Senior PWP Network 4 June 2019 - NHS Senate Yorkshire Health/Senior PWP... · 2019-06-13 · •...
Transcript of Senior PWP Network 4 June 2019 - NHS Senate Yorkshire Health/Senior PWP... · 2019-06-13 · •...
wwwenglandnhsuk
bull Andy Wright IAPT Advisor Heather Stonebank Lead PWP Advisor and Sarah Boul Quality Improvement Manager
bull andywright1nhsnet heatherstonebankshscnhsuk and sarahboulnhsnet
bull Twitter YHSCN_MHDN yhmentalhealth
bull June 2019
Yorkshire and the Humber
Mental Health Network
Senior PWP Network
4 June 2019
wwwenglandnhsuk
YHSCN_MHDN
yhmentalhealth
Housekeeping
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Welcome Introductions Apologies
and Checking In
Andy Wright IAPT Advisor Yorkshire and the Humber
Clinical Network
wwwenglandnhsuk
How are you feeling today
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Compassionate Leadership
Wellbeing exercise presentation
and table top discussion
Andy Wright All
Compassionate Leadership
Who cares
Andy Wright
IAPT Adviser
Yorkshire amp Humber Senior PWP Network
4th June 2019
Introduction
How did I get here today
What have I noticed happening around me
Within my Trust
Within IAPT locally
Within IAPT in the Clinical Network
Would it be helpful to ground ourselves in a
leadership framework that is evidence based and
aligned to us
What could the barriers and benefits be of this
Disclaimer
Aims for our presentation
How Did I get Here
Fantastic achievement at the forefront of shaping future
MH services
IAPT high volume high turnover
Growing body of evidence highlighting concerns about
staff in the NHS amp Mental Health amp IAPT services
Aspiration to lsquodo no harmrsquo applies to us as well as
people we work with
There are also some other observations at all levels
Whats Happening In My Trust
Culture Profiling
The attitudes feelings values and behaviour that
characterise and inform society as a whole or any
social group within it
The general customs and beliefs of a particular group
of people at a particular time
Culture is the way we do things around here it is the
current in the river the hidden determinant of
organisational direction the manifestation of values
Climate control not command and control
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
YHSCN_MHDN
yhmentalhealth
Housekeeping
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Welcome Introductions Apologies
and Checking In
Andy Wright IAPT Advisor Yorkshire and the Humber
Clinical Network
wwwenglandnhsuk
How are you feeling today
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Compassionate Leadership
Wellbeing exercise presentation
and table top discussion
Andy Wright All
Compassionate Leadership
Who cares
Andy Wright
IAPT Adviser
Yorkshire amp Humber Senior PWP Network
4th June 2019
Introduction
How did I get here today
What have I noticed happening around me
Within my Trust
Within IAPT locally
Within IAPT in the Clinical Network
Would it be helpful to ground ourselves in a
leadership framework that is evidence based and
aligned to us
What could the barriers and benefits be of this
Disclaimer
Aims for our presentation
How Did I get Here
Fantastic achievement at the forefront of shaping future
MH services
IAPT high volume high turnover
Growing body of evidence highlighting concerns about
staff in the NHS amp Mental Health amp IAPT services
Aspiration to lsquodo no harmrsquo applies to us as well as
people we work with
There are also some other observations at all levels
Whats Happening In My Trust
Culture Profiling
The attitudes feelings values and behaviour that
characterise and inform society as a whole or any
social group within it
The general customs and beliefs of a particular group
of people at a particular time
Culture is the way we do things around here it is the
current in the river the hidden determinant of
organisational direction the manifestation of values
Climate control not command and control
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Welcome Introductions Apologies
and Checking In
Andy Wright IAPT Advisor Yorkshire and the Humber
Clinical Network
wwwenglandnhsuk
How are you feeling today
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Compassionate Leadership
Wellbeing exercise presentation
and table top discussion
Andy Wright All
Compassionate Leadership
Who cares
Andy Wright
IAPT Adviser
Yorkshire amp Humber Senior PWP Network
4th June 2019
Introduction
How did I get here today
What have I noticed happening around me
Within my Trust
Within IAPT locally
Within IAPT in the Clinical Network
Would it be helpful to ground ourselves in a
leadership framework that is evidence based and
aligned to us
What could the barriers and benefits be of this
Disclaimer
Aims for our presentation
How Did I get Here
Fantastic achievement at the forefront of shaping future
MH services
IAPT high volume high turnover
Growing body of evidence highlighting concerns about
staff in the NHS amp Mental Health amp IAPT services
Aspiration to lsquodo no harmrsquo applies to us as well as
people we work with
There are also some other observations at all levels
Whats Happening In My Trust
Culture Profiling
The attitudes feelings values and behaviour that
characterise and inform society as a whole or any
social group within it
The general customs and beliefs of a particular group
