Newham Improving Access to Psychological Therapies a partnership between

1. Newham Improving Access to Psychological Therapiesa partnership between Newham Health and Community Care Trust East London NHS Foundation Trust

2. IAPT serving BME communitiesDr Ben WrightLead Clinician Newham IAPT

3. London Borough of Newham In East London Population ~250k Very Diverse 61% BME 130+ Languages Deprived 44% live in poverty 20% intense poverty Index of Multiple Deprivation 4th highest in London 15% employment deprivation 10th highest on the Mental Health Needs Index 40% greater demand for mental health services

4. Key Delivery Partners Service Users & Community Groups* Mental Health Matters* (Third Sector Employment Support Provider) Igneus (formerly Work Directions) NHS Newham General Practitioners* Newham Primary Care Trust East London NHS Foundation Trust Third sector organisations NYCT, Harmony, UEL, DAADV

5. Delivering CBT to diverse communities

6. Three Key Messages about Access Access consists of availability, utilization, efficacy and equity We provided multiple entry points Good engagement practices Effective psychological interventions

7. A different kind of service Strong emphasis on access Focus on delivering NICE recommended, evidence based therapies Delivers therapies within a fully integrated stepped care framework Provides evidence of effectiveness using routine outcome measurement

8. Multiple Pathways into Service Flexible engagement Outreach Location Style Method Self referral Present orientated Solution focussed Transparent Hold the tension between acceptance and change. Warmth Respectful Compassionate Collaborative Cognitive case formulationFlexible engagement Outreach Location Style Method Self referral Present orientated Solution focussed Transparent Hold the tension between acceptance and change. Warmth Respectful Compassionate Collaborative Cognitive case formulation

9. Source of Referral

10. Overall BME Access

11. Impact of source of referral on access

12. Impact of source of referral on access for Men Only stat sig is low levels for GP and Other referral for Black men. Only stat sig is low levels for GP and Other referral for Black men.

13. Impact of source of referral on access for Women Stat significant White british GP and secondary referral high White other GP and self high Asian low GP Self other GP Black women low Stat significant White british GP and secondary referral high White other GP and self high Asian low GP Self other GP Black women low

14. Referrals

15. Self referral 22% of all referrals Of these 48% prompted by GP Most of reminder had previous contact with the service

16. Key points GP referrals remain central to access process Must be supplemented by multiple points of access

17. (2) Good Engagement Policies Active engagement Flexible engagement with the clinician Available out of hours, geographically accessible, non-stigmatising locations.

19. Effective psychological interventions

20. Semi-Stratified Care Pathway Ineffective Unsafe InaccessibleIneffective Unsafe Inaccessible

23. Differences in care pathway flow and outcome by BME groups White non-British tended to be referred on to other services more. Slightly more Black / Black British people tended to opt for employment support Slightly greater number of Asian / Asian British people tended to go direct to high intensity Black / Black British people tended to have a higher competition rate for low intensity care and tended to have a higher drop out rate for high intensity care but also a higher recovery rate.

24. Pre-treatment / Post-treatment measure of depression (PHQ) and anxiety (GAD) including therapy drop-outs (n=556, 10% missing)

26. Approaches to caring for people from diverse communities Practical Knowledge Skills Leadership and Service Culture

27. Practical Community networking to promote access and engagement Multi-language advertisement with culturally diverse images Multi-language access out-of hours help line Access to telephone interpreters Access to face to face interpreters IT system that records and provides information on language and individual needs IT system that monitors access and clinical flow through the system Interpreted material (NB Audio)

28. Knowledge Staff training in cultural diversity, cultural competencies in general and specific cultural competencies. Trust training In house training Support and experience in working through interpreters In house expertise staff from different cultures staff experienced in working with different cultures

29. Skills Cultural sensitivity- Shift focus from �educating� to �learning� Cultural competence- Professionals must learn to respect values Adapt treatment techniques to meet service users� needs and demands Planning services-Involve communities/ service users Language & communication

30. Leadership and Service Culture Setting up and maintaining a culture of individual professional responsibility for actively reaching out overcome barriers to promote access NB anti-discrimination is insufficient Passion about really good quality flexible CBT organized around the person�s needs.

31. Leadership and Service Culture How? At interview The service environment & protocols By leadership Maintained in supervision etc

32. Summary of achievements of Newham IAPT (1) Delivered NICE recommended talking therapies for common mental health problems; overcoming the gap between policy and practice.

33. Summary of achievements of Newham IAPT (2) Empowered and informed service user choice Developed and implemented robust information structures to support service users, clinicians and service managers.

34. Summary of achievements of Newham IAPT (3) Provided an integrated service that: educated patients to be their own therapists, improved their well being, reduced the risk of recurrence and promoted social inclusion.

35. Summary of achievements of Newham IAPT (4) Delivered an accessible, popular and effective talking therapy service.