Psychological Therapies for Severe Mental Illness: Recovery through Early Interventions
News and updates from today's conference.
Achieving EIP access and waiting time targets
Dr Nicola Barclay, Clinical Psychologist, Northumberland, Tyne and Wear NHS Foundation Trust
Full powerpoint presentation
The introduction of the 2 week Access and Waiting Time targets and CAARMS assessments was a significant challenge to EIP services. Services were already committed to reducing the duration of untreated psychosis, but the targets enforced a number of particular ways of going about this and how we should record it on our systems. Not only this, but our services were already incredibly busy and our staff stretched very thin. We knew that we would need to make a number of significant changes to support our staff and to ensure that our trust met the 50% target. In preparation, we collected data on the source of EIP referrals, when psychosis was first suspected and identified the delays in the system at a number of points through a client’s journey. The Patient Tracking List (PTL) was developed initially as a manual database where this information was collected and analysed. From this data, we were able to develop a targeted strategy for communicating our targets to other teams and agencies, introduced systems to help to minimise delays in referrals reaching us and developed procedures to help a client’s journey through our services run more smoothly. The PTL helped us to identify at what point in the journey there were delays, and allow us to act quickly to minimise the number of breaches to the target. Working closely with our colleagues in the IT department, the PTL was able to be written into our patient record system (Rio) and run automatically from the data staff were already inputting into Rio. Following a period of running both a manual and automatic PTL, team leaders now have full oversight into cases that are at risk of breaching and able to feedback any delays in referrals reaching EIP. I will discuss what we put in place to help us achieve improved figures in our access and waiting times whilst supporting our staff, and describe the obstacles we came across along the way. I will offer my reflections on how the process has impacted on teams since, and how we have adapted the PTL for monitoring Psychological Therapies within EIP. For details of the patient tracking list, the SQL codes and more information about what we put into place, please contact me on Nicola.Barclay@ntw.nhs.uk, or my colleague Dr Guy Dodgson, Trustwide Lead for EIP at Northumberland, Tyne and Wear NHS Foundation Trust, (Guy.Dodgson@ntw.nhs.uk).
IAPT for SMI (IAPT-SMI) an EIP demonstration site
Dr Louise Johns, Consultant Academic Clinical Psychologist, Early Intervention in Psychosis Service, Oxford Health NHS Foundation Trust
Full power point presentation
The access and waiting time standard for early intervention in psychosis (EIP) services (2016) requires that more than 50% of people experiencing first episode psychosis (aged 14-65) will be assessed and allocated to an EIP care coordinator within 2 weeks of referral to the Trust. The standard also states that EIP services should provide the full range of psychological, social, pharmacological and other interventions shown to be effective in NICE guidelines and quality standards, including support for families and carers.
Despite clinical guidelines and recommendations, access to psychological therapies for psychosis remains low. The UK Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI) initiative aimed to address this issue. There were six IAPT-SMI demonstration sites that collected data from 2012-2016, including two psychosis sites. This presentation highlights the key outcomes and learning points from the South London and Maudsley NHS Foundation Trust IAPT-SMI demonstration site for psychosis.
Additional funding from the Department of Health and NHS England enabled increased therapist capacity within existing secondary care community mental health services (Early Intervention and Promoting Recovery). Self-reported wellbeing and psychotic symptom outcomes were assessed, alongside service use and social/occupational functioning.
We found that referrals increased by 89% and therapy engagement (≥5 sessions) was high, irrespective of ethnicity, age and gender. The assessment protocol proved feasible, and pre-post outcomes showed clinical improvements and reduced service use, with medium effects.
The demonstration site showed that, in a well-organised service structure, ring-fenced investment in competent therapy provision leads to increased and effective delivery of psychological therapies. The IAPT-SMI framework is replicable, and has informed the implementation of psychological therapies as part of the national EIP standards.
A key barrier to implementing CBTp and Family Interventions (FI) is the lack of staff with appropriate competences to deliver these therapies. IAPT-SMI included the development of a national competence framework for delivery of CBT and FI for people with psychosis and bipolar disorder. HEE allocated £5m to fund training and supervision in CBTp and FI to support the implementation of the EIP standard. Training the existing workforce, together with funding for new posts, has significantly increased the number of staff able to deliver and supervise CBTp and FI to a high standard. The challenge is for services to give staff the protected time necessary for delivering therapy and receiving supervision, and also to retain staff following training.
Our IAPT-SMI site found that routine outcome monitoring (ROM) is feasible and acceptable to service users. They generally found ROM satisfactory (Fornells-Ambrojo et al., 2017), and disseminating this information helped to allay therapists’ reservations about sessional outcome measurement. Collecting outcome measures is crucial to evaluate the effects of therapies, and to feed back to commissioners in relation to ongoing funding required to meet the national EIP standards.
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25 May 2018