of people at a particular time
Culture is the way we do things around here it is the
current in the river the hidden determinant of
organisational direction the manifestation of values
Climate control not command and control
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
How are you feeling today
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Compassionate Leadership
Wellbeing exercise presentation
and table top discussion
Andy Wright All
Compassionate Leadership
Who cares
Andy Wright
IAPT Adviser
Yorkshire amp Humber Senior PWP Network
4th June 2019
Introduction
How did I get here today
What have I noticed happening around me
Within my Trust
Within IAPT locally
Within IAPT in the Clinical Network
Would it be helpful to ground ourselves in a
leadership framework that is evidence based and
aligned to us
What could the barriers and benefits be of this
Disclaimer
Aims for our presentation
How Did I get Here
Fantastic achievement at the forefront of shaping future
MH services
IAPT high volume high turnover
Growing body of evidence highlighting concerns about
staff in the NHS amp Mental Health amp IAPT services
Aspiration to lsquodo no harmrsquo applies to us as well as
people we work with
There are also some other observations at all levels
Whats Happening In My Trust
Culture Profiling
The attitudes feelings values and behaviour that
characterise and inform society as a whole or any
social group within it
The general customs and beliefs of a particular group
of people at a particular time
Culture is the way we do things around here it is the
current in the river the hidden determinant of
organisational direction the manifestation of values
Climate control not command and control
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Compassionate Leadership
Wellbeing exercise presentation
and table top discussion
Andy Wright All
Compassionate Leadership
Who cares
Andy Wright
IAPT Adviser
Yorkshire amp Humber Senior PWP Network
4th June 2019
Introduction
How did I get here today
What have I noticed happening around me
Within my Trust
Within IAPT locally
Within IAPT in the Clinical Network
Would it be helpful to ground ourselves in a
leadership framework that is evidence based and
aligned to us
What could the barriers and benefits be of this
Disclaimer
Aims for our presentation
How Did I get Here
Fantastic achievement at the forefront of shaping future
MH services
IAPT high volume high turnover
Growing body of evidence highlighting concerns about
staff in the NHS amp Mental Health amp IAPT services
Aspiration to lsquodo no harmrsquo applies to us as well as
people we work with
There are also some other observations at all levels
Whats Happening In My Trust
Culture Profiling
The attitudes feelings values and behaviour that
characterise and inform society as a whole or any
social group within it
The general customs and beliefs of a particular group
of people at a particular time
Culture is the way we do things around here it is the
current in the river the hidden determinant of
organisational direction the manifestation of values
Climate control not command and control
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Compassionate Leadership
Who cares
Andy Wright
IAPT Adviser
Yorkshire amp Humber Senior PWP Network
4th June 2019
Introduction
How did I get here today
What have I noticed happening around me
Within my Trust
Within IAPT locally
Within IAPT in the Clinical Network
Would it be helpful to ground ourselves in a
leadership framework that is evidence based and
aligned to us
What could the barriers and benefits be of this
Disclaimer
Aims for our presentation
How Did I get Here
Fantastic achievement at the forefront of shaping future
MH services
IAPT high volume high turnover
Growing body of evidence highlighting concerns about
staff in the NHS amp Mental Health amp IAPT services
Aspiration to lsquodo no harmrsquo applies to us as well as
people we work with
There are also some other observations at all levels
Whats Happening In My Trust
Culture Profiling
The attitudes feelings values and behaviour that
characterise and inform society as a whole or any
social group within it
The general customs and beliefs of a particular group
of people at a particular time
Culture is the way we do things around here it is the
current in the river the hidden determinant of
organisational direction the manifestation of values
Climate control not command and control
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Introduction
How did I get here today
What have I noticed happening around me
Within my Trust
Within IAPT locally
Within IAPT in the Clinical Network
Would it be helpful to ground ourselves in a
leadership framework that is evidence based and
aligned to us
What could the barriers and benefits be of this
Disclaimer
Aims for our presentation
How Did I get Here
Fantastic achievement at the forefront of shaping future
MH services
IAPT high volume high turnover
Growing body of evidence highlighting concerns about
staff in the NHS amp Mental Health amp IAPT services
Aspiration to lsquodo no harmrsquo applies to us as well as
people we work with
There are also some other observations at all levels
Whats Happening In My Trust
Culture Profiling
The attitudes feelings values and behaviour that
