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Newham Improving Access to Psychological Therapies a partnership between

Newham Improving Access to Psychological Therapies a partnership between. Newham Primary Care Trust East London NHS Foundation Trust. Evidence Based Choices & ‘Complexity at the coalface’ Dr Ben Wright Lead Clinician Newham IAPT. Three dimensions of complexity. Complexity of context

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Newham Improving Access to Psychological Therapies a partnership between

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

  2. Evidence Based Choices & ‘Complexity at the coalface’Dr Ben WrightLead Clinician Newham IAPT

  3. Three dimensions of complexity • Complexity of context • (Choice & Access) • Complexity of systems • (Treatment Choice) • Clinical complexity • (Choice outcome)

  4. London Borough of Newham Very Diverse • 61% BME • 130+ Languages Deprived • 44% live in poverty • 20% intense poverty 40% greater demand for mental health services

  5. Access - Pathways into Service Resident in Newham Routine screening of new IB claimants Community Groups GP Occupational Health Secondary MH Self Referral Pathways to work referral Formal referral by professional Telephone Assessment Flexible Engagement, Full Assessment & Treatment

  6. Source of Referral (n=5,064)

  7. Overall BME Access 66% of Newham residents come from BME groups 64% of referrals from BME groups in 2008

  8. Impact of source of referral on access

  9. Impact of source of referral on access for Men

  10. Impact of source of referral on access for Women

  11. Key points • GP referral remain central to access process • Must be supplemented by multiple points of access • Different sub-groups respond differently to access points

  12. Three dimensions of complexity • Complexity of context • (Choice & Access) • Complexity of systems • (Treatment Choice) • Clinical complexity • (Choice outcome)

  13. NICE Clinical Guideline 90 - Oct 2009(partial update for depression guide, Research recommendation) • 4.8 “In people with mild, moderate or severe depression, what system of care (stepped care versus matched care) is more clinically effective and cost effective in improving outcomes?” (Page 51)

  14. Matched Care PathwayUsed in Phase One of National IAPT Pilot, May 2006-07 Other Services Formal High Intensity CBT Referral – Mainly GP Flexible engagement by assistant Assessment by Qualified Therapist Low Intensity CBT

  15. Semi-Stratified Stepped Care Pathway All Referrals Other Services Administrator calls & offers appointments Formal High Intensity CBT Assessment & Intervention  Brief Telephone Assessment (Qualified therapist)  Low Intensity (CBT Based) Assessment & Intervention Employment Support Service

  16. System – care pathway flow – impact on recovery rates

  17. System – care pathway flow – impact on recovery rates

  18. System – care pathway flow- impact on productivity

  19. System – care pathway flow- impact on productivity

  20. Three dimensions of complexity • Complexity of context • (Choice & Access) • Complexity of systems • (Treatment Choice) • Clinical complexity • (Choice outcome)

  21. Outcome of Low Intensity Care

  22. Outcome of High Intensity Care

  23. Equity of outcome • Care pathways did have slightly different treatment of some BME groups (e.g. greater proportion Asian & Asian British people going direct to high intensity) however there were similar recovery rates for different BME groups for both Low and High Intensity care • Having Low intensity care first did not alter drop out rate for High Intensity care.

  24. Conclusion – what is needed? • Clinicians need regular, good quality supervision • Clinicians need easy access to a hierarchy of in-house experts • Includes medical psychotherapy & general psychiatry • Integrated care pathways • Disaggregation reduces access, flow & quality • Good IT system for managing monitoring and directing patients flow through care pathways

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