Somerset IAPT SMI Demonstration Site National Networking Forum September Jane Yeandle

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1 Somerset IAPT SMI Demonstration Site National Networking Forum September 2015 Jane Yeandle

2 Context Service user feedback Local integration of Primary and Secondary Care Psychological Services Demonstration Site doing what we were doing anyway and having the capacity to evaluate outcomes

3 Somerset s Approach A Care Pathway that reflects a generalist, whole systems approach, where the majority of patients with PD will be treated. And a Specialist Approach including Specialist Psychological Therapies.

4 Generalist Approach Enhanced Structured Case Management Care Planning Approach, Crisis planning, Assertive follow up, Psycho - education and skills development, Structured Assessments and Diagnosis and Structured Treatment. All underpinned by a Psychological Approach to Assessment, diagnosis, formulation and treatment planning. And a range of tools that structure the process. All supported by Personality Disorder Locality Leads who deliver, supervise, train, consult relating to the above.

5 Clinical Tools The BPD Wheel Guided Formulation Risk Matrix Backwards Chain Looking Ahead Planning Tool

6 Relational Training for PD Development and training which provided staff with tools. Engagement of local clinical leads and managers. Delivery of training and follow up a model aimed at sustainable improvement. At the heart of the training was an opportunity to implement the tools in real time about patients and then with patients so that we could address the head and the heart.

7 Range of Primary Care Initiatives Training DVD for Primary Care Service User Forum developed website Training for Primary Care Talking Therapies staff (an IAPT plus service) Emotional Skills Groups in Primary Care Cognitive Analytic Therapy (CAT) as a Step III intervention

8 Primary Care Outcomes:- Training DVD Developed collaboratively with patients, carers and staff. Providing information about the diagnosis, treatment and management of personality disorder including the Relational Recovery Approach and Guided Formulation. Includes the personal experiences of staff and patients who have used the model Produced and animated by students from Yeovil College Available on request from

9 Primary Care Outcomes:- Website Developed collaboratively with service users and carers the website provides accessible online information about personality disorder, local services and care pathways and, support networks. ialist_services/personality_disorder_service/

10 Outcomes:- Training for Primary Care Talking Therapies Staff Provision of a four day training to 23 Step III Psychological Therapists on Relational Recovery and Guided Formulation. Evaluation showed significant improvement in Knowledge, Attitudes and Skills Challis E, Gordon C, Fawkes L & Yeandle J (2014) Personality Disorder in Primary Care Talking Therapies: the Impact of Staff Training on Knowledge Attitudes and Skills. The Journal of Psychological Therapies in Primary Care, 3,

11 Outcome: Evaluation of Talking Therapy Interventions (Health Warning) The sample (n = 3470) included 63% of people who scored positively for PD traits (had a SAPAS score of 4+) Overall positive across measures, the majority of people showed at least some improvement On depression and anxiety scale (PHQ9 and GAD 7) most individuals show a reliable improvement (60% and 50% respectively) The national standard recovery rates (50%) were nearly met for PHQ9 (44%) and GAD-7 for this group of people Patients experience (measured by PEQ) was positive

12 Outcomes:- Primary Care Emotional Skills Groups (Health Warning!) Based upon Dialectical Behavioural Therapy (DBT) NICE recommended for Borderline Personality Disorder (BPD) Service users completing 5 8 sessions (recently increased to 12 sessions) Modest numbers achieve recovery Statistically significant reductions across both data sets Positive impact on overall health status and daily functioning, reduction in risk and service utilisation

13 Outcomes:- Cognitive Analytic Therapy (Health Warning!) CAT is NICE recommended intervention for Borderline Personality Disorder (BPD) Provision of 8 16 sessions as a Step III therapy. 16 staff currently being trained on a 1 year foundation course In process of evaluation

14 Outcomes- PTS 92% of all referrals who had completed at least one outcome measure scored 3 or above on SAPAS nearly 30% had a Personality Diagnosis recorded on RIO. Overall, this sample showed improvement in outcomes relating to mood, wellbeing and functioning. 33% reached standard recovery in low mood, 32% in GAD. 42% showed reliable improvement in low mood, 48% in GAD. 28% showed reliable recovery in low mood and 30% in GAD.

15 Outcomes- PTS cont Over half of people referred to Psychological Therapies have recorded outcomes for the IAPT SMI project. Data only relates to paired outcomes, so not necessarily first and last measures of treatment. Positive results, in relation to IAPT Year 1 results (Gyani et al 2013) for PRIMARY CARE: reliable recovery rate at 40% and the reliable improvement at 64%.

16 McPin Service User Evaluation

17 McPin cont

18 McPin Evaluation cont Some examples of comments made regarding overall reflections: (I)came away knowing that my reactions to my situation are normal and that I am reasonably mentally well. (PC) I am doing a DBT course and I find that the skills that I have learnt are really helping (me) manage especially self harming (SC). Since therapy I have been to [place] on my own and now have my [child] home with me away from her abusive father. (SC)

19 McPin Evaluation cont Those assessment forms I would recommend you share a more structured sharing of the data and trending as this was really helpful to me. It helped me to focus in on specific areas that needed more of my focus to improve. Its useful and a helpful tool when used for sharing. I otherwise felt it was 1) A tick box exercise 2) depersonalized my therapy experience. (SC).

20 Good Practice Important inroads for Primary Care Integrated evaluation with the usual health warnings

21 Challenges IAPT framework/performance requirements and PD Improving access Barriers and culture Next direction

22 Discussion What else should and could be possible? How best to engage service users and people with lived experience? What other partnerships should and could be enabled?