senior pwp network 24 april 2018 - nhs senate yorkshire health/senior pwp net… · • andy...
TRANSCRIPT
www.england.nhs.uk
• Andy Wright, IAPT Advisor, Heather Stonebank, Lead PWP Advisor and Sarah Boul, Quality Improvement Manager
• [email protected], [email protected] and [email protected]
• Twitter: @YHSCN_MHDN #yhmentalhealth
• April 2018
Yorkshire and the Humber
Mental Health Network
Senior PWP Network
24 April 2018
www.england.nhs.uk
Yorkshire and the Humber
Senior PWP Network
Welcome, Introductions and
Apologies
Andy Wright, IAPT Advisor, Yorkshire and the Humber
Clinical Network
www.england.nhs.uk
Yorkshire and the Humber
Senior PWP Network
Raising Self-Awareness and
Wellbeing
All
www.england.nhs.uk
Happin
ess
Life Approach
Since January 2018 plot your emotional highs and lows –
things, situations, people that had an impact.
What was the situation? How did you feel at the time?
Raising Self-Awareness and Wellbeing
www.england.nhs.uk
• With the person next to you talk through your life
line.
• What did you learn from those experiences?
• Were there any patterns or themes?
• How are you going to take that learning positively
into the future?
Raising Self-Awareness and Wellbeing
www.england.nhs.uk
Choose your future!
Challenges and difficulties will
happen.
It is about how you respond/react
Raising Self-Awareness and Wellbeing
www.england.nhs.uk
Yorkshire and the Humber Senior PWP Network
Time for a break?
15 minutes only please!
www.england.nhs.uk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation: York and Selby Improving Access to
Psychological Therapies Service
Jasmine Turnbull and Lorraine Fourie,
Senior PWPS, York and Selby IAPT
We cover: York
Selby
Easingwold
Tadcaster
Pocklington
Population upwards of 351,000
Commissioned by the Vale of York CCG
Vale of York
Mainly rural aside from York city centre with small market towns
Generally affluent area
Small pockets of deprivation
Higher proportion of 20-24 year old due to the two universities
Higher percentage of the population than the national average is aged
50+
What happened in 2017 Lots of changes in the service:
Long waiting times for clients
Involvement of IST
Development of ‘Interim Pathway’ - combination of 1-1 sessions and
psychoeducational course sessions for clients
Pathway in place for all modalities: PWP, CBT, Counselling
New Pathway then developed:
Wellbeing Course first intervention to be offered for all clients aside from
exceptions:
PTSD, social anxiety, under 18’s, communication difficulties
Development of the Wellbeing Course
in 2017 Lots of changes in the service
Previously 3 groups
Stress Control (Jim White)
Improve your mood (BA group)
GAD (Dugas model) interactive group 2hrs in length
All 6 weeks and lecture style format with some group involvement
Evaluated groups and decided to continue due to recovery and
attendance rates
Problems: Staff sickness, annual leave and shortness of staff
Wellbeing Course 2017
Rolling course - clients could start at any point
8 weeks in duration (Minimum of 6 to be attended)
Made it difficult to monitor attendance
Large course numbers (70)
Low rate of response for reviews
Clinicians felt improvements could be made & the course condensed –
concerns about accessibility of an 8 week course for clients
No data due to incorrect tracking and PARIS input
Rapid Process Improvement Workshop
(RPIW) November 2017
Aims to improve the process of clients accessing the service
Focus on the Wellbeing Course as the main point of entry for most
Courses had a start and end date for monitoring purposes – although no gaps in
delivery for 2 week target
Evening course provided to improve access
Course workbook developed
Feedback forms improved for effective monitoring
Risk management protocol discussed in detail
Clients at higher risk of suicide or self harm now an exception for the course
Wellbeing course 2018 6 week course
3 groups run simultaneously (One evening and two day - 2 week’s
apart)
1 hour sessions
Introduction to CBT and Goal setting
Understanding Anxiety and Lifestyle Factors
How our Behaviours Affect our Wellbeing
Thought Challenging and Worry Management
Relaxation and Sleep
Maintaining Progress and Review
Clients offered a review of therapy after session 6
Data from group Day groups
