1. National Rollout of cCBT

2. Using technology is now a necessity.

3. Demand Continues to Grow
25-30% of all GP consultations involve depression, stress or anxiety
Prescriptions of anti-depressant has doubled in 5 years
Demand on specialist psychology services has doubled in 10 years
75% of people with common mental health problems do not seek treatment

4. Offering large scale, low cost, high capacity solutions
Technology is Part of the Solution
Offering large scale, low cost, high capacity solutions
cCBT = Computerised Cognitive Behavioural Therapy
Video Conferencing = Attend Anywhere
Remote Monitoring = Flo Text Messaging
Artificial Intelligence = Interactive Self-help Guides
SMS Online Digital Therapy
Chat Bots

5. cCBT in Scotland An online self-managed treatment programme
Uses evidence based cognitive behavioural therapy
Been around for over 13 years
Recommended by NICE and SIGN
Consists of 8 weekly 1 hour sessions
Complete in persons own homes or in community locations

6. Services can be delivered at scale

7. 2013: EU MasterMind Project, 3 years 2016: cCBT TEC Programme, 2 years
Implementation Programme
Programme funding across 2 phases
2013: EU MasterMind Project, 3 years
2016: cCBT TEC Programme, 2 years
This was a planned approach for the systematic up scaling of cCBT

8. Progression of cCBT in Scotland
DUMFRIES & GALLOWAY
BORDERS
HIGHLAND
WESTERN ISLES
AYRSHIRE & ARRAN
LOTHIAN
ORKNEY
GLASGOW & CLYDE
GRAMPIAN
FIFE
LANARKSHIRE
SHETLAND
2007: 11% of national population
2015: 44% of national population, funded EU MasterMind Project
TAYSIDE
FORTH VALLEY
2018: 100% of national population, funded by TEC

9. Use the right model

10. Nationally Support Implementation
Existing services feed into national expertise and directly into implementing boards
Expertise and support offered to Health Boards includes policies, key documentation advice and guidance
Implementing Boards in MasterMind able to pass on knowledge and experience to other remaining Health Boards
4 Health Boards
Remaining
Health Boards

11. Set Phases of Implementation
1st Phase: service development, integration into psychology service model, service opens to psychology, early engagement GPs
2nd Phase: continued development, service opens to GPs
3rd Phase: implement marketing strategy
4th Phase: marketing strategy, service improvement
5th Phase: sustainability of service

12. Local Service Model
Patients complete treatment in their homes or community locations such as Libraries
Co-ordinator arranges access to cCBT treatment program
Central Coordination
of service from within psychology
Co-ordinator supports home and community users
All referrals come to one central point using same process
Run with minimal clinical input but support is there when needed
Referrers maintain clinical responsibility and respond to suicide alerts

13. Key Elements of Implementation
Service costs are limited to software licence and administration
Multiple referral routes are created across a number of disciplines
Selection of the right workforce is vital
Early planning and a strategic approach
High level support, commitment and effort in participating boards

14. Data is knowledge

15. Data Collation & Evaluation
Data collated centrally, analyse and outcomes presented at 6 monthly regional meetings

16. Elements of Continual Evaluation
All Health Boards collect same data using same collection tools
Collected through routine practice and administration processes
Benchmarking data comparing service performance is presented to Boards
Service improvements are implemented across all services simultaneously
Data is analysis is done by those with the right expertise and understanding
Programme of research runs in parallel with implementation

17. Service Insight – Patient Contact
By Phone 1.
Most effective method of contact however more intrusive and time consuming for the service and impacts on service capacity
Convenient for patient and unobtrusive, while still feeling personal and direct
Text Message 2.
Slower and inefficient however formality still inspires good rates of response in patients
Letter 3.
has proven to by the least effective with little patient response and can be unaware that an has been sent to them 4.

18. Strategy is key

19. Plan Early for Up Scaling
FUNDING STRATEGY
SUSTAINABILITY PLANNING
MARKETING STRATEGY
Mid 2014
Early 2015
Mid 2015
Mid 2016
End 2016
2017
Services Running Milestones of Development Completed
Organisational Structures in Place
Referrals received and patients commencing treatment
Continued Service Development
Marketing of Service
Monthly Targets Achieved
Service Improvement
Target Achieved
Implementation t Ends
Continued Marketing of Service
Sustainability Planning

20. Getting it accepted

21. Tell Clinicians About It
Extensive marketing of service to key referrer groups
2/3 of implementation time on marketing activity
Single most important activity in the development cCBT services
Is also the most complex and subtle of tasks

22. Marketing creates expectations that need to be met
What is Marketing?
Structured, co-ordinated communication
Used to shape opinion and address negative perceptions
Through consistent messages, prevents confusion and creating clarity
Strategies aims to create 7 points of varying contact
Marketing creates expectations that need to be met

23. Use a Strategic Approach
Co-ordinates activities and message
Define and understanding of objectives
Creates targets that define successful outcome
Identify assets, resources and required man power
Focuses approach
Develops understanding about what can and cannot be achieved

24. Services becomes more efficient and cost effective with increased use
Marketing Works
Use increases dramatically and continues to increase inline with marketing activity
Average cost per patient <£60
Services becomes more efficient and cost effective with increased use

25. Does it work?

26. “I didn't need the talking therapy and I've had my medication reduced”
Patient’s Perspective
“Few methods of CBT I learned will be invaluable to my progression to better mental health”
“Was really easy to use and after only a couple of sessions I started to feel better”
“I didn't need the talking therapy and I've had my medication reduced”
“I thought the program was excellent, just the right amount of information”
“Thanks to the cCBT treatment I have reduced my anti-depressants and have a lot more confidence”

27. Evidence shows patient improvement from Session 1
Clinical Outcome Data
Moderate
1.5 – 1.9
Moderate to Severe
2 – 2.49
Mild
1.0 – 1.49
Low Level
0.6 – 0.9
Healthy
0 – 0.59
Clinical Cut Off
Evidence shows patient improvement from Session 1

28. 2017/18 – cCBT receives 12,634 referrals
Demand
YEAR
TOTAL REFERRALS
2013
1,340
2014
1,370
2015
5,529
2016
7,050
2017
10,553
Shetland refers most per head of population, showing value of technology to overcome barriers of traditional therapy approaches
2017/18 – cCBT receives 12,634 referrals

29. Attitude is everything

30. Always Learn and Improve
The way people engage with technology has changed
Self-management of conditions at home is untested so hard to predict
Use of cCBT at home requires different approach to patient engagement
Need to better manage speed of growth

31. The Right Approach Build sustainable services, no pilots
Maintain focus and drive
Trust the technology
Be ambitious
Make it undeniable