1. Devon Partnership NHS Trust (DPT) Dan Exley & Antonia Ames
Implementing Silvercloud - The Benefits and Challenges
Devon Partnership NHS Trust (DPT)
Dan Exley & Antonia Ames

2. Presentation Overview
What is ‘Silvercloud’?
Who is it for?
Why does DPT offer Silvercloud?
Challenges
Benefits
A Patient’s Story
Implementing cCBT - Lessons Learnt

3. What is ‘Silvercloud’? cCBT package with numerous programmes
Supported by PWP via flexible online reviews
Customisable content
Varied content – formulations, videos, quizzes

4. Who is it for?
Covers a wide range of presentations and includes the core IAPT low intensity interventions
Patients that are sufficiently motivated and confident in using computerised guided self-help
Those with low risk
Antonia - Demo

5. Choice of Programmes
There are several different programmes available, depending on the patient’s needs.
All have similarities and there are some very similar ones (e.g. GAD and anxiety) but it can be worth reminding yourself of the content of each one before deciding either yourself or with the patient, which would be most suitable.
I will go through two programmes – one for depression, and one more specifically for OCD.

6. Common Themes

7. Common Themes

8. Space from Depression
Each section includes quizzes, stories from other patients and suggested skills.
Patient view – modules to continue, messages etc.

9. Space from Depression
Each section starts with a brief video to explain it

10. Space from Depression
Goes through a quiz to explore patients’ existing knowledge and corrects them if incorrect

11. Space from Depression
Specific tools – encourages patients to think about what could help them.
Also includes other users’ suggestions.

12. Space from Depression
Specific tools – ‘Activity Scheduling’ aka behavioural activation.

13. Space from Depression
Specific techniques – thought challenging/cognitive restructuring

14. Space from Depression
Each programme also includes ‘Bringing it all Together’ – relapse prevention.
Example from anxiety programme.

15. Measures and Risk
Also asks patients to complete questionnaires once per review cycle and to complete questions about risk.
If risk is flagged, automatically s PWP to alert them
However is worth considering whether a patient likely to show risk should be on this programme?
Considerations e.g. what if the PWP is away?

16. Why Does DPT Offer Silvercloud?
Managing volume at step two is an on-going challenge
Five Year Forward View
Offering choice and flexibility to patients
Affordability
Therapist workload

17. Challenges for Patients
Patient expectations
Recovery/Drop-out (29% cf 16%)
Can facilitate avoidance
Change!
Unsuitable for certain patient groups (e.g. risk)

18. Challenges for Service
Therapist resistance
Therapeutic alliance
Can take longer than predicted
Patients can stay on caseloads longer
Unclear protocols for managing DNAs/poor engagement

19. Benefits for Patients
Content is interactive, thorough and user-friendly
Emphasis on skill development
Breadth - less constrained than standard LI protocols
24/7 access – flexible
Suits dispersed population
Can be offered as pure self-help, e.g. if below caseness or waiting for step three
Normalising/Non-stigmatising
Recovery rates are good for those who
engage

20. Benefits for Service Affordability
Links directly to Iaptus via the ‘prism’
Less stressful for PWPs – managing volume
Therapists can consider their responses
Less susceptible to therapist drift

21. What the Patients Say
“I have found the silvercloud work useful. It's definitely calmed me down a bit and helped me get a bit of grip on things”
“I am still worrying but what I'm able to do now is use the tools to help me worry less and really put things into perspective.”

22. What the Patients Say
“ I am starting to feel that I can have some quiet time to reflect on my thoughts and feelings.”
“I have found this course really useful and am certainly feeling better. It good to read that even in the recovery stage you can still feel anxious but that is normal. ”

23. A Patient’s Story
Linda, 41 yrs, living in Princetown with two young children
Symptoms of both depression and anxiety
Nearest clinic – Tavistock (8 miles), no car!
Works shifts including some nights
Difficulty attending phone appointments due to childcare commitments
Signed up to ‘Space from Depression &
Anxiety’

24. A Patient’s Story Weekly online reviews with therapist
Gradual reduction in symptoms over 2 month period
After 7 reviews therapist and patient agreed to discharge to pure self-help
“At first it felt like e-learning but after my therapist explained the importance of putting the skills and tools into practise everything started to change for me”

25. Implementing cCBT - Lessons Learnt
Encourage patients to trial it for a week, include a telephone review at this point
Have a ‘champion’ with responsibility to instruct other PWPs
Incorporating a telephone review after one week can help to reduce drop-out
Prepare patients for the amount of work involved

26. Implementing cCBT - Lessons Learnt
Suggest that patients aim to complete one module per week in min ‘chunks’
Clarify protocols around DNAs prior to implementation
Give a brief demonstration in session if possible
Arrange more thorough training, consider contracting an existing service to provide this
cCBT should be one option of many and no patient should be offered only this option

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