hasContentIssue true, This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, British Association for Behavioural and Cognitive Psychotherapies 2020. 10.1002/cpp.1929 Performance-Based Conversations. Design: Qualitative research using recordings of telephone-treatment sessions. It is also common practice in some services for service users and their clinicians to sign an informal treatment contract in which the number of sessions and use of between-session activities (sometimes considered to be homework) are laid out. The North and Central East London (NCEL) IAPT Service Improvement and Research Network (SIRN) includes: Andre Lynam-Smith, Catherine Simpson, Elisa Aguirre, Evi Aresti, James Gray, John Cape, Jon Wheatley, Joshua Buckman, Judy Leibowitz, Lila Varsani, Mina Spatha, Mirko Cirkovic, Nicole Main, Renuka Jena, Rob Saunders, Sarah Ellard, Stephen Pilling, Syed Ali Naqvi and Tania Knight. A further important finding was that higher baseline GAD-7 scores were associated with a higher likelihood of achieving reliable improvement by the end of IAPT treatment. These measures are used in a variety of ways, from monitoring patient progress in treatment, to service development and outcome monitoring. Outcome evaluation mostly focuses on inputs from the participants and how the activity affected them or brought any change in them. As consumers, payers, and regulatory agencies require evidence regarding health care quality, the demand for process of care measures will grow. The Improving Access to Psychological Therapies (IAPT) programme was developed in response to the rising burden of depression and anxiety disorders in England (Clark, Reference Clark2011). It should also demonstrate that a choice of date, time and venue has been offered and whether information about the service was available. King, Sophie During the period from April 2018 to March 2019, over 1.09 million people were seen by IAPT services in England. PRO instruments can be generic or disease-specific . 2022. Aguirre, Elisa Negative attitudes to using ROMs which were endorsed by therapists included; that it does not fit for more complex cases and that is another task to do within the context of time-limited, time pressured therapy sessions. The value of using IAPT data to inform service improvement evaluations is discussed. empirically supported) psychological interventions to patients in the National Health Service (NHS). Oxford University Press is a department of the University of Oxford. 2 But . Pilling, S. A qualitative descriptive study of senior hospital staff, About International Journal for Quality in Health Care, About the International Society for Quality in Health Care, Receive exclusive offers and updates from Oxford Academic, Copyright 2023 International Society for Quality in Health Care and Oxford University Press. and transmitted securely. We are delighted with The BMJ 's continued efforts to keep patient reported outcome measures (PROMs) on the healthcare agenda and enjoyed Calvert and colleagues' helpful article. Recovery and reliable improvement were chosen as the outcomes for this analysis due to their importance to IAPT services and local clinical practice, but other more patient-focused outcomes could be considered in further evaluations. Pilling, Stephen This field is for validation purposes and should be left unchanged. (2015). Routinely collected data from seven IAPT services involved in the North and Central East London (NCEL) IAPT Service Improvement and Research Network (SIRN) were brought together to form a dataset of nearly 88,000 patients who completed a course of IAPT treatment. 2018 Jun;25(5-6):285-296. doi: 10.1111/jpm.12440. 1. 8. Outcomes in IAPT are measured in terms of three measures: recovery, reliable improvement, and reliable recovery. The authors declare they have no competing interests. Such measures capture the patients own perspective of disease and health. Although outcome measures of quality represent the desired end results of health care, validated process of care measures provide an important additional element to quality improvement efforts, as they illuminate exactly which provider actions could be changed to improve patient outcomes. anxiety. An introduction to social constructionism. 10.1037/pst0000030 We aimed to explore therapists experiences of the use of ROM within this context. Epub 2018 Jan 30. There has been a clear reduction in missing problem descriptor information over the last 7 years, with around 45% missing in 20122013, down to less than 10% missing in 20182019. J Psychiatr Ment Health Nurs. (Reference Clark, Canvin, Green, Layard, Pilling and Janecka2018) reinforce the recommendations of the IAPT manual in relation to improving recovery in IAPT services (National Collaborating Centre for Mental Health, 2018). advantages and disadvantages of outcome measures iapt. Employees become focused on modifying their work habits to align with the certain methods and procedures that produce a rewarded outcome. New self- rating scale, New access for depression and anxiety: adapting the UK Improving Access to Psychological Therapies Program across Australia, The relationship between session frequency and psychotherapy outcome in a naturalistic setting, Journal of Consulting and Clinical Psychology, A retrospective observational analysis to identify patient and treatment-related predictors of outcomes in a community mental health programme, Enhancing recovery rates: Lessons from year one of IAPT, Standard versus extended cognitive behavior therapy for social anxiety disorder: a randomized-controlled trial, Prompt mental health care, the Norwegian version of IAPT: clinical