characterise and inform society as a whole or any
social group within it
The general customs and beliefs of a particular group
of people at a particular time
Culture is the way we do things around here it is the
current in the river the hidden determinant of
organisational direction the manifestation of values
Climate control not command and control
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Disclaimer
Aims for our presentation
How Did I get Here
Fantastic achievement at the forefront of shaping future
MH services
IAPT high volume high turnover
Growing body of evidence highlighting concerns about
staff in the NHS amp Mental Health amp IAPT services
Aspiration to lsquodo no harmrsquo applies to us as well as
people we work with
There are also some other observations at all levels
Whats Happening In My Trust
Culture Profiling
The attitudes feelings values and behaviour that
characterise and inform society as a whole or any
social group within it
The general customs and beliefs of a particular group
of people at a particular time
Culture is the way we do things around here it is the
current in the river the hidden determinant of
organisational direction the manifestation of values
Climate control not command and control
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Aims for our presentation
How Did I get Here
Fantastic achievement at the forefront of shaping future
MH services
IAPT high volume high turnover
Growing body of evidence highlighting concerns about
staff in the NHS amp Mental Health amp IAPT services
Aspiration to lsquodo no harmrsquo applies to us as well as
people we work with
There are also some other observations at all levels
Whats Happening In My Trust
Culture Profiling
The attitudes feelings values and behaviour that
characterise and inform society as a whole or any
social group within it
The general customs and beliefs of a particular group
of people at a particular time
Culture is the way we do things around here it is the
current in the river the hidden determinant of
organisational direction the manifestation of values
Climate control not command and control
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
How Did I get Here
Fantastic achievement at the forefront of shaping future
MH services
IAPT high volume high turnover
Growing body of evidence highlighting concerns about
staff in the NHS amp Mental Health amp IAPT services
Aspiration to lsquodo no harmrsquo applies to us as well as
people we work with
There are also some other observations at all levels
Whats Happening In My Trust
Culture Profiling
The attitudes feelings values and behaviour that
characterise and inform society as a whole or any
social group within it
The general customs and beliefs of a particular group
of people at a particular time
Culture is the way we do things around here it is the
current in the river the hidden determinant of
organisational direction the manifestation of values
Climate control not command and control
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Whats Happening In My Trust
Culture Profiling
The attitudes feelings values and behaviour that
characterise and inform society as a whole or any
social group within it
The general customs and beliefs of a particular group
of people at a particular time
Culture is the way we do things around here it is the
current in the river the hidden determinant of
organisational direction the manifestation of values
Climate control not command and control
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Culture Profiling
The attitudes feelings values and behaviour that
characterise and inform society as a whole or any
social group within it
The general customs and beliefs of a particular group
of people at a particular time
Culture is the way we do things around here it is the
current in the river the hidden determinant of
organisational direction the manifestation of values
Climate control not command and control
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Whats Happening In IAPT Locally
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Buthellip
Nationally IAPT is an example of how setting targets
has improved patientsrsquo access to psychological
therapy
Targets could be blamed for distorting clinical priorities
(Kingrsquos Fund)
Mid-Staffordshire is an example of what happens when
the target is hit but the point is missed (Frances
Report)
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Spinning Plates
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Action Plans
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
ldquoPeople need a period of stability otherwise they may
actively resist beneficial changerdquo
raquo G Kinman Jan 2018
Potential conflict when we work within an organisation
which has at itrsquos core the principle of continuous
improvement if this becomes perceived as continual
change
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Living In The Moment
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
We know what to do but hellip
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
So it was about climate (cultural) change
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Professor Michael West
Senior Fellow NHS Leadership Academy
httpsyoutube0RXthT32vcY
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Dr Paul Gilbert emotional regulation systems
