Older People and IAPT: Commissioning Guidance to Date

1. Older People and IAPT: Commissioning Guidance to Date Dr. Olga Horgan Team Leader, Salford Later Life Psychology Service in Primary Care Greater Manchester West

2. Content of Today’s Talk • Background to development of Commissioning Guidance • Overview of the Content of Commissioning Guidance • A closer look: Benefits, Principles, Care Pathway

3. Background to development of Commissioning Guidance

4. Background to development of Commissioning Guidance • IAPT extended to include older people during its first 3 years. • Access for older people to IAPT sites significantly below what would be expected. • Barriers at all levels - Referrers; Older People; Service Level

5. Background to development of Commissioning Guidance Access for older people = KEY ISSUE PSIGE + National IAPT Programme + Key Organisations have been working together

6. Stakeholders day in June 2011: 4 Working Groups 1. Develop commissioning guidelines for older people in IAPT services 2. Ensure IAPT workforce competency in delivering psychological therapies 3. Consider how older people with MCI and dementia and families/carers are accommodated and signposted within IAPT services 4. Highlight adaptations and collaborative care required for older people with long term health conditions (LTCs).

7. Overview of the Content of the Commissioning Guidance to Date

8. Understanding the benefits to older people, existing services, the wider economy Overarching clinical principles for service providers Service model & care pathway Workforce planning & development Stakeholder engagement Needs assessment & gap analysis Understanding the market Commissioning for outcomes Content Overview

9. A Closer Look: , Benefits, Principles and Care Pathway

10. Understanding the Benefits Health & well-being benefits – Psychological, social, psychological Benefits to other services – Competent workforce, effective risk management, effective treatments Wider economic benefits – Services, individual

11. Clinical Principles for Service Providers AT ALL STAGES OF THE PATHWAY: Collaborative and systemic working

12. Clinical Principles for Service Providers Person-centred: sensitivity to physical, psychological, cognitive, sensory, and environmental needs and presentations of older people AT ALL STAGES OF THE PATHWAY:

13. Clinical Principles for Service Providers AT ALL STAGES OF THE PATHWAY: Awareness of mental health history, life , developmental context, personal & professional relationships on presentations

14. Clinical Principles for Service Providers • Ongoing supervision at each stage of the pathway from a qualified person specialising in older people’s psychology • Ongoing CPD in relation to older people’s psychological needs for therapists, at each stage of the pathway.

15. Care Pathway Demonstrating Principles of an Effectual and Successful Care Pathway

17. ACCESS Must be accessible to older people Consideration of need to adjust for sensory/physical/cognitive function Opt-out rather than opt-in Suitable location of appointments Reminder/prompts re appointments Assertive review of non-attendance LTC pathway Or Dementia & Carers pathway ASSESSMENT: TREATMENT DECISIONS Assessment carried out by clinician skilled in later life mental health, using measures and tools validated for older people. Choice of treatment discussed with patient Targeted PROMOTION of service to older people; clear access criteria; self-help materials relevant to older people; active monitoring using measures relevant to older people TREATMENT Step 1: Referral to service Sources include self-referral, GPs, community services for older people, voluntary sector, other primary care health professionals, hospital staff Pt declines treatment or treatment not appropriate. Discuss ways forward with pt – e.g. signposting to other services. Referrer promptly informed of outcome ONGOING SUPERVISION AND CONSULTATION BY CLINICAL PSYCHOLOGIST SPECIALISED IN LATER LIFE MENTAL HEALTH ONGOING MONITORING OF SUCCESSFUL NAVIGATION OF THE PATHWAY BY “OLDER PEOPLE’S CHAMPION”

18. TREATMENT Specialist mental health services, including step 4: Psychological therapy services specialists for older people LTC pathway Or Dementia & Carers pathway Where onward referral is required, and pt consent given, treatment outcomes to be communicated to new team TREATMENT Step 3: High-intensity interventions; adapting delivery appropriately for physical/sensory/cognitive abilities ASSESSMENT: TREATMENT DECISIONS Assessment carried out by clinician skilled in later life mental health, using measures and tools validated for older people. Choice of treatment discussed with patient Discharge or onward referral Outcome measures validated for older people; appropriate frequency Pt ends treatment andconsents for outcomes to be communicated to referrer, inc ongoing monitoring and follow-up TREATMENT Step 2 Low-intensity intervention using materials appropriate for older people; adapting delivery appropriately for physical/sensory/cognitive abilities Pt declines treatment or treatment not appropriate. Discuss ways forward with pt – e.g. signposting to other services. Referrer promptly informed of outcome ONGOING SUPERVISION AND CONSULTATION BY CLINICAL PSYCHOLOGIST SPECIALISED IN LATER LIFE MENTAL HEALTH ONGOING MONITORING OF SUCCESSFUL NAVIGATION OF THE PATHWAY BY “OLDER PEOPLE’S CHAMPION”

19. Any Questions?