USING DATA COLLECTED FROM ROUTINE OUTCOME MEASURES….

….. to inform practice in Psychological Therapies Services

Dr Patricia Graham &

Maureen Mckenna

WHERE OUR STORY BEGAN ACTION LEARNING: QMU

Action Cluster?Research Cluster?

Knowledge Cluster?

Are you a...

Identify cluster’s

knowledge needs

Available from NHS

Lothian

Not available from NHS

Lothian

Database academic

involvement

Develop evidence

based summaries

Arrange audience-

tailored sharing methods

Re-evaluate needsIdentify type of

knowledge (systematic

review, audit, new research)

Appropriate for rapid TS intervention

Yes

NoConsider for inclusion as

Research Cluster

Consider inclusion as Action Cluster

Provide support/rapid intervention

Knowledge relevant,

accessible, applicable?

Identify change champions &

senior sponsor

Referral systemsAssessment packages etc

Support cluster to develop change

plans

Construct infrastructures to support changes

Yes

No

Continue with staged changes

Document learning from

Cluster

Consider for progression to

Research Cluster

e.g.

New Knowledge Skills training for

practitionersConsider for inclusion as Knowledge

Cluster

Build ‘yellow pages’ of research expertise/

activities in NHS Lothian

Generate knowledge of greater priority,

relevance, practicality & transferability

Develop engagement between Knowledge/

Action Clusters & academic partners

Develop engagement between Research Cluster & academic

partners

Facilitate development of joint research proposals

Support potential MSc/Prof Doc post-reg students

around strategic objectives

Consider inclusion as Action Cluster

Include outcomes in Knowledge Cluster system

For instance, a Research Cluster may also be included as an Action Cluster to support the implementation of their findings,

or

a Knowledge Cluster may find that there is no available evidence for there needs & wish to be involved in producing this as a Research Cluster.

The three clusters are not mutually exclusive or arranged linearly & the period spent working with the Transformation Station will vary dependent on need, context & circumstance

The processes shown here are simplified examples of possible support offered by the Transformation Station.

The project is designed to be flexible and sensitive to individual cluster needs and does not intend to impose a predesigned plan.

An included cluster can participate in one, two or all three of the cluster processes.

Transformation Station

WHY IS IT SO DIFFICULT TO COLLECT ROUTINE OUTCOME

DATA?

Action Cluster: Transformation Station

MAIN LEARNING POINT FROM TS

Nothing sinister found re difficulties re use of outcome measurements – Psychology staff very used to it <difficulty

Staff who have been involved in clinical trials very used to it!

Some PT staff not so used to routine O/C and worried to begin with.

Quickly resolved with modelling and routine use.

Main Conclusion: make it easy and remind staff….

CHOOSING OUR MEASURES

Redesign of Services for Psychology in NHSLothian

AMH Psychology & PTAdvice from Tayside & BordersValue in having consistency in the type of outcome measures used and potentially having a larger data base

Use of Mandatory and Minimum Data Sets

MEASURES

A12 meetings agreed on CORE 10 session by session

Proposal: Borders’ adaptation of Tayside submitted to A12 Board

Proposal accepted with some minor changes: Use Primary focus of Treatment

Guidance available; Data to be entered on TRAK

Format of Mandatory Data Set requirements

  Assessment (includes assessment clinics)

One to one Group intervention (where sufficient information is

available to rate individual measures)

Group intervention (where sufficient information is

UNAVAILABLE to rate individual measures)

Family interventions eg BFT

Measure Initial Appointment

Every following

appointment continuing

assessment

Every treatment

appointment to discharge

Initial appointment

Discharge appointment

only

Initial appointment

Discharge appointment

only

Initial appointment

Every treatment

appointment to discharge

Primary

focus of

treatment

√     √   √   √  

CORE 10 √ √ √ √ √ √ √    

CGI-S √ √ √ √ √        

CGI-I   √ √   √       √ (based on

family)

PGI-I   √ √   √   √    

Format of Mandatory Data Set Requirements for Therapeutic Interventions: General Adult Mental Health

….. TO INFORM PRACTICE IN PSYCHOLOGICAL THERAPIES

SERVICES

28/0

6/20

14

12/0

7/20

14

09/0

8/20

14

16/0

8/20

14

11/0

9/20

14

25/1

0/20

14

05/1

1/20

14

13/1

1/20

14

09/1

2/20

14

12/0

3/20

15

06/0

8/20

150

5

10

15

20

25

30

ML: 4 PFoT: Trauma - Complex TM: CBT

CGI-S: Normal CGI-I: Very much improved

PGI-I: Very much improved

Core 10 Score

22/04/2015 10/06/2015 15/06/2015 06/07/20150

5

10

15

20

25

30

35

40

ML: 3 PFoT: Trauma- PTSD TM: EMDR CGI-S: Mildly ill CGI-I:Very much im-

proved PGI-I: Very much improved

Core 10 Score

CLINICIAN DISCHARGE REPORT

Patient Details

Name – A Patient

CHI - 2503541103

Date Admitted – 1/4/14

Date Discharged – 3/11/14

No of attends - 8

No of DNA - 1

Therapy Details

PFOT – start – PTSD

PFOT – end – Complex PTSD

Matrix Level - start – 3

Matrix Level - during – 4

Treatment Model - EMDR

CORE – start – 31 (severe)

CORE –end – 5 (healthy)

CGI-S –end –Normal

CGI-I – end – Much improved

PGI-I - end – Much improved

USING THE MEASURES IN SESSION

Focusing the session

Understanding improvements

Understanding and normalising increase in symptoms e.g. Exposure to trauma

Feedback at the end of therapy – journey forgotten

USING THE MEASURES IN SUPERVISION

Supporting the clinician – not policing

Assisting the clinician to better understand the patients formulation and future treatment

Having data now to quantify change or increase in symptoms

Identifying training needs

Reflecting on patient groups which the clinician works well with and being able to maximise this

IMPROVING RECORDING

Paper Audit Move to TRAK Guides for TRAKVisits to teams – reassurance, culture change

Reusable measures to reduce paper in files

IMPROVING RECORDING

TRAK Audit System issues Compliance reportTwo teams focusing on data improvement

Feedback to Team Leads, Service Leads

PLANS FOR FURTHER DATA IMPROVEMENT

TRAK online videos

Reports for teams – patient report, clinician discharge report

Moving to use in supervision

GROUP SERVICE

Plans for expansion to the service

Gathering data on our innovations

Informing future practice

FUTURE PLANS

Adding in the minimum dataset (not decided yet)

No we can start to analyse the data – by condition, by matrix level, by model

Assisting us to understand how the research translates to practice... Real life.

Dosage of treatment for more complex conditions – we don’t know that yet – can we start to understand this?

MANDATORY AND MINIMUM

Mandatory: Refers to a valid data set that can be used across services by clinicians delivering psychological therapy at every session

Minimum: Refers to the least number of agreed service/disorder specific outcome measures used in addition to Mandatory Data Set