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

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

DCAQ Phase One Phase One DeliverableProgress Develop a high level understanding of service processes. Completed Identify and implement immediate service improvement opportunities. Partially completed - improvement opportunities identified but none implemented to date. Gather appropriate information to undertake a detailed DCAQ analysis. Partially completed - some of the data to complete a full analysis is not currently available. This report makes recommendations on how to address going forward. Complete the DCAQ analysis and agree further areas for service improvement activity. Partially completed - not able to complete full analysis due to lack of data, however partial analysis completed and a range of improvement opportunities recommended in this report.

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

DCAQ Phase 2  Addressing the data issues  Solid project governance

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

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!

DCAQ and A12 Agreement on core data set (i) 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 (ii) 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 (iii) 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, 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

DCAQ and A12 and 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

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

reflections

What you may hear…  “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 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

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?

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

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