Drive SystemTo motivate us
towards resources
Feelings wanting
pursuing achieving
Soothing SystemTo manage distress and promote
connecting
Feelings content safe connected
trust
Threat SystemTo detect and protect
against threats
Feelings anxiety anger
disgust
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
How might the balance of the systems look
DRIVE
SOOTHING
THREAT
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Blocks to compassion
Drive and
Achievement Soothing and
Connection
Threat and
Protection
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Audience Participation
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Question OneIn what ways can
work contribute to our
or staffrsquos ill health
How do we currently
acknowledge our
own and staffrsquos
compassionate
behaviour at work
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Question Two Paying attention and being
present
Understanding the causes
of distress
Empathic response
Helping taking intelligent
action
How do we currently model
the components of
compassionate leadership
What are the barriers (internal
and external)
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Question
Three
Clear vision and purpose (the
narrative)
Agree objectives and goals that
are clear aligned and not
overwhelming for staff
Ensure enlightened people
management Positive
authentic supportive interactions
with staff Appreciative of staff
contributions
An environment of continual
learning improvement and
innovation
Effective (inter) team working
How could we support each
other to lead more
compassionately
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Provider Presentation Bradford IAPT
Sharon Edwards and Simon White Bradford
IAPT
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
MyWellbeing College
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Overview
bull Large diverse demographic
bull Standalone psychological therapy service
bull Disorder specific interventions as recommended by the National Institute of Clinical Excellence (NICE guidelines)
bull Mental Health Clustering Tool ndash 1-4
bull Stepped care model
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Stepped Care Model
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Common mental health disorders
bull Depression
bull Recurrent depression
bull Generalised anxiety disorder
bull Panic disorder (with or without Agoraphobia)
bull Health anxiety
bull Social anxiety
bull Obsessive-compulsive disorder
bull Post-traumatic stress disorder
bull Specific phobia
bull Binge eating and bulimia (mild)
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Assessment (Enrolment Team)
bull MyWellbeing Check
bull Peer Support Workers
In progress
bull New app design for the Wellbeing Check
bull Step 2 automatic online enrol
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Treatment interventions
bull Step 2
bull Guided self- help ndash Low intensity
bull Course
bull Individual face to face or telephone based
bull Online
bull 6 treatment (review) sessions
bull Wellbeing promotion
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Recovery data using GSH workbooks
Month LI service recovery Recovery with use of a workbook
February 60 67
March 55 61
April 59 64
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Treatment interventionsbull Step 3
bull Personalised formulation driven therapy
bull Cognitive behavioural therapy
bull Eye movement desensitisationreprocessing therapy (EMDR)
bull Counselling for Depression
bull Interpersonal Psychotherapy
bull Disorder specific model informed therapy
bull Duration dependent on NICE recommendations
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Targets
bull Access rates
bull Commissioned to deliver 163 (with Cellar Trust telehealth)
bull Achieving 15 (Telehealth delayed implementation)
bull National target is 19 and 22 from 1st April ndash awaiting CCG
bull Waiting times
bull Above target for both 6 weeks and 18 week targets
bull Recovery
bull Improving within City CCG area (now above 40)
bull Business Intelligence team discovered error in reporting should show improvement from January published data
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Research projects
EQUITy ndash Enhancing the Quality of psychological Interventions delivered by Telephone
TTRR - Talking Therapies Research Resource
My Wellbeing College Black Asian and Minority Ethnic Project Improving Access Rates - Led by Hari Sewell
An Exploration of Bradford-based Pakistani womenrsquos views of Mental health experiences and Help-seeking using a Vignette-based Interview Approach
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Service developments and projects
bull Telehealth service
bull Digital platform
Disorder specific workbooks
bull Robust supervision including reflective practice and recording of therapy sessions
bull Structured CPD approach linked to outcomes
bull Disorder specific (skills based) refresher training
Continuing Professional
Development
bull Self Management After Therapy
bull Care for Screen Positive Elders
SMArT
CASPER Trial
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Service developments and projects
bull Priority treatmentsBlue light pathway
bull Priority treatmentsMaternal
mental health
