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Improving access to psychological therapy: Initial evaluation of two UK demonstration sites.

Clark DM, Layard R, Smithies R, Richards DA, Suckling R, Wright B - Behav Res Ther (2009)

Bottom Line: Clinical outcomes were broadly in line with expectation. 55-56% of patients who had attended at least twice (including the assessment interview) were classified as recovered when they left the services and 5% had improved their employment status.Outcomes were comparable for the different ethnic groups who access the services.Issues for the further development of IAPT are discussed.

View Article: PubMed Central - PubMed

Affiliation: NIHR Biomedical Research Centre for Mental Health, South London & Maudsley NHS Foundation Trust & Kings College London, UK. david.clark@kcl.ac.uk

ABSTRACT
Recently the UK Government announced an unprecedented, large-scale initiative for Improving Access to Psychological Therapies (IAPT) for depression and anxiety disorders. Prior to this development, the Department of Health established two pilot projects that aimed to collect valuable information to inform the national roll-out. Doncaster and Newham received additional funds to rapidly increase the availability of CBT-related interventions and to deploy them in new clinical services, operating on stepped-care principles, when appropriate. This article reports an evaluation of the new services (termed 'demonstration sites') during their first thirteen months of operation. A session-by-session outcome monitoring system achieved unusually high levels of pre to post-treatment data completeness. Large numbers of patients were treated, with low-intensity interventions (such as guided self-help) being particularly helpful for achieving high throughput. Clinical outcomes were broadly in line with expectation. 55-56% of patients who had attended at least twice (including the assessment interview) were classified as recovered when they left the services and 5% had improved their employment status. Treatment gains were largely maintained at 10 month follow-up. Opening the services to self-referral appeared to facilitate access for some groups that tend to be underrepresented in general practice referrals. Outcomes were comparable for the different ethnic groups who access the services. Issues for the further development of IAPT are discussed.

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Related in: MedlinePlus

Patient progress: Doncaster.
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fig1: Patient progress: Doncaster.

Mentions: The Doncaster site managed an impressively high number of patients. In the 13 months covered by this report (up to end September 2007), 4451 patients were referred to the programme. Fig. 1 shows what happened to them. 378 patients (8.5%) were deemed unsuitable and a further 967 patients were still in the system, either in treatment or waiting for it. This means that 3102 patients were referred, deemed potentially suitable and completed their involvement with the service in the 13 months (‘concluded cases’). Of these, 877 had no sessions. 42% of the people with no sessions did not contact the service after referral and could not be reached by the service. A further 27% refused treatment. For the remaining 31% non-attendance was mutually agreed between the service and the patient. This means that 2225 concluded cases attended one or more sessions. 571 of the 2225 came only once, and are therefore likely to have only received an assessment and brief advice. Again, they can be split into types of service conclusion. For 44%, the decision was jointly reached between the service and the patient themselves that no further treatment from IAPT was required. For many, they are likely to have been signposted to other appropriate interventions (for example, debt counselling, voluntary groups, etc). A further 22% of patients decided, independently of the service, to refuse further treatment. Finally, 34% were coded as ‘discontinued unexpectedly’; these are people who did not contact the service again after the first session and could not be reached by the service.


Improving access to psychological therapy: Initial evaluation of two UK demonstration sites.

Clark DM, Layard R, Smithies R, Richards DA, Suckling R, Wright B - Behav Res Ther (2009)

Patient progress: Doncaster.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111658&req=5

fig1: Patient progress: Doncaster.
Mentions: The Doncaster site managed an impressively high number of patients. In the 13 months covered by this report (up to end September 2007), 4451 patients were referred to the programme. Fig. 1 shows what happened to them. 378 patients (8.5%) were deemed unsuitable and a further 967 patients were still in the system, either in treatment or waiting for it. This means that 3102 patients were referred, deemed potentially suitable and completed their involvement with the service in the 13 months (‘concluded cases’). Of these, 877 had no sessions. 42% of the people with no sessions did not contact the service after referral and could not be reached by the service. A further 27% refused treatment. For the remaining 31% non-attendance was mutually agreed between the service and the patient. This means that 2225 concluded cases attended one or more sessions. 571 of the 2225 came only once, and are therefore likely to have only received an assessment and brief advice. Again, they can be split into types of service conclusion. For 44%, the decision was jointly reached between the service and the patient themselves that no further treatment from IAPT was required. For many, they are likely to have been signposted to other appropriate interventions (for example, debt counselling, voluntary groups, etc). A further 22% of patients decided, independently of the service, to refuse further treatment. Finally, 34% were coded as ‘discontinued unexpectedly’; these are people who did not contact the service again after the first session and could not be reached by the service.

Bottom Line: Clinical outcomes were broadly in line with expectation. 55-56% of patients who had attended at least twice (including the assessment interview) were classified as recovered when they left the services and 5% had improved their employment status.Outcomes were comparable for the different ethnic groups who access the services.Issues for the further development of IAPT are discussed.

View Article: PubMed Central - PubMed

Affiliation: NIHR Biomedical Research Centre for Mental Health, South London & Maudsley NHS Foundation Trust & Kings College London, UK. david.clark@kcl.ac.uk

ABSTRACT
Recently the UK Government announced an unprecedented, large-scale initiative for Improving Access to Psychological Therapies (IAPT) for depression and anxiety disorders. Prior to this development, the Department of Health established two pilot projects that aimed to collect valuable information to inform the national roll-out. Doncaster and Newham received additional funds to rapidly increase the availability of CBT-related interventions and to deploy them in new clinical services, operating on stepped-care principles, when appropriate. This article reports an evaluation of the new services (termed 'demonstration sites') during their first thirteen months of operation. A session-by-session outcome monitoring system achieved unusually high levels of pre to post-treatment data completeness. Large numbers of patients were treated, with low-intensity interventions (such as guided self-help) being particularly helpful for achieving high throughput. Clinical outcomes were broadly in line with expectation. 55-56% of patients who had attended at least twice (including the assessment interview) were classified as recovered when they left the services and 5% had improved their employment status. Treatment gains were largely maintained at 10 month follow-up. Opening the services to self-referral appeared to facilitate access for some groups that tend to be underrepresented in general practice referrals. Outcomes were comparable for the different ethnic groups who access the services. Issues for the further development of IAPT are discussed.

Show MeSH
Related in: MedlinePlus