(IAPT) in Bexley, Bromley and Greenwich
(IAPT) in Bexley, Bromley and Greenwich
(IAPT) in Bexley, Bromley and Greenwich
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Plan for the even<strong>in</strong>g:<br />
• Local <strong>IAPT</strong> services <strong>and</strong> Long Term<br />
Conditions<br />
• 10 m<strong>in</strong>ute CBT<br />
• Next steps
All <strong>IAPT</strong> services:<br />
• Deliver NICE recommended psychological<br />
<strong>in</strong>terventions for anxiety <strong>and</strong> depression<br />
• Offer treatments <strong>in</strong> a stepped care model<br />
• Employ properly tra<strong>in</strong>ed <strong>and</strong> supervised<br />
cl<strong>in</strong>icians<br />
• Collect rout<strong>in</strong>e outcome measures <strong>and</strong><br />
patient satisfaction rat<strong>in</strong>gs.<br />
• Data is published on DH Information Centre
<strong>IAPT</strong> <strong>and</strong> LTC<br />
• NHS Operat<strong>in</strong>g Framework 2011/12<br />
• Access to psychological therapy for<br />
people with co-morbid mental <strong>and</strong><br />
physical health long term conditions,<br />
significantly improves health outcomes<br />
<strong>and</strong> reduces health care costs (Long<br />
Term Conditions Positive Practice<br />
Guide <strong>IAPT</strong>)
<strong>Bromley</strong> Work<strong>in</strong>g for<br />
Wellbe<strong>in</strong>g<br />
25 April 2012<br />
Vimbai Egaru- Service Lead<br />
work<strong>in</strong>g with
Aims of the Service<br />
• Improve <strong>in</strong>dividual’s well be<strong>in</strong>g, satisfaction <strong>and</strong> choice<br />
• Improve access <strong>and</strong> support to ma<strong>in</strong>ta<strong>in</strong> people <strong>in</strong> work <strong>and</strong><br />
to help them to return to work<br />
• Develop cl<strong>in</strong>ical protocols to ensure cl<strong>in</strong>ically effective,<br />
evidence based treatments are available to people <strong>in</strong><br />
primary care <strong>and</strong> community locations<br />
• Develop service models for deliver<strong>in</strong>g <strong>in</strong>tegrated, stepped<br />
care for people requir<strong>in</strong>g access to psychological therapies<br />
across the spectrum of services<br />
work<strong>in</strong>g with
Service Structure<br />
• <strong>Bromley</strong> M<strong>in</strong>d- provide low <strong>in</strong>tensity <strong>and</strong><br />
employment support<br />
• <strong>Bromley</strong> Healthcare- provide high<br />
<strong>in</strong>tensity <strong>in</strong>terventions<br />
work<strong>in</strong>g with
Low Intensity Interventions<br />
• Provided by <strong>Bromley</strong> M<strong>in</strong>d<br />
• Groups (Cop<strong>in</strong>g with Depression, Anxiety,<br />
Stress) 6 sessions @90 m<strong>in</strong>utes<br />
• Guided Self Help (Telephone <strong>and</strong> 1:1) up<br />
to 6 sessions @ 30 m<strong>in</strong>utes<br />
•cCBT<br />
work<strong>in</strong>g with
High Intensity Interventions<br />
• Delivered by <strong>Bromley</strong> Healthcare<br />
• CBT (up to 20 sessions)<br />
• IPT (16 sessions)<br />
• Counsell<strong>in</strong>g (up to 8 sessions)<br />
work<strong>in</strong>g with
Innovative Practice<br />
• Service user <strong>in</strong>volvement<br />
• Develop<strong>in</strong>g care pathways with<strong>in</strong> BHC<br />
with LTC teams<br />
• Dental phobia<br />
work<strong>in</strong>g with
Feedback<br />
• “<strong>Bromley</strong> is a small but effective service <strong>and</strong> the high<br />
level of <strong>in</strong>tegration between the two different providers is<br />
an example of best practice.” London Health Programme<br />
Cl<strong>in</strong>ical Assurance (2012)<br />
work<strong>in</strong>g with
Do you feel that the service has<br />