bull 45 minute sessions
bull Generate referrals via VCS organisations
Wellbeing promotion
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Long term conditions
Service development in long term conditions includes development of courses workbooks and potentially webinars for the following conditions
bull Chronic Fatigue Syndrome (ME)
bull Diabetes
bull COPD Respiratory
This project will include a focus on increasing access joint working with other services LTC training for staff
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
bull Low access rates for South Asian Community
bull Poor recovery rate within City demographic
bull Stigma of mental health issues
bull Education around mental health
bull Recovery Rates
bull Increasing promotion of services within schools and community services that work directly with the South Asian population
bull Working less with interpreters and using staff language skills
bull Staff focus groups concentrating on delivering treatment in other languages
bull CPD linked directly with working cross-culturally
bull Psychoeducation program to be delivered within faith establishments and culturally diverse locations across the City
Challenges Work in progress
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
bull Multiple trauma
bull Negative view nationally of IAPT impact on staff wellbeing
bull Working with Trust Communications team to develop appropriate promotional materials
bull Holding assessment clinics within City GP practices
bull Long Term Conditions work
bull Using telephone interpreting service to organise appointments
bull Promoting services where singular trauma might be present
bull Stopped presenting team targets moved to individual performance management
bull Introduced wellbeing action plans for each staff member
Challenges Work progress
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for some lunch
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Clinical Skills ndash Psychoed Courses
Lottie Hutton Tyra Sutton Poppy Danahay and
James Walton North Yorkshire IAPT
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
North Yorkshire IAPT Service ndash
Psychoeducational Course
Improvement
Charlotte Hutton James Walton Poppy Danahay amp Tyra Sutton
-
Senior PWPs
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Main Themes
What have we been doing and what are we doing
now
Measuring changes in recovery from courses
Drop-out management
Direct observation of courses and key learning points
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
But firsthelliphellip Group Exercise
A little fun to create some new groups in order to
complete a group exercise
CHANGE CHAIRShelliphellip
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Change Chairs
Read out a statement
Change chairs with someone else in the room that also
gets up in response to the statement
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Change chairs ifhellip
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Change chairs ifhellip
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Change chairs ifhellip
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Change Chairs ifhellip
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Group Exercise
What courses do you run
How many sessions is it
What is the recovery rate for your course
How do you manage DNA Drop out
Have you considered best practice
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
What we were doinghellip
North Yorkshire IAPT service ndash 3 localities
2 Psychoeducational Courses
Stress Control ndash 6 sessions
Healthy Minds ndash 4 sessions
Mixture of daytime and evening sessions
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
What we foundhellip
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Implicationshellip
4 session Healthy Minds Course
60 recovery rate ndash good
Buthellip
6 session Stress Control Course
72 recovery rate
Offering 4 sessions only missing out on a further 12
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Other Considerationshellip
Recovery Rate different across localities
Local variations
Confidence in course and offering at assessment
Amendments to slides
Greeting Clients
Music No Music
Refreshments No Refreshments
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
What we didhellip
6 session Healthy Minds Course
Senior PWPrsquos developed course
Cascaded out to PWPrsquos ndash feedback
Roll out
Amendments
Observations
Standard delivery across localities
Best Practice Tool
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
What we foundhellip (after assessment)
Therapist confidence in course grew
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Recovery Rates
Treatment Type Number of patients
attended (in total)
Of which calculated
recovery rate
Course 979 5619
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Where we go from herehellip
Recovery rates ndash how to improve (we know we can
reach 72)
DNA Drop-Out management
Observations ndash development of a Best Practice Tool
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Drop-out Management -
Observations
Courses tend to have high levels of DNACNA
Courses tend to have good recovery rates overall
Patients who attend courses tend to be the most truly
ldquomild-moderaterdquo and therefore evidence would suggest
