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Newham Improving Access to Psychological Therapies a partnership between. Newham Primary Care Trust East London NHS Foundation Trust. Evidence Based Choices & ‘Complexity at the coalface’ Dr Ben Wright Lead Clinician Newham IAPT. Three dimensions of complexity. Complexity of context

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newham improving access to psychological therapies a partnership between

Newham Improving Access to Psychological Therapiesa partnership between

Newham Primary Care Trust

East London NHS Foundation Trust

three dimensions of complexity
Three dimensions of complexity
  • Complexity of context
    • (Choice & Access)
  • Complexity of systems
    • (Treatment Choice)
  • Clinical complexity
    • (Choice outcome)
london borough of newham
London Borough of Newham

Very Diverse

  • 61% BME
  • 130+ Languages

Deprived

  • 44% live in poverty
  • 20% intense poverty

40% greater demand for mental health services

access pathways into service
Access - Pathways into Service

Resident in Newham

Routine screening of new IB claimants

Community Groups

GP

Occupational Health

Secondary MH

Self Referral

Pathways to work referral

Formal referral

by professional

Telephone Assessment

Flexible Engagement, Full Assessment & Treatment

overall bme access
Overall BME Access

66% of Newham residents come from BME groups

64% of referrals from BME groups in 2008

key points
Key points
  • GP referral remain central to access process
  • Must be supplemented by multiple points of access
  • Different sub-groups respond differently to access points
three dimensions of complexity12
Three dimensions of complexity
  • Complexity of context
    • (Choice & Access)
  • Complexity of systems
    • (Treatment Choice)
  • Clinical complexity
    • (Choice outcome)
nice clinical guideline 90 oct 2009 partial update for depression guide research recommendation
NICE Clinical Guideline 90 - Oct 2009(partial update for depression guide, Research recommendation)
  • 4.8 “In people with mild, moderate or severe depression, what system of care (stepped care versus matched care) is more clinically effective and cost effective in improving outcomes?”

(Page 51)

matched care pathway used in phase one of national iapt pilot may 2006 07
Matched Care PathwayUsed in Phase One of National IAPT Pilot, May 2006-07

Other Services

Formal High Intensity CBT

Referral –

Mainly GP

Flexible engagement by assistant

Assessment by Qualified Therapist

Low Intensity CBT

semi stratified stepped care pathway
Semi-Stratified Stepped Care Pathway

All Referrals

Other Services

Administrator calls & offers appointments

Formal High Intensity CBT Assessment & Intervention

Brief Telephone Assessment

(Qualified therapist)

Low Intensity (CBT Based)

Assessment & Intervention

Employment Support Service

three dimensions of complexity20
Three dimensions of complexity
  • Complexity of context
    • (Choice & Access)
  • Complexity of systems
    • (Treatment Choice)
  • Clinical complexity
    • (Choice outcome)
equity of outcome
Equity of outcome
  • Care pathways did have slightly different treatment of some BME groups (e.g. greater proportion Asian & Asian British people going direct to high intensity) however there were similar recovery rates for different BME groups for both Low and High Intensity care
  • Having Low intensity care first did not alter drop out rate for High Intensity care.
conclusion what is needed
Conclusion – what is needed?
  • Clinicians need regular, good quality supervision
  • Clinicians need easy access to a hierarchy of in-house experts
    • Includes medical psychotherapy & general psychiatry
  • Integrated care pathways
    • Disaggregation reduces access, flow & quality
  • Good IT system for managing monitoring and directing patients flow through care pathways