1. Wellbeing Suffolk Clinical Model -Adults
Senior Clinical Team, Wellbeing Suffolk, Norfolk and Suffolk NHS Foundation Trust
May 2017

2. Referrals
Self-referral for 16 + yrs 8am to 8pm tel or 24/7
Professional referral via letter, website or

3. Step 1 Advice and Consultation
For health and care professionals working with adults, CYP, families
Every surgery and school have a named contact

4. Triage To determine primary or secondary care or other services
Service criteria for 16 + : common mental health problems, have a goal to work towards, risk manageable at primary care level
Not suitable for when presenting problems indicate short-term interventions aimed at self-management not recommended by NICE

5. Triage outcomes Suitable for Wellbeing: Intro to wellbeing
Stress control course
Intro to mindfulness
Wellbeing Advice Session
Not suitable for Wellbeing:
Step up to AAT
Signpost to other community services

6. Introduction to Wellbeing
Often the 1st step on patient journey
Intro of options available : step 2 courses, Silvercloud, WAS, partners, discharge

7. Step 2 courses Psychoeducational courses based on adult learning
Level of interaction varies
4-week courses on stress, depression, anxiety management
Review if not recovered

8. Guided online self-help
Silver Cloud – online guided self-help package consisting of self-help modules; progress reviewed and guided by therapist

9. Wellbeing Advice Session
Tel or face to face to identify treatment goals and best way forward
Outcomes:
Intervention within Wellbeing – most often step 2 course at this stage either on traditional IAPT pathway or Resilience pathway
Partners
Step up
Signpost

10. Step 2 one to one Guided self help Low intensity CBT
Short term 4-6 sessions, typically over telephone
Evidence based
BA; CR; exposure therapy; problem solving; anxiety management
Step up if not recovered

11. Step 3 Typically after Step 2
Automatic step up if PTSD or social phobia
Short term
Evidence based
Courses: LSE, MBCT, MBSR
One to one: CBT, IPT, IPT-A, Counselling for depression, Couples counselling, EMDR

12. Monitoring Progress
IAPT dataset, minimum PHQ-9 as measure of depression and GAD-7 as measure of anxiety
At every session
Monitoring progress
Appropriate action if improvement/deterioration/no change
Recovery metric: 50 % of IAPT therapy pathway clients recovered at the end of treatment
Recovery = PHQ-9 at 9 or below and GAD-7 at 7 or below

13. Discharge Mutually agreed
Dependent on achievement of recovery and goals, appropriateness of service, whether right time to make changes
DNA policy
Relapse Prevention
Re-referral

14. Correspondence / Sharing of Information
Communication via letters, s and phone calls
Copies of letters at assessment, review and discharge stages sent to relevant GP practice