USING DATA COLLECTED FROM ROUTINE OUTCOME MEASURES…. ….. to inform practice in Psychological Therapies Services Dr Patricia Graham & Maureen Mckenna

WHERE OUR STORY BEGAN ACTION LEARNING: QMU

Transformation Station

WHY IS IT SO DIFFICULT TO COLLECT ROUTINE OUTCOME DATA? Action Cluster: Transformation Station

MAIN LEARNING POINT FROM TS  Nothing sinister found re difficulties re use of outcome measurements – Psychology staff very used to it <difficulty  Staff who have been involved in clinical trials very used to it!  Some PT staff not so used to routine O/C and worried to begin with.  Quickly resolved with modelling and routine use.  Main Conclusion: make it easy and remind staff….

CHOOSING OUR MEASURES  Redesign of Services for Psychology in NHSLothian  AMH Psychology & PT  Advice from Tayside & Borders  Value in having consistency in the type of outcome measures used and potentially having a larger data base  Use of Mandatory and Minimum Data Sets

MEASURES  A12 meetings agreed on CORE 10 session by session  Proposal: Borders’ adaptation of Tayside submitted to A12 Board  Proposal accepted with some minor changes: Use Primary focus of Treatment  Guidance available; Data to be entered on TRAK  Format of Mandatory Data Set requirements

Assessment (includes assessment clinics) One to oneGroup intervention (where sufficient information is available to rate individual measures) Group intervention (where sufficient information is UNAVAILABLE to rate individual measures) Family interventions eg BFT MeasureInitial Appointment Every following appointment continuing assessment Every treatment appointment to discharge Initial appointment Discharge appointment only Initial appointment Discharge appointment only Initial appointment Every treatment appointment to discharge Primary focus of treatment √ √ √ √ CORE 10√√√√√√√ CGI-S√√√√√ CGI-I √√ √ √ (based on family) PGI-I √√ √ √ Format of Mandatory Data Set Requirements for Therapeutic Interventions : General Adult Mental Health

….. TO INFORM PRACTICE IN PSYCHOLOGICAL THERAPIES SERVICES

CLINICIAN DISCHARGE REPORT Patient Details  Name – A Patient  CHI  Date Admitted – 1/4/14  Date Discharged – 3/11/14  No of attends - 8  No of DNA - 1 Therapy Details  PFOT – start – PTSD  PFOT – end – Complex PTSD  Matrix Level - start – 3  Matrix Level - during – 4  Treatment Model - EMDR  CORE – start – 31 (severe)  CORE –end – 5 (healthy)  CGI-S –end –Normal  CGI-I – end – Much improved  PGI-I - end – Much improved

USING THE MEASURES IN SESSION  Focusing the session  Understanding improvements  Understanding and normalising increase in symptoms e.g. Exposure to trauma  Feedback at the end of therapy – journey forgotten

USING THE MEASURES IN SUPERVISION  Supporting the clinician – not policing  Assisting the clinician to better understand the patients formulation and future treatment  Having data now to quantify change or increase in symptoms  Identifying training needs  Reflecting on patient groups which the clinician works well with and being able to maximise this

IMPROVING RECORDING  Paper Audit  Move to TRAK  Guides for TRAK  Visits to teams – reassurance, culture change  Reusable measures to reduce paper in files

IMPROVING RECORDING  TRAK Audit  System issues  Compliance report  Two teams focusing on data improvement  Feedback to Team Leads, Service Leads

PLANS FOR FURTHER DATA IMPROVEMENT  TRAK online videos  Reports for teams – patient report, clinician discharge report  Moving to use in supervision

GROUP SERVICE  Plans for expansion to the service  Gathering data on our innovations  Informing future practice

FUTURE PLANS  Adding in the minimum dataset (not decided yet)  No we can start to analyse the data – by condition, by matrix level, by model  Assisting us to understand how the research translates to practice... Real life.  Dosage of treatment for more complex conditions – we don’t know that yet – can we start to understand this?

MANDATORY AND MINIMUM  Mandatory: Refers to a valid data set that can be used across services by clinicians delivering psychological therapy at every session  Minimum: Refers to the least number of agreed service/disorder specific outcome measures used in addition to Mandatory Data Set