i / d / c + CBT - Healthcare Conferences UK · 2019. 7. 16. · Vlad iorga, MSc, PgCert LI CBT,...

i / d / c + CBT

Ensuring safe delivery and risk management

Vlad iorga, MSc, PgCert LI CBT,

NELFT B&D IAPT PWP & Quality Lead HEE – digital health literacy workgroup

NHSx – IAPT Digital triage workgroup

Visiting Lecturer – Teesside university

© Vladut-Mihai Iorga 2019

Today’s Structure

Risk (Suicide, DSH)

Part 2 - Ensuring safe iCBT and managing risks in iCBT

• issues around self referral

• understanding the impact of iCBT for depression and anxiety in the longer term

• the importance of effective risk assessment for iCBT

• our experience


Background & Policy on suicide


Definition : In England and Wales, suicide is

legally defined as death given an underlying

cause of intentional self-harm or

injury/poisoning of undetermined intent.

What does “risk” mean ?


Originally a sailing term from

Portuguese ->

RISK = “The likelihood of an event

happening with potentially harmful

or beneficial outcomes for self and

others” Morgan (2000)

versus

DANGER = “the damage or harm

that may occur from an event”

Structure of a Risk formulation :


Past events

Presenting

Event

Mental State

Impulse control

Historical Current

Intent

Protective factors

Safety plan

Past triggers

Past coping

Past lethality

Help seeking

behaviours

Problem

solving

Future

Plans

Getting the #digitalIAPT journey right


Assessment of Risk at referral


Assessing Risk at referral / sign-up


Are you currently or have you ever had

thoughts of ending your life? Y/N

Are you currently or have you ever had

thoughts of harming others? Y/N

Are you currently or have you ever been at

risk of any harm from others? Y/N

Are your current difficulties impacting on

your ability to look after yourself? Y/N

Have you attempted suicide or self-harmed in

the past 2 months? Y/N

Risk assess / Duty

Monitoring Risk- in treatment


(9-5) Duty call

(out-of-hours) Support page high intent >5 Call / SMS from MHD

Function of cCBT


Key points: Establish good triage / assessment

Have clear suitability criteria

Have clear Terms and Conditions

Have a nominated clinician responsible / Duty

Signpost to Support (dial 112 / 3rd sector)

Always signpost to Duty / Access (out of hours)

Be transparent, normalise risk

Embrace positive risk approach

Sign post to Safety *

Be flexible (Stepped care)

Monitor and reach out (call, email, sms)


Happy to collaborate, consult and work together,

connect with me :

@psylligent / 075 81 82 0 882

[email protected]


i / d / c + CBT - Healthcare Conferences UK · 2019. 7. 16. · Vlad iorga, MSc, PgCert LI CBT,...

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Transcript of i / d / c + CBT - Healthcare Conferences UK · 2019. 7. 16. · Vlad iorga, MSc, PgCert LI CBT,...