helped you to better underst<strong>and</strong><br />
<strong>and</strong> address your difficulties<br />
45<br />
40<br />
35<br />
30<br />
25<br />
20<br />
Series1<br />
15<br />
10<br />
5<br />
0<br />
at all times<br />
most of the<br />
time<br />
Sometimes rarely Never<br />
work<strong>in</strong>g with
Plans for the future<br />
• Self Referrals<br />
•LTC<br />
• M<strong>in</strong>dfulness<br />
• Groups at Step 3<br />
work<strong>in</strong>g with
How to Refer <strong>in</strong>to the service<br />
• GP Referral via email<br />
bro-pct.bromley<strong>IAPT</strong>@nhs.net<br />
• Via the BHC S<strong>in</strong>gle Po<strong>in</strong>t of Entry from<br />
01/05/2012)<br />
work<strong>in</strong>g with
Be<strong>in</strong>g Well <strong>in</strong> <strong>Bexley</strong>
<strong>IAPT</strong> <strong>and</strong> MIND: A GOOD FIT
Direct Access to M<strong>in</strong>d <strong>in</strong> <strong>Bexley</strong><br />
Service Provision<br />
Via Be<strong>in</strong>g Well <strong>in</strong> <strong>Bexley</strong> Hub<br />
ADVOCACY SUPPORT<br />
Via Day Support <strong>and</strong><br />
Social Inclusion<br />
Service<br />
LIFE PLANNING<br />
MINORITIES /<br />
MARGINALISED<br />
SUPPORT<br />
TRAINING ADVICE /<br />
SUPPORT<br />
VOLUNTEERING<br />
OPPORTUNITIES<br />
THE CENTRAL HUB<br />
TALKING THERAPIES<br />
STEP 2<br />
STEP 3<br />
EMPLOYMENT ADVICE /<br />
SUPPORT<br />
HOLISTIC SUPPORT<br />
DATA MANAGEMENT &<br />
RESEARCH<br />
WELFARE ADVICE /<br />
SUPPORT<br />
DEBT ADVICE<br />
Via Health Tra<strong>in</strong>ers<br />
FITNESS ADVICE<br />
LEISURE ADVICE<br />
MENTAL HEALTH<br />
PROMOTION<br />
PHYSICAL HEALTH<br />
PROMOTION
The Stepped Care Model<br />
Anxiety , Depression, Long‐Term Conditions<br />
Step 0<br />
Public<br />
Health/Services<br />
Rais<strong>in</strong>g Awareness<br />
Well Be<strong>in</strong>g programmes<br />
Health Tra<strong>in</strong>ers<br />
Step 2<br />
Low Intensity Service<br />
Guided Self‐Help<br />
Computerised CBT<br />
Psycho‐educational Groups<br />
Behavioural Activation<br />
Structured Exercise Groups<br />
Brief 1:1 sessions<br />
Step 1<br />
Primary Care/ <strong>IAPT</strong><br />
Service<br />
Recognition/Assessment<br />
Active Monitor<strong>in</strong>g<br />
Primary Care Counsell<strong>in</strong>g Service<br />
Step 3<br />
High Intensity Service<br />
CBT, IPT, DIT, behavioural<br />
activation, counsell<strong>in</strong>g, couples<br />
therapy, eye movement<br />
desensitisation <strong>and</strong> reprocess<strong>in</strong>g<br />
(EMDR)<br />
Step 4<br />
Risk/Complex<br />
Secondary Services<br />
Oxleas/SLAM
How is CBT delivered <strong>in</strong> <strong>Bexley</strong><br />
• Guided Self –Help work books, supported by a<br />
Psychological Wellbe<strong>in</strong>g Practitioner (PWP), either <strong>in</strong><br />
person or over the telephone<br />
• Computerised CBT supported by a PWP either from<br />
home or <strong>in</strong> our Hub location<br />
• Individual face to face sessions with a Step 3 CBT<br />
Psychotherapist or limited sessions with a PWP<br />
• Behavioural Couples Therapy<br />
•Group Therapy<br />
• Delivered at Milton House Hub, <strong>in</strong> Childrens’<br />
Centres, currently 3 GP surgeries<br />
• Even<strong>in</strong>g appo<strong>in</strong>tments available Mondays, Thursdays
Group Therapy <strong>and</strong> other Therapies<br />
• Groups:<br />
– M<strong>in</strong>dfulness for Depression <strong>and</strong> Anxiety<br />
– Stress Control<br />
– Overcom<strong>in</strong>g Depression<br />
– Build<strong>in</strong>g Confidence <strong>and</strong> Assertiveness<br />
– Manag<strong>in</strong>g Mood <strong>in</strong> Health<br />
– Cop<strong>in</strong>g with Post‐natal Depression<br />
– OCD<br />