that these are most likely to recover
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
What does this mean
Are patients dropping out of treatment because they
are recovered
Or because itrsquos the wrong treatment for them and the
format of the course makes it difficult for this to be
identified
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
What did we do (1)
Improve provisional diagnosis from routine assessment
using a provisional diagnosis ldquoquick guiderdquo
This was visible to all PWPs at assessment
Identify correct presenting problem in order to inform
which treatment most appropriate
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
What did we do (2)
Develop an evidence-based decision making tool
Using statistics on diagnosis age severity of scores
specific to our service
To offer an ldquoevidence-basedrdquo choice rather than a
ldquomenu of choice
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Course Drop-Out Management (1)
Patients who do not attend 2 or more sessions of a
course without prior notice
Previously would have resulted in automatic discharge
in line with attendance policy with ldquoget in touchrdquo
deadline of 2 weeks
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Course Drop-Out Management (2)
Responsibility shared throughout team
Flagged by admin when entering MDS
Attempt to contact patient or send out a letter offering a
review appointment in 1 week
Review reasons for drop-out with patient and agree to
discharge move to next course (only once) or offer
alternative treatment
If they do not attend the review offer 1 week to get in
touch or discharge as normal ndash does not extend time
in service
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Statistics
Trialled initially on a Stress Control course with 64
patients
Responsibility for drop out management shared
between staff
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Without Drop-Out Management
21
16
1
4
11 11
0
5
10
15
20
25
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
With Drop-Out Management
26
5
1
5
16
11
0
5
10
15
20
25
30
Recovered ampDischarged
Not Recovered ampDischarged
Non-Caseness DNAd (No SessionsAttended) ampDischarged
Stepped (Next Courseor Reviewed and
Stepped)
Awaiting Follow-up
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Within Drop-Out Management
5
2
4
1
4
0
1
2
3
4
5
6
Recovered amp Discharged Not Recovered amp Discharged Attending Next Course Moved to GSH DNAd amp Discharged (NoImpact on Rec Rate)
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Conclusions
Drop-out management means that patients who would
have been discharged are able to be offered a
treatment that may be more appropriate for them rather
than being discharged re-referred etc
Drop-out management means we are able to capture
recovery from patients who drop out because theyrsquove
recovered
Patients were not staying in the service any longer than
before due to the 1 week deadlines (for managing
risk)
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Staff Feedback
Staff found that due to sharing it out as a team it did
not require a lot of extra work
Patients who were stepped elsewhere tended to be
ones who had not understood what the course
entailed was not what they expected or was not the
right treatment
Some patients had not felt comfortable to call up and
tell us it was the wrong treatment
One patient had attended felt too anxious to come in
and not come back
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Direct observations
Template Observation Proforma
Pre-course check list
Couse Opening
Application of Communication Skills
Professionalism
Use of Volunteers
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Direct Observations
3 offices - Harrogate with one venue
-Hambleton with 2 venues
- SWR with 3 venues
Stress Control and Healthy Minds run at all
locations
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Ensure appropriate temperature and lighting
Use safety behaviour chairs and ensure chairs are
spaced apart
Ensure screen size is good and projection clear
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Course Observations
Best Practice
Play music appropriate volume and Type
Service wide guidance re music type
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Greet participants individually with individual and
genuine interactions eg The journey nice to see you
again the weather
Where there are two facilitators andor volunteer one
individual to greet at the door one to move round the
room to give further opportunities for questions
Consider if booklets pens and MDS should be placed
on the chairs or given at the door
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Introduce self (and colleague volunteers) and role
Smile in a warm and genuine manner give good eye
contact to all participants
Thank participants for attending and reinforce the value
and attending each week
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Revisit all areas when appropriate slide is shown
Suggest that it is fine to visit the toilet during the
session or to stand up at the backtake time out if
needed
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Give a rationale for use of MDS
Encourage participants to speak to a facilitator if they score
1 or more on PHQ 9 Q9 or if they have any concerns re
