Measuring: the real life challenges Lessons and reflections the NHS Lothian Early Implementer Site

Linda Irvine Strategic Programme Manager, Mental Health and Wellbeing

Overview of Presentation

DCAQ Phase 1 learning and Phase 2 progress

DCAQ and A12 DCAQ, A12 and Outcome Measures Learning and Reflections

DCAQ Phase One Phase One Deliverable Progress

Develop a high level understanding of service processes.

Completed

Identify and implement immediate service improvement opportunities.

Partially completed - improvement opportunities identified but none implemented to date.

Gather appropriate information to undertake a detailed DCAQ analysis.

Partially completed - some of the data to complete a full analysis is not currently available. This report makes recommendations on how to address going forward.

Complete the DCAQ analysis and agree further areas for service improvement activity.

Partially completed - not able to complete full analysis due to lack of data, however partial analysis completed and a range of improvement opportunities recommended in this report.

Phase I : Outcomes

Partially completed because DCAQ data…

not collected or

not collected consistently or

not reflective of realityor

Conflicting – more than one source

DCAQ Phase 2

Addressing the data issues Solid project governance

Challenges

Amount of work required to improve data

Identifying where to invest the time

Providing the right frame of reference for DCAQ

Timescales and availability

Testing and Making Changes to practice

New information process Opt-in Case review (one off and ongoing process) DNA and CNA policy Activity Audits completed Admin processes Use of Groups And more!

DCAQ and A12 Agreement on core data set (i)

Primary Focus of Treatment

Abnormal Grief Reaction Agoraphobia Anger Management Autism Spectrum Bipolar disorder with

psychosis Bipolar disorder without

psychosis Borderline Personality

Disorder Depression Dementia Eating Disorder

Generalised Anxiety Disorder

Health Anxiety Obsessive Compulsive

Disorder Other (please Detail) Other Personality Disorder Other Psychosis Panic Disorder Post-Traumatic Stress

Disorder Psychosexual difficulties Schizophrenia Sleep problems Social Phobia Specific Phobia

DCAQ and A12 Agreement on core data set (ii)

Psychological Therapies List

Acceptance and Commitment

Therapy Behavioural Family Therapy Cognitive Analytical Therapy Cognitive Behaviour Therapy Cognitive Behavioural Analysis

System of Psychotherapy Counselling Dialectical Behaviour Therapy Eye Movement Desensitization

and Reprocessing (EMDR)

Solution Focused Brief Therapy Interpersonal Therapy Mentalisation Mindfulness Based Cognitive

Therapy (MBCT) Motivational Interviewing Psychodynamic /

psychoanalytic Psychotherapy Schema Focused Therapy Solution Focussed Therapy Systemic Therapy Other - to be reviewed after

4 weeks

DCAQ and A12 Agreement on core data set (iii)

Group Work Manage your mood -

CBT Manage your anxiety -

CBT Introduction to

Therapy Mindfulness - CBT Survive and Thrive Recovery and Support

Relaxation Coping Skills Anxiety

management - CBT Overcoming

depression - CBT Assertiveness - CBT Beyond sexual abuse Survive and Thrive

(planned)

DCAQ, A12 and Mental Health Transformation Station

Mental Health Transformation Station – using outcomes measures in routine clinical practices

Understanding why Understanding how the team works Collective ownership and

understanding – recognising the values

Simple, transferable solutions

DCAQ and A12and Outcome Measures Agreement on core data set (iv)

Use of CORE 34 for all conditions Use of additional outcome measures

for depression And other measures for specific

conditions as we progress

Supported by I M & T – PIMS

Adding Primary reason for treatment as coding type – alongside DSM4 and ICD10

Psychological therapy specific waiting lists Capture of CORE 34 scores on individual

patient records – date stamped Process mapping – training – patience! Data inputted using new model – 22

August

reflections

What you may hear…

“Not sure how you are going to meet your target”

Be in your interest to tighten up referral criteria have less people referred

Really hard to describe what we do under one model

The data reports we get are wrong

Ownership

Ensuring people get the therapy that will most benefit them

Rubbish in - rubbish out

What you need to remember

Priority is the person being seen Fear of lifting the stone Different pressures How to measure the therapeutic relationship Positioning of psychological therapies over other

intervention/ treatment Fidelity to psychological model People don’t always “get better” Breadth of change - It’s not about you Care and understand what it must feel like to be on

a waiting list Different languages people use

Being grounded…

How many people need psychological therapies?

How many people are referred for them?

How long have they been waiting? What are they waiting for? Why that therapy? And is the / has the therapy made a

difference?

Learning to date

The data now matters to everyone – the service users, the teams, the organisation

The value of the right level of oversight (ie project sponsor to make things happen, assistant to take pressure off clinicians and who can deliver quickly)

Strengthened relationships and sustainable skills and interfaces with other projects

DCAQ not a one-off – model for delivery of A12

Outcome

How many people need psychological therapies? How many people are referred for them? How long have they been waiting? What are they waiting for? Why that therapy? And is the / has the therapy made a difference?

We will be able to answer that question for East and Midlothian

Actively review the dataset – and assess fitness for purpose