Enhancing IAPT Outcomes1: How to sustainably improve recovery and reliable improvement rates through reflective service review. David M Clark National.

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Presentation transcript:

Enhancing IAPT Outcomes1: How to sustainably improve recovery and reliable improvement rates through reflective service review. David M Clark National Clinical Advisor

The IAPT Approach to Outcome Measurement Traditionally NHS has been very poor at measuring and reporting mental health outcomes. CORE team markedly improved the position with CORE-OM BUT only a minority of people still had pre and post treatment scores (38% Stiles et al, 2007) A tragedy pointed the way forward

Omagh Treatment Study (Gillespie, Duffy,Hackmann & Clark, 2002, Behav Res Ther) Drop-in community therapy service created. No guarantee clients would come back to the next therapy session. Measures of PTSD and Depression given EVERY session to ensure clinical end-point available. A novel approach for the therapists. 86% of patients had pre and post PTSD scores. Outcomes as good as RCTs. Presenting outcomes to government released funding to create Northern Ireland Centre for Trauma & Transformation

IAPT Pilots (Doncaster & Newham) (Clark, Layard, Smithies, Richards, Suckling & Wright, 2009, Behav. Res.Ther) Adopted Omagh principle of session by session measures (PHQ & GAD) to achieve high completeness rates. BUT some people felt it would be too burdensome for patients and it wasn’t necessary as missing data doesn’t really matter. SO Core-OM at pre and post only was also deployed.

IAPT Pilots (Doncaster & Newham) (Clark, Layard, Smithies, Richards, Suckling & Wright, 2009, Behav. Res.Ther) Session by session outcome system produced excellent pre-post data completeness (99% in Doncaster, 88% in Newham). Traditional Pre-Post system (CORE-OM) did not (56% in Newham, less in Doncaster). It was clear that missing data really matters. We tend to over-estimate how good are services are when we have missing data.

Why getting complete data matters. (Clark, Layard, Smithies, Richards, Suckling & Wright, 2009, Behav. Res.Ther)

IAPT Minimum Data Set Session by session depression and anxiety measures Stringent recovery and improvement indices Detailed information about personal characteristics (age, ethnicity, gender) clinical condition (ICD-10 codes), type of treatment, stepping, number of sessions etc Nationally IAPT services now achieve 97% completeness of pre and post measures

How outcome measurement helps Guides therapy at the individual level. Allows services to reflect, launch innovations and see whether they help (today’s session). Allows benchmarking of services against each other to help services and commissioners to learn from each other. Produces public transparency (tomorrow).

Thank You