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 Learning and Reflections
DCAQ Phase One Phase One Deliverable Progress
Develop a high level understanding of service processes.
Completed
Identify and implement immediate service improvement opportunities.
Partially completed - improvement opportunities identified but none implemented to date.
Gather appropriate information to undertake a detailed DCAQ analysis.
Partially completed - some of the data to complete a full analysis is not currently available. This report makes recommendations on how to address going forward.
Complete the DCAQ analysis and agree further areas for service improvement activity.
Partially completed - not able to complete full analysis due to lack of data, however partial analysis completed and a range of improvement opportunities recommended in this report.
Phase I : Outcomes
Partially completed because DCAQ data…
not collected or
not collected consistently or
not reflective of realityor
Conflicting – more than one source
DCAQ Phase 2
Addressing the data issues Solid project governance
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
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 (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 (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, 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 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
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
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 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…
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
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
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