Average 48 people on register before start and 38 attending
31.5% recovery rate
59% reliable improvement
Evening groups
65 people on the register before start and 44 people attending
38% recovery rate
62% reliable improvement
Data from group Similarities of groups
20-25% drop out/cancelled before sessions started
70-75% completion rate
25-28% drop out rate during the group
25-30% of people accepted reviews after course
Of those people 20-30% were stepped up for further treatment
77% of attendees scored Moderate – Severe for GAD 7 at start of group
51% of attendees scored Moderate – Severe for PHQ 9 at start of group
Data from group Positives:
Drop out rate low
Feedback from clients consistent with Data for attendance rates
Completed treatment rate high and people being stepped up is low
Positive changes can be made from data
Negatives:
Inconsistent data capture
Reason for discharge
Lack of admin support
Missing data values
No current theme or significant correlation between groups
Feedback from service users It conceptualised my situation, put it into words and made me feel less
alone/isolated
Really grateful for this course and being able to get on it so quickly when I was in
a very dark place
The course has been really well presented and I’ve looked forward to attending.
All of the presenters are very knowledgeable and empathetic
Still think it’s such a shame that our ideas are not shared in the session. I feel
talking and sharing is so important in mental health but I understand that some
people would be uncomfortable to share! Loved today’s session though, very
useful. I will definitely be challenging my thoughts from now on!
Informative but overwhelming
SWOT Analysis
Strengths Reasonably quick access for clients
Evening course for those who work full time
Amazing team
New senior management
Retaining staff
Trainee placements
New groups (Step 2 and 3)
Treatment choices
Same building as other services
Weaknesses Recruitment – difficult location and university doesn’t
offer training in York
PARIS
Backlog pathway and transition to new pathway
Opportunities New pathways (LTC, perinatal, students)
Development of groups
Self-referral platform
Website
Threats Newly qualified staff team
Access rates
Agency staff (remote working and training needs)
http://www.valeofyorkccg.nhs.uk/about-us/about-the-ccg/
http://www.valeofyorkccg.nhs.uk/about-us/about-the-vale-of-york/
www.england.nhs.uk
Yorkshire and the Humber
Senior PWP Network
IAPT LTC Service Presentation
Liz Ruth, Senior PWP, Sheffield IAPT
Sheffield – a diverse city
• pop: 575,400 (2016) • 19% BME communities – Caribbean,
Indian, Bangladeshi, Somali, Yemeni, Eritrean and Chinese
• ‘City of sanctuary’ • Student population • Variation in depravation • NHS in Sheffield
IAPT in Sheffield
• Established in 2008 • Working in GP practices and community
venues • Across 4 sector teams • Achieves 18% access target – rising to 23%
in 2018 • Front line interventions Improving Wellbeing Sessions Stress Control cCBT (Silvercloud)
Five Year Forward View for
Mental Health
IAPT Expansion
National Top-up
training curriculum
underway for
PWPs and CBT –
for LTC/MUS
Top-up
training
By 2020/21
1.5 million
people
entering
treatment in
IAPT
1.5 million
people
2/3rds of this expansion –
integrating physical and mental health:
development of Integrated IAPT
Integration
Maintaining
integrity to the key
characteristics of
IAPT and
implementing
national guidance
Evidence-base
Early Implementer Wave 2 Site
Sheffield IAPT-LTC
NHSE
investment &
CCG
commitment
to recurrent
funding
Building on
Pathfinder with
additional
investment
Ambitious
and
transformati
onal bid to
create
systemic
change
Ambitious
bid
Establishment of a
Health and Wellbeing
Service: integrating
with primary care
health and medical
psychology
Establish new
service
Whole pathway
approach to
LTC/MUS from
Step1-Step 4:
Pathway
approach
Context
• LTC spending accounts for ~ 70% total NHS budget1
• At least 30% of people with a LTC also have a co-morbid MH problem2
• Comorbid MH problems interact with and exacerbate physical health problems - raising health care costs by at least 45%3
1. DoH, 2010, in Centre for MH Report 2. Cimpean and Drake, 2011, cited in IAPT Building the Business Case 3. Naylor et al, Kings Fund, 2012