• Eye Movement Desensitization <strong>and</strong> Reprocess<strong>in</strong>g<br />
(EMDR)<br />
• Counsell<strong>in</strong>g for Depression
Recovery Rate Per Quarter
How satisfied are you with the overall<br />
experience of us<strong>in</strong>g this service (PEQ)
MINDFULNESS<br />
PHQ‐9 GAD‐7 W&SAS<br />
SESSION 1 9 9 13<br />
SESSION 2 10 9 17<br />
SESSION 3 7 9 12<br />
SESSION 4 8 7 13<br />
SESSION 5 6 6 12<br />
SESSION 6 5 6 11
MANAGING MOOD & HEALTH<br />
PHQ‐9 GAD‐7 W&SAS<br />
SESSION 1 11 7 18<br />
SESSION 2 14 10 25<br />
SESSION 3 16 10 23<br />
SESSION 4 13 7 19<br />
SESSION 5 10 6 12<br />
SESSION 6 11 8 17<br />
SESSION 7 8 5 13<br />
SESSION 8 9 7 14
A personal story from a Manag<strong>in</strong>g Mood &<br />
Health group participant…….<br />
Thanks to all at M<strong>in</strong>d, my mental health issues have all<br />
but disappeared <strong>and</strong> I am feel<strong>in</strong>g great. The peer<br />
mentor<strong>in</strong>g has slightly stalled, my mentee didn't turn up<br />
for his first session! It shouldn't be too long before I get<br />
another. The exercise classes are go<strong>in</strong>g well, I'm feel<strong>in</strong>g a<br />
lot fitter <strong>and</strong> am los<strong>in</strong>g weight. As you can see, I am also<br />
gett<strong>in</strong>g better on the computer( still only one f<strong>in</strong>ger<br />
though!) All of this is only possible because of the help<br />
<strong>and</strong> encouragement from you <strong>and</strong> all the other staff.<br />
Once aga<strong>in</strong>, a huge thank you to all at M<strong>in</strong>d!
How to refer to the service<br />
• GP or healthcare professional can refer<br />
• Service‐user can self refer<br />
• An assisted self‐referral can be made<br />
–For self referral see our website to<br />
download a referral form<br />
www.be<strong>in</strong>gwell<strong>in</strong>bexley.org.uk<br />
–<strong>in</strong>fo@be<strong>in</strong>gwell<strong>in</strong>bexley.org.uk<br />
–020 8303 5816
Further developments<br />
• Pathf<strong>in</strong>der site for Long<br />
Term Conditions <strong>and</strong><br />
Medically Unexpla<strong>in</strong>ed<br />
Symptoms<br />
• Partnership with<br />
Southwark, Oxleas &<br />
<strong>Bromley</strong> to deliver 10<br />
M<strong>in</strong>ute CBT to GPs <strong>and</strong><br />
health professionals<br />
• More on this later……..
The <strong>Greenwich</strong><br />
model
Collaboration/ partnership<br />
Innovation<br />
Long Term Conditions groups:<br />
•Breathlessness (COPD)<br />
•Chronic pa<strong>in</strong><br />
•Chronic disease<br />
Progress Group – SU Council
Quality<br />
• Accredited supervisor to therapist ratios<br />
• No of sessions dictated by cl<strong>in</strong>ical need<br />
• In vivo experiments encouraged<br />
• Ongo<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g<br />
• Robust cl<strong>in</strong>ical governance structures
Efficiency <strong>and</strong> choice<br />
• Self referral means motivated clients<br />
• Triage assessments with<strong>in</strong> 5 work<strong>in</strong>g<br />
days<br />
• Choice of appo<strong>in</strong>tment days/ times/<br />
venues/ therapist<br />
• Range of treatment options at Step 2<br />
<strong>and</strong> 3
Proven track record<br />
• 3500 referrals<br />
• 70% <strong>in</strong>to treatment<br />
• 50% recovery rate<br />
• Satisfied clients <strong>and</strong> GPs<br />
• Consistently <strong>in</strong> the top quartile for the<br />
Key Performance Indicators for the 31<br />
London <strong>IAPT</strong> sites
How to access the service<br />
• Self referral encouraged:<br />
Telephone 020 3260 1100<br />
• Feedback or questions re GTTT:<br />
Katy.grazebrook@oxleas.nhs.uk
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