Measuring the real life challenges lessons and reflections the nhs lothian early implementer site
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Measuring: the real life challenges Lessons and reflections the NHS Lothian Early Implementer Site. Linda Irvine Strategic Programme Manager, Mental Health and Wellbeing. Overview of Presentation. DCAQ Phase 1 learning and Phase 2 progress DCAQ and A12 DCAQ, A12 and Outcome Measures

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Measuring the real life challenges lessons and reflections the nhs lothian early implementer site

Measuring: the real life challenges Lessons and reflections the NHS Lothian Early Implementer Site

Linda Irvine

Strategic Programme Manager, Mental Health and Wellbeing


Overview of presentation

Overview of Presentation

  • DCAQ Phase 1 learning and Phase 2 progress

  • DCAQ and A12

  • DCAQ, A12 and Outcome Measures

  • Learning and Reflections


Dcaq phase one

DCAQ Phase One


Phase i outcomes

Phase I : Outcomes

Partially completed because DCAQ data…

  • not collected

    or

  • not collected consistently

    or

  • not reflective of reality

    or

  • Conflicting – more than one source


Dcaq phase 2

DCAQ Phase 2

  • Addressing the data issues

  • Solid project governance


Challenges

Challenges

  • Amount of work required to improve data

  • Identifying where to invest the time

  • Providing the right frame of reference for DCAQ

  • Timescales and availability


Testing and making changes to practice

Testing and Making Changes to practice

  • New information process

  • Opt-in

  • Case review (one off and ongoing process)

  • DNA and CNA policy

  • Activity Audits completed

  • Admin processes

  • Use of Groups

  • And more!


Dcaq and a12 agreement on core data set i

Primary Focus of Treatment

Abnormal Grief Reaction

Agoraphobia

Anger Management

Autism Spectrum

Bipolar disorder with psychosis

Bipolar disorder without psychosis

Borderline Personality Disorder

Depression

Dementia

Eating Disorder

Generalised Anxiety Disorder

Health Anxiety

Obsessive Compulsive Disorder

Other (please Detail)

Other Personality Disorder

Other Psychosis

Panic Disorder

Post-Traumatic Stress Disorder

Psychosexual difficulties

Schizophrenia

Sleep problems

Social Phobia

Specific Phobia

DCAQ and A12 Agreement on core data set (i)


Dcaq and a12 agreement on core data set ii

Psychological Therapies List

Acceptance and Commitment Therapy

Behavioural Family Therapy

Cognitive Analytical Therapy

Cognitive Behaviour Therapy

Cognitive Behavioural Analysis System of Psychotherapy

Counselling

Dialectical Behaviour Therapy

Eye Movement Desensitization and Reprocessing (EMDR)

Solution Focused Brief Therapy

Interpersonal Therapy

Mentalisation

Mindfulness Based Cognitive Therapy (MBCT)

Motivational Interviewing

Psychodynamic / psychoanalytic Psychotherapy

Schema Focused Therapy

Solution Focussed Therapy

Systemic Therapy

Other - to be reviewed after 4 weeks

DCAQ and A12 Agreement on core data set (ii)


Dcaq and a12 agreement on core data set iii

Group Work

Manage your mood - CBT

Manage your anxiety - CBT

Introduction to Therapy

Mindfulness - CBT

Survive and Thrive

Recovery and Support

Relaxation

Coping Skills Anxiety management - CBT

Overcoming depression - CBT

Assertiveness - CBT

Beyond sexual abuse

Survive and Thrive (planned)

DCAQ and A12 Agreement on core data set (iii)


Dcaq a12 and mental health transformation station

DCAQ, A12 and Mental Health Transformation Station

  • Mental Health Transformation Station – using outcomes measures in routine clinical practices

  • Understanding why

  • Understanding how the team works

  • Collective ownership and understanding – recognising the values

  • Simple, transferable solutions


Dcaq and a12 and outcome measures agreement on core data set iv

DCAQ and A12and Outcome Measures Agreement on core data set (iv)

  • Use of CORE 34 for all conditions

  • Use of additional outcome measures for depression

  • And other measures for specific conditions as we progress


Supported by i m t pims

Supported by I M & T – PIMS

  • Adding Primary reason for treatment as coding type – alongside DSM4 and ICD10

  • Psychological therapy specific waiting lists

  • Capture of CORE 34 scores on individual patient records – date stamped

  • Process mapping – training – patience!

  • Data inputted using new model – 22 August


Reflections

reflections


What you may hear

“Not sure how you are going to meet your target”

Be in your interest to tighten up referral criteria have less people referred

Really hard to describe what we do under one model

The data reports we get are wrong

Ownership

Ensuring people get the therapy that will most benefit them

Rubbish in - rubbish out

What you may hear…


What you need to remember

What you need to remember

  • Priority is the person being seen

  • Fear of lifting the stone

  • Different pressures

  • How to measure the therapeutic relationship

  • Positioning of psychological therapies over other intervention/ treatment

  • Fidelity to psychological model

  • People don’t always “get better”

  • Breadth of change - It’s not about you

  • Care and understand what it must feel like to be on a waiting list

  • Different languages people use


Being grounded

Being grounded…

  • How many people need psychological therapies?

  • How many people are referred for them?

  • How long have they been waiting?

  • What are they waiting for?

  • Why that therapy?

  • And is the / has the therapy made a difference?


Learning to date

Learning to date

  • The data now matters to everyone – the service users, the teams, the organisation

  • The value of the right level of oversight (ie project sponsor to make things happen, assistant to take pressure off clinicians and who can deliver quickly)

  • Strengthened relationships and sustainable skills and interfaces with other projects

  • DCAQ not a one-off – model for delivery of A12


Outcome

Outcome

  • How many people need psychological therapies?

  • How many people are referred for them?

  • How long have they been waiting?

  • What are they waiting for?

  • Why that therapy?

  • And is the / has the therapy made a difference?

  • We will be able to answer that question for East and Midlothian

  • Actively review the dataset – and assess fitness for purpose


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