The reality … is that we are seeing more and more people with two or more long term conditions at a time… I suggest it is this expansion of multi morbidity, both in terms of overall numbers and at earlier ages, that is not only impacting on healthy life expectancy but is also the key factor in driving the increase in the demand for health and social care services. Director of Public Health Report for Sheffield 2017
Sheffield
• Almost 40% population have at least one LTC
• 94,110 people have 2 or more LTCs
• Multi-morbidity – increasing and key factor driving increased health and social care demand
• 18% least deprived people in Sheffield have developed a LTC by their 50s cf 40% most deprived
Director of Public Health Report, 2017
Sheffield’s Integrated IAPT
Team • Clinical lead
• Operations manager
• Lead CBT and Lead Clinical Psychologist
• 3 Psychologists working at Step 4 – pathway leads
• 2 psychologists and 11 CBT therapists at Step 3
• 3f/t Senior PWP (4 staff)
• 9 PWP
• Evaluation lead
Key Principles
Mental health promotion
Increase identification of
anxiety and depression in
physical health settings enhanced by
joint training
Integration greater parity of
esteem- part of the multidisciplinary teams within and across the
pathways
Partnership working work with CCG, primary care
and ‘neighbourhoods’ to understand local populations/
key priorities. Developing further partnerships with STH,
specialist services & third sector
Close to home Deliver psychological
therapy at ‘Neighbourhood’ level
Whole pathway approach
Integrate Step 1 to 4 psychological
interventions within condition specific
pathways
Health and Wellbeing Service
Step 1
Joint
Training
Screening/
Identification
Psycho-
education/
Self-Help
Information
Leaflets
Health and
Wellbeing
Online booking/
patient portal in
development
Self-Help and
Training
Resources
Adapted Stress
Control
A range of ‘living
well with’ groups
for LTC/PPS
Silvercloud: LTC
cCBT
Condition-
specific
Guided Self-
Help
Condition-
specific
Group
Interventions
(Co-delivery)
Condition-
specific CBT
1:1
Condition-
specific CBT
Groups eg
CBT for
Health
Anxiety
Transdiagnostic
Group
Interventions eg
MBSR pilot,
MBCT, ACT
Psychological Assessment,
Formulation, Intervention
Consultation, Case Review
Care Planning
MDT
assessment
&
intervention
Step 2
‘First Line’
Step 2
PWP
Step 3
CBT
Step 4
Psychology
Specialist
MDTs
Stepped Interventions for LTC/MUS
10 Condition Pathways
1 Pain/MSK
2 COPD
3 CHD (including non cardiac chest pain)
4 IBS
5 CSF/ME
6 Generic Long Term Conditions (including dermatology)
7 Health anxiety
8 Diabetes (Type 1 and 2)
9 Generic MUS/PPS
Cancer (following successful treatment) 10
The Bio-Psycho-Social
Model Biological factors
(disease & other bodily changes)
Social factors (family, relationships,
support)
Psychological factors
(thoughts feelings & behaviours)
The experience of illness
Living well after cancer
treatment – psycho education
course
To book a place: Website: www.iaptsheffield.shsc.nhs.uk Telephone: 0114 271 6568
Case study
• GR – female, 34 years old
• 10 year history of depression
• 1 year history back pain – herniated disk
• Managed with medication and awaiting surgery
• Unable to work 9 months
• Living well with back pain course (co-facilitated with physioworks)
• 3x PWP appointments – sleep
• PHQ-9: 19-9 GAD-7: 10-7 Brief Pain inventory: 21/59 -12/29
Outcome Measurement • Mental health outcomes: session by session outcome measures will be completed as usual
• Perception of physical health: it is important to measure service users’ perceptions of their LTC as the
therapy progresses in order to ensure that treatment focuses on the whole person
• Healthcare utilisation: it is expected that the treatment of mental health problems will reduce a person’s
use of other health service resources. Documenting this effect will be important for sustaining IAPT- LTC
services. The Client Service Receipt Inventory (CSRI) will help to document reduction in health care
costs. In the longer term, this self-report measure will be complemented by linking the national IAPT
database with other National NHS datasets
• Patient-reported experience measures (PREM): will measure the quality of a person’s experience of
the service.