safety
Normalise thoughts of suicide in Depression and encourage
help seeking behaviour
Have resources re MH helplineSamaritans number etc
Offer opportunity to review MDS scores with facilitators
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Instil hope using dose recovery slide
Encourage use of in-between session work and link to
recovery
Normalise impact of Depression on motivation and invite
participants to discuss with facilitators if concerned
Encourage participants to attend further sessions and
complete the intervention
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Listen well with attentive manner open body posture
and good eye contact
Summarise what the participant has asked
Provide a clear answer where you are able if you are
unsure advise the participant you will find out and get
back to them
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Allow appropriate pacing of speech for participants to
process new information
Ensure a break is always given
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Speak in a clear and audible manner ndash check with
participants that facilitator can be heard
Speak with a warm and genuine tone being respectful
and professional in manner
Use humour in a careful and appropriate manner
Add variation in tone and volume during presentation
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Stand and move appropriate during the presentation
Use warm friendly approach
Connect with all areas of the room ensuring good eye
contact
Use gestures to enhance points
Be attentive and towards fellow presenters smiling and
nodding in a genuine manner to reinforce points
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Take a warm and empathic stance
Engage with the whole room ensuring good eye
contact with all participants
Use inclusive and collaborative language (ldquoI can see
from some of your reactionshelliprdquo etc)
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Promote a sense of team work with smooth transitions
Ensure attentive NVC when other facilitator speaking
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Ensure a smooth ending summarising the content covered
and introducing the content of the next session
Thank participants for coming and encourage attendance at
next session
Promote in between session work and link to recovery
Provide opportunity for individual questions
Ensure that someone is at the door giving warm and
genuine individual farewells
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Wear NHS badge
Remain professional throughout the session
Demonstrate leadership throughout the session
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Collated Observations
Best Practice
Welcome volunteers warmly
and genuinely
Ensure that the volunteer
has a clear understanding of
their role allowing
opportunity for questions or
concerns to be raised by
volunteer if necessary
Thank volunteer for their
contribution
Monitor volunteerrsquos role
during the evening
Flag up any concerns re the
volunteer stepping outside
their role with your team
manager
Thank volunteer give helpful
feedback on their
contribution
Give opportunities for
volunteer to ask questions
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Additional Observations to consider
Ensure each slide is explained well providing
participants time to process the information
Consider use of appropriate self-disclosure metaphors
or stories to illustrate points
Pay attention to the therapeutic alliance utilising
opportunities to build good alliances with participants
Use open body posture and be available for
participants to approach facilitators for questions at the
break and at the end of the session
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Further suggestions by observers
Use a questions box and answers the questions the
following week
Have resources available on exercise alcohol etc on
a side table for participants to pick up
Peer feedback and skill development ndash possibly
develop a specific
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Suggestions for the course books
Rationale for courses and importance of the
intervention including data
Overview of both courses
Normalising of anxiety self soothing and presentation
techniques including the danger of over preparing
Application and communication
Ending
Role of volunteers
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
Q amp A time
Any questions
Any thoughts or reflections
Does this fit with what your service does
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
Yorkshire and the Humber Senior PWP Network
Time for a break
15 minutes only please
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Materialsstrategy for adjustments
made to treatengage diverse
patients - Discussion
Heather Stonebank All
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
Discussion
Points for discussion
bull What are the challenges
bull What are the solutions
bull What adaptations do you make
bull What self-help materials do you use
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Any Other Business
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms
wwwenglandnhsuk
Yorkshire and the Humber
Senior PWP Network
Thank you for Attending
Please remember to fill out
your evaluation forms