South London and Maudsley (SLaM) IAPT-SMI Demonstration Site for Psychosis

Transcription

1 South London and Maudsley (SLaM) IAPT-SMI Demonstration Site for Psychosis Dr Louise Johns Consultant Clinical Psychologist PICuP Coordinator and IAPT-SMI Project Lead Psychosis Clinical Academic Group (CAG) 9 th March 2015

2 Dolly Sen, Service User I always asked for some kind of psychological therapy or talking therapy but was told, no, it was too dangerous. I had to wait 20 years for something that was the most beneficial thing. [Therapy] has changed my life basically. Talking to Rt Hon Norman Lamb MP on 19 December 2012

3 Barriers to access Unclear referral pathways Prioritisation of other interventions Lack of suitably trained staff Restricted access to supervision for therapists Lack of organisational support (Shafran et al., 2009; Prytys et al., 2011)

4 Overcoming obstacles to access in SLaM

5 Work in SLaM Ten Point Charter addressing barriers and facilitators to delivering CBTp and FIp

6 Overcoming obstacles to access through IAPT-SMI

7 IAPT for SMI Initiative Part of the government s four-year plan to increase access to talking therapies Transforming mental health services to be better able to provide NICE approved psychological therapies to people with bipolar disorder, personality disorders and psychosis Equity of provision regardless of age, gender & BME status 6 SMI demonstration sites, started in Nov PD, 2 psychosis, 1 bipolar disorder Data collection until Dec 2014, report in April 2015 Further data collection, including follow-up

8 Selection of Demonstration Sites Delivering evidence-based psychological therapies Therapists with appropriate competences Have strategic approach, which is replicable Collecting outcome data routinely and effectively (access to historical data) Provision of training and supervision Overcoming barriers to implementation: e.g. senior management buy-in ; ring-fenced time

9 SLaM demonstration site: Strategic approach to improving access to therapy A 50% increase in access with the funding provided Reduced waiting times Implementation of our 10 Point Charter Close and frequent supervision of trained staff Clear referral pathways, including self referral Regular assessment of progress in therapy A range of outcomes, including health economics

10 SLaM Psychosis Demonstration site: Improving access in two care pathways IAPT-EI Early Intervention Pathway (Southwark, Lambeth, Croydon & Lewisham) IAPT- PICuP IAPT- SHARP Promoting Recovery Pathway (Lambeth) Promoting Recovery Pathway (Southwark, Croydon & Lewisham)

11 What IAPT-SMI offers: CBTp CBT for psychosis: Weekly or fortnightly individual 1 hour sessions 6-9 months therapy Therapists receive weekly-fortnightly group supervision Suitability criteria: not in high need of MDT input (or well engaged with MDT & requires additional psychotherapy), current low risk F20 diagnosis (schizophrenia spectrum) distressing positive symptoms of psychosis OR secondary emotional disturbances / sense-making & recovery work not predominantly negative symptoms motivated to attend

12 IAPT-SMI: CBT assessments Pre 3-month Post PSYRATS Voices & Beliefs PSYRATS Voices & Beliefs PSYRATS Voices & Beliefs WEMWBS WEMWBS WEMWBS WSAS WSAS WSAS EQ-5D EQ-5D EQ-5D Short CHOICE Short CHOICE Short CHOICE CORE-10 CORE-10 CORE-10 Brief IPQ Brief IPQ Brief IPQ Measures Feedback Measures Feedback Measures Feedback Satisfaction with therapy & PEQ Satisfaction with therapy & PEQ Short CHOICE weekly

13 FI for psychosis: What IAPT-SMI offers: FIp Fortnightly 1 hour sessions with client and carer(s) Up to ten sessions, over a period of 3-9 months Therapy delivered by two trained therapists Usually delivered at home Therapists receive weekly-fortnightly group supervision Suitability criteria: F20 spectrum diagnosis In close contact with an informal caregiver (approx. 10 plus hours face to face or living with) Need carer and service user agreement

14 IAPT-SMI: Carer assessments Pre Post Experience of caregiving inventory Experience of caregiving inventory WEMWBS WEMWBS DASS-21 DASS-21 CORE-10 CORE-10 IPQ carer version IPQ carer version Confidant question Confidant question Measures Feedback Measures Feedback Satisfaction with therapy Sessional satisfaction measure

15 Quality of CBTp A key challenge has been lack of clarity about quality Lack of criteria have resulted in an anything goes approach to psychological therapy in mental health services, and inflated estimates of provision RCTs: Generic CBT competencies are not associated with good clinical outcomes (Durham et al, 2003); specific CBTp competencies are (Wykes et al, 2008 ; Steel et al, 2011) IAPT-SMI: nationally agreed criteria for training and competencies in CBTp and FI Competency Frameworks for Psychosis, Bi-Polar Disorder and Personality Disorder.

16 CBTp in SLaM Demonstration Site Individualised and formulation based, but adheres to published manuals and the CORE CBTp competence framework (Roth and Pilling, 2013). Therapists are trained to competence, using assessments of adherence and competence. Supervision provided weekly to fortnightly in groups of 3-6 therapists for 1.5 hours, with fortnightly to monthly individual supervision. Supervisors are senior clinicians with experience of training therapists and of providing therapy within RCTs.

17 Training structure in the SLaM site

18 Key Aspects of our Demonstration Site

19 The primary facilitators have been: ring-fenced investment in competent therapy provision ring-fenced time for therapists to deliver therapies (aligned with or embedded within the MDT) adequate supervision, training and CPD trained independent assessors established service pathways & governance structures strong clinical leadership & management

20 The secret to our success

21 People Assistants, administrators, business intelligence People Therapists, supervisors and trainers People Leads, managers, consultants

22 Thank you for listening