Christopher Buckingham, Computer Science, Aston University

1. www.egrist.org Improving care of people with mental health problems using the Galatean Risk and Safety Tool (GRiST) The potential for IAPT services LUFC Elland Road April10th, 2013 Christopher Buckingham, Computer Science, Aston University Ann Adams, Medical School, University of Warwick

2. Risks associated with mental health problems • Suicide • Self harm • Harm to others and damage to property • Self neglect • Vulnerability • Risk to dependents Our research is about better understanding, detection, and management It is aimed at both clinicians and service users It feeds into the GRiST clinical tool and improved services

3. Some of the Research Team Christopher Buckingham, Ashish Kumar, Abu Ahmed University of Aston Ann Adams, & Christopher Mace University of Warwick

4. Evidence about mental-health risks Risk particular cue combinations cue clusters Risk We know a little Risk We know quite a lot independent cues cue interactions specific cue values occurring together We hardly know anything

5. No explicit integration Clinical judgement Risk tool RISK ASSESSMENT

6. Need to connect the information sources Clinical judgement Risk tool holistic RISK ASSESSMENT

7. Data hard to extract

8. Electronic documents: little structure, information buried Yes, this really is an NHS decision support document

9. Data not shared Mon RISK ASSESSMENT Tue RISK ASSESSMENT or exploit the semantic web Fri RISK ASSESSMENT

10. The solution: GRiST • Explicitly models structured clinical judgements • Underpinned by a database with sophisticated statistical and pattern recognition tools. • linked with empirical evidence • Developed from the start to exploit the semantic web • universally available • ordinary web browsers • Designed as an interactive tool with sophisticated interface functionality • Provides a common risk language with multiple interfaces • collecting information • providing advice • Supports shared decision making and self-assessment

11. The solution: GRiST • Versions for different populations • older, working age, child and adolescent • specialist services (e.g. learning disability, forensic) • A whole (health and social care) system approach to risk assessment

12. www.egrist.org

13. Eliciting expertise Knowledge bottleneck • Extracting expertise • Representational language experts understand • Gain agreement between multiple experts • Lowest common denominator ……

14. Unstructured Interview • What factors would you consider important to evaluate in an assessment of someone presenting with mental health difficulties? • prompts or probes to explore further • 46 multidisciplinary mental-health practitioners

18. Mind map with total numbers of expertsresults of integrating interview data • experts • identifies relevant service-user data • “tree” relates data to risk concepts and top-level risks • information profile for service user

19. Different risk screening tools for varying circumstances and assessors XSLT Tree for pruning Lisp or XSLT Lisp Pruned tree Mind map mark up Interview transcripts Coding Fully annotated pruned tree XSLT Qs & layers Data gathering tree with questions and layers that organise question priority Data gathering tree All trees are implemented as XML

20. Multiple populations handled by instructions in the tree • Work on specifying different models done by XML attributes • End-users access their own simple tree • What is XML? <family> <brother “john”/> <sister “mary”/> <daddy “long legs”/> </family>

21. Arboreal sculpture

22. Complete “universal” tree: multiple overlays working age

23. Complete “universal” tree: multiple overlays CAMHS

24. Complete “universal” tree: multiple overlays Older Adults

25. Complete “universal” tree: multiple overlays Service users

26. Complete “universal” tree: multiple overlays Carers

27. Complete “universal” tree: multiple overlays Friends

28. Multiple services • Same idea as populations • Customise service requirements • Difference is that they cover all populations • Services so far: • IAPT • Primary Care • Forensic

29. How not to design and develop • Must be able to meet end-user’s changing and varied requirements

30. Iterative development for implementing research results into evolving GRiST and myGRiST Agile software engineering

33. IAPT demo If the person says yes IAPT version of Grist just 6 screening questions

34. Opens up four subsidiary questions for IAPT If the person says yes

35. Two more IAPT questions are asked.

36. Comments and management information can be added to any questions

37. An overall risk judgement is made along with supporting comments and risk management information

38. Risk reports are generated immediately and can be downloaded as a pdf. This shows a summary just for suicide

39. Each risk has a detailed information profile that explains where the risk judgement came from.

40. Interface functionality comment gold padlock silver padlock red means filled action/intervention

41. Manage patient assessments

42. Service audit data (i)

43. Service audit data (ii)

44. myGRiST

45. myGRiST

46. Communication • GRiST Cloud • common data Data sharing Data exchange Data integration IAPT MH trusts myGRiST PHQ-9 et al Non-health orgs: education, work, community GAD-7 social services GPs Private hospitals

47. Patient-centric web of care

48. Current GRiST database (now twice as big) • 96,040 cases of patient data linked to clinical risk judgements • Different risks • Different age ranges • Precise quantitative input linked with qualitative free text

49. Dissemination Expertise Wisdom

50. How we do it Transparent Knowledge and reasoning can be understood Risk evaluation Risk data f(data) output judgement input data • Black box • Can’t see how answer derived