1. The Rapid Assessment Pilot
St. Andrew’s Healthcare Psychology Service
Dr James Fowler, PhD, CPsychol
June 2019

2. St. Andrew’s Healthcare
St Andrew’s is a not-for profit Mental Health Charity providing services to the NHS, having built its reputation for quality over 175 years
As a charity we have no shareholders or owners to whom we pay dividends. Our surpluses are reinvested in our patients and staff.
St Andrew’s is the first non-NHS Teaching Hospital in the UK. The charity has partnerships with universities around the UK.
Some facts:
We have 4 main hospitals
Employ over 4,500 people
We have successful outpatient and medico-legal services.
We work in partnership with multiple providers
                          

3. The London Service
Successfully tendered in 2014 following the implementation of the Transforming Rehabilitation agenda
Works with the London CRC and receives referrals for psychological therapies across all London boroughs

4. Today’s Presentation What we do The Rapid Assessment Pilot Results
Service Offering
Accessibility
The Rapid Assessment Pilot
Demand
Efficiency
Results
Spread of Recommendations
Other Findings
Next Steps

5. What We Do
Provide highly effective one to one psychological intervention
Reduce symptoms of mental health difficulty
Reduce offending
Treatment is key to preventing further offending in cases featuring MH concerns
Discuss the treatment itself – largely based on ERT but also some social elements.
All sessions held in probation offices

6. Accessibility
Providing services within the probation environment is about access for service users
Probation service users struggle to be offered services due to:
Dual diagnosis
Substance misuse
Homelessness
Risky behaviours
Probation service users often struggle to engage with services due to:
Enhanced stigma
Chaotic lifestyles
Priority needs

7. Outcomes 37% Reduction of General Distress (K6) 46%
%age Change
Presentation
37%
Reduction of General Distress (K6)
46%
Reduction in Low Mood (PHQ9)
44%
Reduction in Anxiety (GAD7)
36%
Reduction in Social Impairment (WSAS)
These are done in session 1 – not the assessment, and will continue that way.
Values are based on final session and 6 month follow-up through ANOVA

8. Outcomes contd.
Post-treatment, matched control and pilot study post-treatment results are for a 12 month period following discharge

9. Demand Simplified referrals process Streamlined assessment process
Qtr 2
2017
2018
Total Referrals into London TR 71
208
Total assessments attended in the month 39 64
Total treatments attended
233
656
Total Caseload 51
123
Total discharged 36
210
Simplified referrals process
Streamlined assessment process
Faster evidence of success
Mention the Volunteers

10. Efficiency Barriers to assessments in our usual method:
Average time was 1.5 hours during assessment
Few could be held each week (12 across London)
High number of missed appointment (60%)
The Rapid Assessment Pilot aimed to:
Assess an individual in .5 hour
Invite 12 people to be assessed each day
Usual method involves APs, whereas RAS involves qualified psychologists

11. Efficiency How is it possible? Pose highly targeted questions
Minimise or eliminate time building rapport
Reduce the number of potential outcomes
If referred on into one of our services, that clinician will receive an extra session simply to build rapport and familiarity

12. Targeted Questions Utilising other MH services currently?
Tick-box of symptoms (e.g. anxiety, anger, intrusive thoughts)
Tick-box Substances/alcohol
Suicide risk (past attempts, current thoughts/plans and signs of safety)
Recent offending history – attempt to establish link to MH
Homeless? If so – has housing plan?
Sleep difficulties? If so describe these
Ever suffered a serious head injury? If so – assessed and how?
Additional considerations (e.g. interpreter needed)?
Tick boxes have frequency/duration as well

13. Potential Outcomes One to one treatment (with St Andrew’s)
Group Therapy (with St Andrew’s, currently in development)
Immediate advice / wellbeing support
Referral (typically to a GP or housing support)
Right now, anyone identified as a good fit for group therapy receives one to one instead

14. Group or 1 to 1 Group Therapy Check:
1 Severe social anxiety or impairment
2 Struggles to understand concepts
3 Easily triggered
4 Highly pessimistic about groups
5 Already had Thinking Skills Programme or similar group
1 Yes ☐ No ☐
2 Yes ☐ No ☐
3 Yes ☐ No ☐
4 Yes ☐ No ☐
5 Yes ☐ No ☐

15. Results 132 assessments offered over 11 clinic days
38% attendance of assessments (n=50)

16. Other Results
70% n=35 reported struggling to sleep (e.g. little or no sleep)
44% n=22 reported a serious head injury
Of those – only 4 had been assessed and only 1 comprehensively
Some people reported no head trauma but had signs of head injury visible
Others reported being victims of serious violence over years (e.g. DV) but never were assessed even though they report symptoms (e.g. fainting)

17. Waiting List Impact

18. Questions
Contact:
Dr James Fowler