Humber Clinical Networks
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across Yorkshire and the Humber – 90 PWPs/Senior PWPs trained in:
term health conditions & older adults
long term conditions and role changes
Follow up work with the University of York is also being undertaken – watch this space!
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On your tables please spend 15 minutes discussing the following questions. Please use the templates provided to write down the key points discussed.
increased access for older adults?
your staff to work with older adults?
working with older adults?
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Yorkshire and the Humber IAPT Providers Network
Feedback from the National Team BIT, Yammer, NHS Choices and Service User Involvement: Offer from the National IAPT Team
Sarah Boul, Quality Improvement Manager, Yorkshire and the Humber Clinical Networks
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and the Equality and Human Rights Commission (EHRC) to examine how behavioural insights could be used to increase access IAPT services for underrepresented groups.
age, gender and race.
qualitative research for 2 identified population groups, and use the findings to consider how best to increase IAPT usage in the identified
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.
groups and older adults.
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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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
let us know by contacting england.mentalheath@nhs.net.
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.
any inconvenience and we hope for the issue to be resolved soon.
Feedback from the National Team - Yammer
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the product manager for the mental health project focussing on improving IAPT self-referral on NHS Choices / NHS.UK.
which there will be redesign work, updating content and a “beta” testing of the web pages.
pages.
correct?
Feedback from the National Team – NHS Choices
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Service User Workshop in Bristol to seek views from those who have used IAPT services to help shape the programme going forwards.
areas are doing to engage with their service users.
visit by which the national team could engage directly with your service users. Would you like a visit from the national team?
Feedback from the National Team – Service User Involvement
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Yorkshire and the Humber IAPT Providers Network
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Yorkshire and the Humber IAPT Providers Network
Thank you for Attending! Please remember to fill out your evaluation forms!