Senior PWP Network 4 June 2019 Andy Wright, IAPT Advisor, Heather - - PowerPoint PPT Presentation
Yorkshire and the Humber Mental Health Network Senior PWP Network 4 June 2019 Andy Wright, IAPT Advisor, Heather Stonebank, Lead PWP Advisor and Sarah Boul, Quality Improvement Manager andywright1@nhs.net,
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Quality Improvement Manager
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@YHSCN_MHDN #yhmentalhealth
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Andy Wright, IAPT Advisor, Yorkshire and the Humber Clinical Network
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Andy Wright IAPT Adviser Yorkshire & Humber Senior PWP Network 4th June 2019
⚫ 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 ?
⚫ 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 & Mental Health & IAPT services ⚫ Aspiration to ‘do no harm’ applies to us as well as people we work with. ⚫ There are also some other observations at all levels
⚫ 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
⚫ Culture is the way we do things around here; it is the current in the river; the hidden determinant of
⚫ Climate control not command and control
⚫ Nationally, IAPT is an example of how setting targets has improved patients’ access to psychological therapy. ⚫ Targets could be blamed for distorting clinical priorities (King’s Fund) ⚫ Mid-Staffordshire is an example of what happens when the target is hit but the point is missed (Frances Report)
⚫ “People need a period of stability, otherwise they may actively resist beneficial change”
» G. Kinman Jan 2018
⚫ Potential conflict when we work within an organisation which has at it’s core the principle of continuous improvement if this becomes perceived as continual change!
⚫ https://youtu.be/0RXthT32vcY
Drive System
To motivate us towards resources Feelings : wanting, pursuing, achieving
Soothing System
To manage distress and promote connecting Feelings content, safe ,connected, trust
Threat System
To detect and protect against threats Feelings anxiety, anger , disgust
DRIVE
SOOTHING
THREAT
Drive and Achievement
Soothing and Connection Threat and Protection
⚫ Paying attention and being present ⚫ Understanding the causes
⚫ Empathic response ⚫ Helping, taking intelligent action ⚫ How do we currently model the components of compassionate leadership ⚫ What are the barriers (internal and external)
⚫ Clear vision and purpose (the narrative) ⚫ Agree objectives and goals that are clear, aligned and not
⚫ Ensure enlightened people
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
compassionately ?
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Clinical Excellence (NICE guidelines)
In progress:
intensity
face or telephone based
sessions
promotion
Month LI service recovery Recovery with use of a workbook February 60% 67% March 55% 61% April 59% 64%
driven therapy
therapy
desensitisation reprocessing therapy (EMDR)
Depression
Psychotherapy
informed therapy
NICE recommendations
should show improvement from January published data
EQUITy – 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 women’s views of Mental health experiences and Help- seeking using a Vignette-based Interview Approach
Disorder specific workbooks
Continuing Professional Development
SMArT CASPER Trial
Service development in long term conditions includes development of; courses, workbooks and potentially webinars for the following conditions;
This project will include a focus on increasing access, joint working with other services, LTC training for staff.
Community
demographic
schools and community services that work directly with the South Asian population
staff language skills
delivering treatment in other languages
culturally
delivered within faith establishments and culturally diverse locations across the City
impact on staff wellbeing
to develop appropriate promotional materials
practices
might be present
individual performance management
staff member
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Lottie Hutton, Tyra Sutton, Poppy Danahay and James Walton, North Yorkshire IAPT
Charlotte Hutton, James Walton, Poppy Danahay & Tyra Sutton
⚫ 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
⚫ A little fun to create some new groups in order to complete a group exercise ⚫ CHANGE CHAIRS…….
⚫ Read out a statement ⚫ Change chairs with someone else in the room that also gets up in response to the statement
⚫ 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?
⚫ North Yorkshire IAPT service – 3 localities ⚫ 2 Psychoeducational Courses ⚫ Stress Control – 6 sessions ⚫ Healthy Minds – 4 sessions ⚫ Mixture of daytime and evening sessions
⚫ 4 session Healthy Minds Course ⚫ 60% recovery rate – good ⚫ But….. ⚫ 6 session Stress Control Course ⚫ 72% recovery rate ⚫ Offering 4 sessions only, missing out on a further 12%
⚫ 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
⚫ 6 session Healthy Minds Course
⚫ Senior PWP’s developed course ⚫ Cascaded out to PWP’s – feedback ⚫ Roll out ⚫ Amendments
⚫ Observations
⚫ Standard delivery across localities ⚫ Best Practice Tool
Therapist confidence in course grew
Treatment Type Number of patients attended (in total) Of which calculated recovery rate Course 979 56.19%
⚫ Recovery rates – how to improve (we know we can reach 72%) ⚫ DNA / Drop-Out management ⚫ Observations – development of a Best Practice Tool
⚫ Courses tend to have high levels of DNA/CNA ⚫ Courses tend to have good recovery rates overall ⚫ Patients who attend courses tend to be the most truly “mild-moderate” and therefore evidence would suggest that these are most likely to recover.
