Académique Documents
Professionnel Documents
Culture Documents
Children and Young Peoples Improving Access to Psychological Therapies Outcomes and Feeedback Bulletin - March 2013
For more information please see: http://www.iapt.nhs.uk/cyp-iapt
1
Measures were selected by the Outcomes and Evaluation Group and were agreed by the CYP IAPT Expert Reference Group. Please see http://www.iapt.nhs.uk/cyp-iapt/ for more details. Some measures were selected to be primarily used as clinical tools, others to be used to allow meaningful comparison across cases.A range of options was provided for session by session tracking to allow clinicians to select measures that were most relevant and meaningful collaboratively with young people and families.
One of the main difficulties for ROM implementation is posed by IT infrastructure. All partnerships would like an electronic system that allows data to be entered once with immediate upload to the patient record system, and that can provide a data report with graphs in real-time. Staff have expressed concerns about the time ROM use will add to their clinical sessions and the knock on effect this will have on waiting times, plus feeling overwhelmed by the additional paperwork. They are also concerned about how the ROM data would be used by managers and supervisors, and a number of clinicians remain unconvinced about the clinical benefits. A further issue emerged about identifying the most appropriate measures when working with young people who present with a range of issues and the clinicians tendency to opt for global measures that were not always clinically relevant.
Sites are reporting that the capital funds given by the Department of Health for handheld technology and the changes to allow children and young people to enter data via the web will mitigate some of the IT infrastructure risks, not least because IT departments have engaged with clinical teams to support their bid.
Despite the difficulties and concerns, most partnerships describe a shift in culture and a growing understanding of how ROM can benefit clinical practice and service development. Foremost are the comments from young people and their families, who value the opportunity to give immediate feedback and report their concerns and issues regularly, as well as being able to visualise how they are doing on a graph.
It means if we go off track or get a bit lost along the way, we can both figure out how to find the way back again.
Young person from YoungMinds Very Important Kids Group
It supports us to feel more in control of its direction to understand when things are working, when things are not and what we can do about it.
Young person from YoungMindsVery Important Kids Group
Services report that ROM supports clinical team discussions and decisions about the appropriate level of care needed by presenting an unbiased view of the young persons wellbeing, and has enhanced supervisory practice, further encouraging reflective practice.
Developing practitioner skills at the same time as changing the way services are delivered through ROM has kick started a change in culture.
Gloucester CAMHS
Feedback is that they [trainees] are finding it very useful and it has helped improve patient outcomes and end treatment at an agreed time, based on the presenting outcome data.
Derby CAMHS
ROM is being used to support service design and development plans. Some partnerships are in discussions with commissioners about how they can build outcomes into a review of their performance. The patient experience measures such as how are you doing SRS and Chi are being used to inform consultations with young people and guide service development.
The service has been able to demonstrate to commissioners collaborative engagement with young people and their families, which has contributed to securing the contract for the next 3 years.
Hertfordshire CAMHS partnership
Outcomes workshops
In January Hertfordshire CAMHS flew over Scott Miller, one of the pioneers of service user feedback and outcomes in clinical practice, to present an Outcomes Masterclass. Simon Shattock, a Systemic Family Therapist from Hertfordshire Partnership NHS Foundation Trust, attended the training. Heres what he thought of it.
I was rather sceptical about what this day would achieve for me as I have been using regular outcome monitoring in my work since participating in the CYP IAPT course. The day helped me understand how to use the session by session tools in a meaningful way to achieve feedback on the therapeutic relationship. Scott Millers work challenges the orthodox view about the dominant discourse of evidence-based practice. This is not to say we should not undertake treatments that are useful to children and families, but should consider that real change with clients should happen in the first 4-6 sessions, and that the greatest predictor of positive outcome for clients is the therapeutic relationship regardless of the model. The most effective therapists are those who seek negative feedback from clients earlier on in treatment. and then tailor his or her approach to the client accordingly. I have used his ideas in therapy with a teenage girl and was able to find out that she did not like the silences in the room between us and would prefer if I talked more and asked lots of questions. I have altered my position as a therapist accordingly and hope now to be more effective in my therapy now.
The session made me excited & passionate about the transformation of our service.
Trainee attending the workshop
Really informative, much better understanding of what IAPT means in real terms and outcome measures.
Trainee attending the workshop
Helped me understand the national context of IAPT and the use/ importance of routine outcome measures.
Trainee attending the workshop
A child was able to highlight in a session the issues we were NOT talking about more easily than if we had not had it clearly identified on the SRS/ORS Family members like the visual aspects of this process it shows the change not just talking
Feedback from clinician
Version 3
Version 3 of the dataset will be released in April 2013, and the following measures will be added (subject to final sign off by measure developers) to track change in:
l l l l l
Family relationships (SCORE 15) Eating disorders (EDE-Q) Parenting ( Parental Efficacy Scale) Management of learning disability (SLDOM) General wellbeing (Warwick-Edinburgh scale)
In addition, the group are looking at whether a) some costed measures can be supported (but this requires discussion on copyright issues); b) whether CORE YP and CORE OM can be used (but this requires discussion around data sharing.) For more information please see: http://www.iapt.nhs.uk/cyp-iapt
7
The frequency of child and young person-rated session by session measures completed at first time point (Q1-Q3 2012).
Data collection Dataset Phase 1 Phase 2 sites period version sites End of year col- v2 All service Trainees only lection (Jan to March 2013) Verification of the outcomes tools proposed in the data set consultation and development of associated guidance Q1 (Apr to Jun) v3 All service Trainees only 2013 Q2 (Jul to Sep) v3 All service Trainees only 2013 Q3 (Oct to v3 All service Trainees only. All service Dec) 2013 gearing up 1st Dec 2013
Dec 2012 to Feb 28th 2013 1st to 15th July 2013 1st to 15th Oct 2013 1st to 15th Jan 2014