outcomes and predictors of change in a multicenter cohort study, The PHQ-9: validity of a brief depression severity measure, National Collaborating Centre for Mental Health, A cognitive-behavioral model of anxiety in social phobia, Trajectories of depression and anxiety symptom change during psychological therapy, Latent variable mixture modelling and individual treatment prediction, Predicting treatment outcome in psychological treatment services by identifying latent profiles of patients, What predicts outcome, response, and drop-out in CBT of depressive adults? sharing sensitive information, make sure youre on a federal For example, previous analyses have identified distinct profiles of patients attending IAPT services with significant differences in outcomes observed between these profiles (Saunders et al., Reference Saunders, Cape, Fearon and Pilling2016). See this image and copyright information in PMC, Abstracts of Presentations at the Association of Clinical Scientists 143. Proportion of patients with a diagnosis of MADD or without a diagnosis recorded, by financial year. Button, Katherine S. However, multivariate regression models controlling for baseline severity did not alter the findings, indicating that the impact of treatment-delivery factors identified in the current analysis was independent of initial patient severity. There have been large decreases in the proportion of patients missing a problem descriptor code and the proportion of patients who were in caseness pre-treatment but had been incorrectly coded as having MADD. Uncategorized . of this land, and whose cultures are among the oldest continuing in human history. for this article. The factors considered in the current analysis are all mentioned in the IAPT manual (National Collaborating Centre for Mental Health, 2018) in relation to improving service recovery rates. http://creativecommons.org/licenses/by/4.0/, https://doi.org/10.1146/annurev-clinpsy-050817-084833, https://doi.org/10.1016/S0140-6736(17)32133-5, https://doi.org/10.1016/j.jad.2013.02.030, https://doi.org/10.1016/j.brat.2017.04.006, https://doi.org/10.1017/CBO9781107415324.004, https://doi.org/https://doi.org/10.1017/S1352465818000590, https://doi.org/10.1016/j.cpr.2018.07.005, https://doi.org/10.3109/09540261.2011.606803, https://www.england.nhs.uk/mental-health/case-studies/mh-islington/, https://www.england.nhs.uk/mental-health/case-studies/islington-icope-making-the-most-of-a-close-working-relationship-with-gps/, https://doi.org/10.1136/bmjopen-2014-006103, https://doi.org/10.1016/j.brat.2013.06.004, https://doi.org/10.1017/S1352465804001171, https://doi.org/10.1186/s12888-018-1838-0, http://www.ncbi.nlm.nih.gov/pubmed/11556941, https://www.england.nhs.uk/wp-content/uploads/2018/06/iapt-manual-resources-v2.pdf, https://doi.org/10.1016/S0005-7967(97)00022-3, https://www.england.nhs.uk/mental-health/case-studies/staff-wellbeing-is-everyones-responsibility-at-islington-icope/, https://doi.org/10.1016/J.JAD.2019.02.043, https://doi.org/10.1016/j.brat.2019.103505, https://doi.org/10.1016/j.jad.2016.03.011, https://doi.org/10.1017/S1352465812001063, https://doi.org/10.1001/archinte.166.10.1092, https://doi.org/10.1192/bjp.bp.112.113134. Dom, Gabriele The most likely explanation for using ROMs more appears to be the mandate to do so from management. A metaregression analysis, How durable is the effect of low intensity CBT for depression and anxiety? and Buckman, Joshua E. J. RP-PG-1016-20010/DH_/Department of Health/United Kingdom, Barkham, M. , MellorClark, J. , & Stiles, W. B. The univariable models presented in the left-hand columns show that all variables were significantly associated with reliable improvement. Barnett, Phoebe A number of services made a point of focusing on patient recovery and reliable improvement outcomes, introducing training and workshops with staff to share best practice, and in two services they introduced 6-monthly one-to-one meetings with a line manager (recovery consultations) which included an in-depth look at a number of cases where patients the staff member had worked with did recover and a number of cases where their patients did not recover, in order to highlight commonalities and discrepancies. Lack of therapeutic use of item and total scores. 2. Adopted the principles of the C/YP IAPT programme 1. Method: Some received just an assessment and advice or signposting, whereas others (582,556 individuals) received a course of IAPT treatment (defined as two or more treatment sessions) (NHS Digital, 2019). This double edged sword leaves the quantitative method unable to deal with questions that require specific feedback, and often lacks a human element. Although this study benefits from a large sample of patients, with data spanning 7 years to assess change in both clinical practice and outcomes, there are a number of limitations to the current analysis. The IAPT target was twofold: to treat 15% of the estimated 6.1m people with anxiety and/or depression each year by March 2015, and to achieve a recovery rate of at least 50% for those that complete treatment. Overall outcomes are good. Ethnical approval was not sought for this study as the data used were provided as part of a wider service improvement initiative conducted in accordance with the procedures of the host institution. Specifically, this analysis will focus on annual changes in a number of variables that are mentioned in the IAPT manual (a guide for commissioners, managers and IAPT clinicians to support the expansion and development of local IAPT services) as being important to consider for improving recovery rates (National Collaborating Centre for Mental Health, 2018).