Challenges Work progress: • Working with Trust Communications team • Multiple trauma to develop appropriate promotional materials • Negative view nationally of IAPT • Holding assessment clinics within City GP impact on staff wellbeing practices • Long Term Conditions work • Using telephone interpreting service to organise appointments • Promoting services where singular trauma might be present • Stopped presenting team targets, moved to individual performance management • Introduced wellbeing action plans for each staff member
Yorkshire and the Humber Senior PWP Network Time for some lunch? www.england.nhs.uk
Yorkshire and the Humber Senior PWP Network Clinical Skills – Psychoed Courses Lottie Hutton, Tyra Sutton, Poppy Danahay and James Walton, North Yorkshire IAPT www.england.nhs.uk
North North Yorkshire Yorkshire IAPT IAPT Service Service – Psychoe Psychoedu duca cational tional Course Course Impro Improvemen vement Charlotte Hutton, James Walton, Poppy Danahay & Tyra Sutton - Senior PWPs
Main The Main Themes mes ⚫ 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
But first…… Group Exercise ⚫ A little fun to create some new groups in order to complete a group exercise ⚫ CHANGE CHAIRS…….
Change Change Chair Chairs s ⚫ Read out a statement ⚫ Change chairs with someone else in the room that also gets up in response to the statement
Change chairs if…
Change chairs if….
Change chairs if….
Change Chairs if…
Group Group Exercis Exercise e ⚫ 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?
What we What we were were doing… ⚫ North Yorkshire IAPT service – 3 localities ⚫ 2 Psychoeducational Courses ⚫ Stress Control – 6 sessions ⚫ Healthy Minds – 4 sessions ⚫ Mixture of daytime and evening sessions
What we found…
Implications… ⚫ 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%
Other Considerations… ⚫ 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
What What we we did did … ⚫ 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
What we found… (after assessment) Therapist confidence in course grew
Recovery Recovery Rates Rates Treatment Type Number of patients Of which calculated attended (in total) recovery rate Course 979 56.19%
Where we go from here… ⚫ Recovery rates – how to improve (we know we can reach 72%) ⚫ DNA / Drop-Out management ⚫ Observations – development of a Best Practice Tool
Dr Drop op-ou out t Man Manag ageme ement nt - Observ Observations ations ⚫ 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.
What d What does this oes this mean? mean? ⚫ 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?
What d What did we id we do? ( do? (1) 1) ⚫ 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.
What d What did we id we do? ( do? (2) 2) ⚫ 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.
Cours Course e Dr Drop op-Out Out Man Manag ageme ement ( nt (1) 1) ⚫ 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.
Cours Course e Dr Drop op-Out Out Man Manag ageme ement ( nt (2) 2) ⚫ 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.
Stati Statisti stics cs ⚫ Trialled initially on a Stress Control course with 64 patients. ⚫ Responsibility for drop out management shared between staff.
Wit Without hout Dr Drop op-Out Out Man Manag ageme ement nt 25 21 20 16 15 11 11 10 5 4 1 0 Recovered & Not Recovered & Non-Caseness DNAd (No Sessions Stepped (Next Course Awaiting Follow-up Discharged Discharged Attended) & or Reviewed and Discharged Stepped)
With Wit h Dr Drop op-Out Out Man Manag ageme ement nt 30 26 25 20 16 15 11 10 5 5 5 1 0 Recovered & Not Recovered & Non-Caseness DNAd (No Sessions Stepped (Next Course Awaiting Follow-up Discharged Discharged Attended) & or Reviewed and Discharged Stepped)
Wit Within hin Dr Drop op-Out Out Man Manag ageme ement nt 6 5 5 4 4 4 3 2 2 1 1 0 Recovered & Discharged Not Recovered & Discharged Attending Next Course Moved to GSH DNAd & Discharged (No Impact on Rec Rate)
Conclusi Conclusions ons ⚫ 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 Staff Feed Feedback back ⚫ 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 ones who had not understood what the course 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.
Di Direct rect observati observations ons Template Observation Proforma ⚫ Pre-course check list ⚫ Couse Opening ⚫ Application of Communication Skills ⚫ Professionalism ⚫ Use of Volunteers
Di Direct rect Observ Observations ations ⚫ 3 offices: - Harrogate with one venue -Hambleton with 2 venues - SWR with 3 venues Stress Control and Healthy Minds run at all locations
Coll Collated ated Observ Observations ations Best Practice? ⚫ Ensure appropriate temperature and lighting ⚫ Use safety behaviour chairs and ensure chairs are spaced apart ⚫ Ensure screen size is good and projection clear
Cours Course e Observ Observations ations Best Practice? ⚫ Play music, appropriate volume and Type ⚫ Service wide guidance re music type?
Coll Collated ated Observ Observations ations Best Practice? ⚫ 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 on the chairs or given at the door
Coll Collated ated Observ Observations ations Best Practice? ⚫ 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
Coll Collated ated Observ Observations ations Best Practice? ⚫ 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
Coll Collated ated Observ Observations ations Best Practice? ⚫ 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
Coll Collated ated Observ Observations ations Best Practice? ⚫ 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
Coll Collated ated Observ Observations ations Best Practice? ⚫ 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
Coll Collated ated Observ Observations ations Best Practice? ⚫ Allow appropriate pacing of speech for participants to process new information ⚫ Ensure a break is always given
Coll Collated ated Observ Observations ations Best Practice? ⚫ 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
Coll Collated ated Observ Observations ations Best Practice? ⚫ 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
Coll Collated ated Observ Observations ations Best Practice? ⚫ 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.)
Coll Collated ated Observ Observations ations Best Practice? ⚫ Promote a sense of team work with smooth transitions ⚫ Ensure attentive NVC when other facilitator speaking
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