Integrated IAPT - Ambitious programme Contributions to:
• Ensuring parity of esteem between MN and PH by 2020; increased access to talking treatments (FYFW)
• Effective management of long term conditions and personalised care (FYFW)
• Challenging organisational and conceptual division between mental and physical health, as a barrier to improvement in health care (Annual Report of CMO, 2013; Kings Fund)
• Educating and training physical health practitioners in mental health (Closing the Gap, 2013)
Outcomes so far
• Small numbers so far
• Outcomes from ‘Living Well with…’ are Comparable with Stress Control
• Ongoing evaluation
Qualitative feedback • ‘Yes the cancer’s gone, but I’m not alright...[this course]
makes it more normal to be feeling like this.’
• ‘The emotional side of your treatment plan is as important as radiotherapy and surgery, this course is fantastic’.
• ‘What you’ve described [about the impact of Living after cancer treatment] is true…this is what it’s like.
• ‘I’m learning more about myself and what I can do’
• ‘You explain it [how I feel] in a way that I can relate to…so that I can understand and work through it.’
• ‘If I wasn’t here I would be sat wallowing at home. I’ll be sad when it ends…talking and listening to other people helps.’
• ‘I start to understand what the problems are and some strategies
The future: opportunities and challenges
• Access targets
• Data collection
• BME access
• Small PWP rescource
• Integration with physical health teams
• Patient awareness
Thank you for your time
Any questions? [email protected]
www.england.nhs.uk
Yorkshire and the Humber Senior PWP Network
Time for a break?
15 minutes only please!
www.england.nhs.uk
Yorkshire and the Humber
Senior PWP Network
Promoting Resilience and
Self-Reflection
All
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Aim of the Session
To understand more about
resilience and look at how to use
different strategies to be resilient
and self-reflective in the Senior
PWP role.
www.england.nhs.uk
What is resilience?
Resilience is the ability to bounce
back from difficult situations and to
see problems as opportunities for
learning and growth.
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What is self-reflection?
Self reflection is like looking into a
mirror and describing what you see.
It is a way of assessing yourself and
your ways of working.
www.england.nhs.uk
Why is resilience and self-reflection important
in the Senior PWP role?
Resilience helps us to be:
• Happier
• Healthier
• Adaptable
• Able to achieve what we want to achieve
Self reflection is an is an important part of learning.
Spending time thinking about your own skills can help you
identify changes you might need to make.
www.england.nhs.uk
Resilience and Self-Reflection Discussion:
Consider the following questions, in the context of
your role as a Senior PWP, and capture your
thoughts on the template provided on the table:
1. On a scale of 1-10 (1 low; 10 high), how resilient
are you?
2. In what situation do you find it most difficult to be
resilient?
3. How could you become more resilient?
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Courage does not always roar.
Sometimes courage is the quiet voice at
the end of the day saying,
“I will try again tomorrow”.
www.england.nhs.uk
Yorkshire and the Humber
Senior PWP Network
Feedback from the IAPT Providers’
Network
Heather Stonebank, Lead PWP Advisor,
Yorkshire and the Humber Clinical Networks
www.england.nhs.uk
Questions for discussion
• Are you getting the most out of your SPWP’s for example they are really interested in the data
• How are you encouraging the integration of learning from the SPWP network in your service?
• How can we develop SPWPs leadership potential?
