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CYP IAPTChildren and young people’s
Improving access to psychological therapies
Duncan LawClinical Lead
[email protected]: @DrDuncanLaw
What is CYP IAPT?
CYP IAPT
NSF and Every child matters
Five Year Forward ViewCAPAChimat
TaMHS
CORC
NICETHRIVE
CYP and
parents’ voices
Third sector and Professional
voices and research
QNCC
PbR CQC
CYP IAPT is part of the bigger picture
Future in Mind and Local Transformation Planning and Implementation
Mental Health
Services
Data Set
CYP-IAPT is a set of principles for Whole Service Transformation
&
The CYP IAPT Learning Collaborative is aplatform that supports & facilitates change
CYP-IAPT is a set of principles for Whole Service Transformation
The CYP-IAPT principles:
1. Better evidence-based practice
2. Better collaborative practice and shared decision making
3. Authentic participation of families and Young People who have used or may use services
4. Rigorous outcomes monitoring
Leading to appropriate, accessible,
effective and efficient services
Do you want to do a good job as practitioner?Do you actually do a good job?Do young people and families agree with you?Are you getting better at what you do?How do you know?How could you ‘prove’ it?
Clinician expertise
Evidenced BasedPractice
Shared Formulation & Agreed InterventionGoals
YP/Family’s goals preferences, values, and unique context
+ +
Research evidence
Adapted and used with thanks to Peter Fonagy and Duncan Law Frueh et al (2012) Evidence-Based Practice in Adult Mental Health. Handbook of Evidence-Based Practice in Clinical Psychology. Published online.
Do you do Evidenced-Based
Practice?
What about the person
next to you?
FEEDBACK AND OUTCOMES Transparency and collaboration
17
Feedback & Outcomes Forms
Why bother using them?
Values behind outcomes and feedback
1. Demonstrate/celebrate/prove:
effectiveness of interventions and service
1. Enhance collaborative practice:
– Better service user voice in therapy (&
supervision)
– Facilitates good clinical practice
Assessment/Choice
• “What’s the problem?”
• “What do you want to change?”
Partnership/on-going work
• “How are we getting on together?”
• “How are things going?”
Review & Close
• “Have we done as much as we need to?”
• “How has this been generally?”
6 useful questions that forms can help with
It’s not (just) about measurement, it’s about a culture of collaboration
Feedback & Outcomes Monitoring
The evidence base
What’s the evidence?
There is evidence that use of feedback forms/measures can:
• Improve clinicians ability to detect worsening of symptoms (Lambert, 2010)
• Provide information that may have otherwise been missed (Worthen & Lambert, 2007)
• Reduce drop out (e.g. Miller et al. 2006)
• Increase speed to reach good outcomes (Lambert et al. 2005)
• Improves outcomes (Bickman et al 2011)
Mike Lambert
• Feedback to clinicians on outcomes trajectories
• Reduced drop-out
• Better outcomes
• No advice given to clinicians on how to use the feedback
• Lambert, M. J. (2007). PRESIDENTIAL ADDRESS: A program of research aimed at improving psychotherapy outcome in routine care: What we have learned from a decade of research. Psychotherapy Research, 17, 1-14.
Len Bickman
• Big RCT (28 sites in 10 states) ‘real world CAMHS’
• Feedback weekly or every three months
• Faster improvement with weekly feedback
• Even better if clinicians looked at the feedback! (paraphrased)
• Bickman, L., Kelley, S., Breda, C., De Andrade, A, & Riemer, M. (2011): Effects of routine feedback to clinicians on youth mental health outcomes: A randomized cluster design, Psychiatric Services, 62(12), p.1423-1429
The golden rule…..
numbers should always, and only, be an invitation to dialogue
It is the conversation that is generated by feedback and outcomes data that is the vital part of the process
26
What is expected
From Jan after completing the first year in the programme, 90% of all closed cases, seen three times should have:
• At least one of the MHSDS outcomes forms completed at least twice – One measure of impact or service change using a ‘normed’ measures: a form that has a
normed statistical treshold (such as the SDQ, RCADS, ORS/CORS, RMQ, or on of the ‘normed’ symptom trackers). - The same form completed by the same person twice: for example, a young person completing the CORS twice, or a parent completing the SDQ twice.
AND– One measures of personalized goals (GBO)– One measure of satisfaction (CHI ESQ)
AND• Complete the Education Employment and Training (EET) form (part of the current
view form).
Clinical judgment rules!!
Resources
