Measuring Real-Life Challenges: Lessons & Reflections from NHS Lothian Early Implementer Site

1. Measuring: the real life challenges Lessons and reflections the NHS Lothian Early Implementer Site Linda Irvine Strategic Programme Manager, Mental Health and Wellbeing

2. Overview of Presentation • DCAQ Phase 1 learning and Phase 2 progress • DCAQ and A12 • DCAQ, A12 and Outcome Measures • Learning and Reflections

3. DCAQ Phase One

4. Phase I : Outcomes Partially completed because DCAQ data… • not collected or • not collected consistently or • not reflective of reality or • Conflicting – more than one source

5. DCAQ Phase 2 • Addressing the data issues • Solid project governance

6. 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

7. 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!

8. 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 (i)

9. 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 (ii)

10. 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 and A12 Agreement on core data set (iii)

11. 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

12. 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

13. 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

14. reflections

15. “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 may hear…

16. 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

17. 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?

18. 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

19. 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