• What key messages does the provider forum want to send to the SPWP network?
www.england.nhs.uk
Are you getting the most out of your SPWP’s
for example they are really interested in the
data
• Acknowledgement that it is important to share
recovery rate data with Senior PWPs and PWPs
• Data needs to be shared with Senior PWPs and PWPs in the form of key messages
• The narrative of data needs to be shared with PWPs to demonstrate and help understanding of the links to the wider picture and service change
www.england.nhs.uk
How are you encouraging the integration of
learning from the SPWP network in your
service?
• Clinical leads and managers really value the network and your attendance and feedback
• Services need to implement a feedback process/meeting to and from the Senior PWPs
• Feedback key messages to PWPs
• Service managers and clinical leads need to invest in the Network, encourage people to attend and then ensure the learning is spread through the service
www.england.nhs.uk
Key message
• Service managers and clinical leads value your
attendance and keen to integrate learning from the
network into service
What next…
Five W’s and How
• who, what, why, when, where and how
www.england.nhs.uk
How can we develop SPWPs
leadership potential?
• How can people access leadership training courses?
• Ensure career path is clear and create room for ambition
• Enabling SPWPs to build on experience e.g. project
management
• Mentoring in place for those taking the step up from PWP
• Create opportunities for Senior PWPs to be involved in
recruitment
• Recognition the PWP role should be recognised as a core
profession
• Invite and include in senior forum meetings
www.england.nhs.uk
Key message
• Service managers and clinical lead keen to support
leadership and development in the role
What next…
• Reflection, what are you already doing, what are the
opportunities
• PDR/LDR - future leadership development
opportunities
www.england.nhs.uk
What key messages does the
provider forum want to send to the
SPWP network?
• Senior PWPs are doing a great job
• It’s can be a challenging role, you work really hard and we really appreciate you
• Recognition of the importance of the Senior PWP role as a role model for others and brilliant support for PWPs
• Seniors should be part of the decision making process
• Senior PWPs to work closely with data analysts
• We want the network to continue and grow
• We will continue to support/encourage Senior PWPs to attend.
• Senior PWPs are important in developing quality of step 2
• How do we retain Senior PWPs? What do you need in terms of development?
www.england.nhs.uk
Reflection
Feedback
• How do you feedback learning from the network?
• Have you integrated any learning which has improved your practice/service?
Data
• Are you having conversations about data?
• What’s working well?
Leadership
• What are you already doing?
• What are the leadership development opportunities?
• What do you need in terms of development?
www.england.nhs.uk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
Video Selfies
Feedback from the National Team
(BIT, Yammer & NHS Choices)
CASPER Plus Training
cCBT Update
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Yorkshire and the Humber
Senior PWP Network
Promoting the PWP Role: Video
Selfies!
Sarah Boul, Quality Improvement Manager,
Yorkshire and the Humber Clinical Networks
www.england.nhs.uk
The National IAPT Programme have concluded
that:
PWPs are an invaluable part of IAPT
services and the mental health
workforce.
The PWP Role:
National Recognition
www.england.nhs.uk
Apparently not!
As a relatively new role, we hear that
healthcare professionals outside IAPT, and
the general public, often don’t know what a
PWP is or what wonderful work you do.
The PWP Role:
But does everyone know what you
do?
www.england.nhs.uk
That’s right – video selfies – 60-90 seconds long covering:
• Your name
• Role
• Where you work (you could give us a little tour)
• The type of work you do and the patients you see
• What a typical day looks like
• An example of a piece of clinical work you’ve done or a group you’ve run (whilst maintaining patient confidentiality)
• How you work with GPs and other healthcare professionals.
The PWP Role:
How can we raise awareness?
www.england.nhs.uk
And there’s more!
The national team would also like – video selfies – 60-90 seconds long covering:
• PWPs who are working in specialist areas or
leading innovative projects. For example, this
might include PWPs working in LTC teams, with
BAME communities, in prisons, in management
roles or with older adults.