⚫ Are patients dropping out of treatment because they are recovered? ⚫ Or because it’s the wrong treatment for them and the format of the course makes it difficult for this to be identified?
⚫ Improve provisional diagnosis from routine assessment using a provisional diagnosis “quick guide”. ⚫ This was visible to all PWPs at assessment. ⚫ Identify correct presenting problem in order to inform which treatment most appropriate.
⚫ Develop an evidence-based decision making tool. ⚫ Using statistics on diagnosis, age, severity of scores specific to our service. ⚫ To offer an “evidence-based” choice, rather than a “menu of choice.
⚫ 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 “get in touch” deadline of 2 weeks.
⚫ 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 – does not extend time in service.
⚫ Trialled initially on a Stress Control course with 64 patients. ⚫ Responsibility for drop out management shared between staff.
21 16 1 4 11 11 5 10 15 20 25 Recovered & Discharged Not Recovered & Discharged Non-Caseness DNAd (No Sessions Attended) & Discharged Stepped (Next Course
Stepped) Awaiting Follow-up
26 5 1 5 16 11 5 10 15 20 25 30 Recovered & Discharged Not Recovered & Discharged Non-Caseness DNAd (No Sessions Attended) & Discharged Stepped (Next Course
Stepped) Awaiting Follow-up
5 2 4 1 4 1 2 3 4 5 6 Recovered & Discharged Not Recovered & Discharged Attending Next Course Moved to GSH DNAd & Discharged (No Impact on Rec Rate)
⚫ 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 they’ve recovered. ⚫ Patients were not staying in the service any longer than before, due to the 1 week deadlines (for managing risk).
⚫ 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
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.
Template Observation Proforma ⚫ Pre-course check list ⚫ Couse Opening ⚫ Application of Communication Skills ⚫ Professionalism ⚫ Use of Volunteers
⚫ 3 offices:
Stress Control and Healthy Minds run at all locations
⚫ Ensure appropriate temperature and lighting ⚫ Use safety behaviour chairs and ensure chairs are spaced apart ⚫ Ensure screen size is good and projection clear
⚫ Play music, appropriate volume and Type ⚫ Service wide guidance re music type?
⚫ Greet participants individually with individual and genuine interactions, eg: The journey, nice to see you again, the weather ⚫ Where there are two facilitators and/or 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
⚫ 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
⚫ 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 back/take time out if needed
⚫ 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 helpline,Samaritans number etc ⚫ Offer opportunity to review MDS scores with facilitators
⚫ 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
⚫ 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
⚫ Allow appropriate pacing of speech for participants to process new information ⚫ Ensure a break is always given
⚫ Speak in a clear and audible manner – 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
⚫ 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
⚫ Take a warm and empathic stance ⚫ Engage with the whole room, ensuring good eye contact with all participants ⚫ Use inclusive and collaborative language (“I can see from some of your reactions…” etc.)
⚫ Promote a sense of team work with smooth transitions ⚫ Ensure attentive NVC when other facilitator speaking
⚫ 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
⚫ Wear NHS badge ⚫ Remain professional throughout the session ⚫ Demonstrate leadership throughout the session
Best Practice?
⚫ Welcome volunteers warmly and genuinely ⚫ Ensure that the volunteer has a clear understanding of their role, allowing
concerns to be raised by volunteer if necessary ⚫ Thank volunteer for their contribution ⚫ Monitor volunteer’s 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
⚫ Ensure each slide is explained well providing participants time to process the information ⚫ Consider use of appropriate self-disclosure, metaphors
⚫ Pay attention to the therapeutic alliance utilising
⚫ Use open body posture and be available for participants to approach facilitators for questions at the break and at the end of the session
⚫ 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 – possibly develop a specific
⚫ 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
⚫ Any questions? ⚫ Any thoughts or reflections? ⚫ Does this fit with what your service does?
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Heather Stonebank / All
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