The PWP Role:
How can we raise awareness?
www.england.nhs.uk
These videos will showcase the breadth of PWP
roles and skills to:
• Commissioners,
• Service leads and
• Other PWPs to encourage their career
development.
The PWP Role:
But why video selfies?
www.england.nhs.uk
• You read the: “Quick guide to filming with a camera phone or small camera”;
• You complete a consent form, which will enable us to use your PWP video-selfie for NHS England communication purposes;
• You get filming for 60-90 seconds;
• You email your completed video selfie to [email protected] via wetransfer.com;
And then you will be…
The PWP Role:
So how do I make a video selfie?
www.england.nhs.uk
• NHS England is collaborating with Behavioural Insights Team (BIT) and the Equality and Human Rights Commission (EHRC) to examine how behavioural insights could be used to increase access IAPT services for underrepresented groups.
• The project will explore inequalities in access to IAPT, particularly by age, gender and race.
• BIT will conduct a review of the behavioural literature, undertake qualitative research for 2 identified population groups, and use the findings to consider how best to increase IAPT usage in the identified groups. A final report will summarise the findings, providing suggestions for behaviourally-informed interventions and how these could be evaluated. We hope that, if feasible, this project will lead to a rigorous trial of one or more of our suggested behavioural interventions to test their effectiveness.
• BIT and the EHRC have agreed the project will focus on BAME groups and older adults.
• BIT are currently in the explore phase and would like to interview staff working in IAPT and service users from the two focus groups. If you want to be involved in this project please email: [email protected]
Feedback from the National
Team - BIT
www.england.nhs.uk
• We have been experiencing some technical difficulties on Yammer due to the move from the nhs.net server. Some members with an @nhs.net email address were no longer able to access Yammer. This has included members of the IAPT national team and the only solution for this problem is to be re-approved using an email address other than [email protected]. If you have experienced this problem please let us know by contacting [email protected].
• In order to re-access Yammer, you will need to be added with an alternate email address to an @nhs.net account. For NHS England colleagues the @england.nhs.uk can be used, or for provider colleagues an @[trust].nhs.uk email address will suffice. Please email [email protected] with the new email address to receive a new invite to join the IAPT Yammer network.
• So in short, the IAPT Yammer network is still in use. We apologise for any inconvenience and we hope for the issue to be resolved soon.
Feedback from the National
Team - Yammer
www.england.nhs.uk
• The National IAPT Programme are working with Ros Hewitt who is the product manager for the mental health project focussing on improving IAPT self-referral on NHS Choices / NHS.UK.
• The work is currently underway and is set to run for 8 weeks during which there will be redesign work, updating content and a “beta” testing of the web pages.
• Ros is looking for a few providers (clinical leads, clinicians, data leads or admin) who would be interested in reviewing and testing the pages.
• Would you like to be involved and is your service information correct?
Feedback from the National
Team – NHS Choices
www.england.nhs.uk
• 3x full day CASPER Plus training sessions held across Yorkshire and the Humber – 90 PWPs/Senior PWPs trained in:
• Collaborative Care (CC)
• Behavioural activation (BA) - working with long term health conditions & older adults
• Functional Equivalence
• Using Functional Equivalence to accommodate long term conditions and role changes
• Staying well
Follow up work with the University of York is also being undertaken – watch this space!
CASPER Plus Training
www.england.nhs.uk
cCBT Workshop: Enhancing Treatment with Digital Technologies
• The Yorkshire and the Humber Clinical Network, in conjunction with SilverCloud, is delighted to be hosting an event focussing on the use of cCBT within IAPT services.
• The event intends to enable attendees to develop their understanding of digital technologies; hear first-hand how SilverCloud has been implemented in a local service, learn how to manage the cultural shift required for cCBT and learn how to utilise data to model an optimised service.
• The event will be held: Wednesday 16 May 2018, 09:30-15:30, Novotel, Leeds.
(Currently fully booked)
cCBT Training Day 16.05.18