BtB - Computerised CBT

GPs

MOODJUICE

BEATING THE BLUES

BRIEF THERAPY

PSYCHOLOGY

STEP 1

STEP 2

STEP 3

STEP 4

The Matched Care Model

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Well Being Problems Functioning Risk Mean Mean - Risk

Before

After

Clinical Cut-Off

(CORE-OM Manual, 1998)

Core OM scores taken at beginning of 1st and end of 8th sessions. Average score taken from 77 patients.

Measured

Core Score

BtB – Clinical Outcomes

Systems Success

30/04/2006 30/04/2007 30/04/2008 30/04/2009 30/04/2010 30/04/2011181 339 836 1040 1154 1133

30/04/2006 30/04/2007 30/04/2008 30/04/2009 30/04/2010 30/04/2011Average Waiting Days 34 42 33 29 31 32Average Days between referral and appointment letter sent24 26 13 11 9 11

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339

836

1040

1154 1133

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2006 2007 2008 2009 2010 2011

Reporting year (1st May to 30th April)

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rrals

NUMBERS OF REFERRALS

Average waiting time for treatment = 31 days

Number of Primary Care Doctors (GPs) = 220

Percentage of Psychology Referrals = 46%

The percentage DNA for 1st sessions = 28.7%.   

The percentage DNA overall = 11.7%. 

The Cost

System becomes more efficient with increased use

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Column B

2009 20102006 2007 2008 2009 2011

COST PER PATIENT

Where to Start

Phases of Implementation

4) DESIGN OF SERVICE MODEL

5) DEVELOP IMPLEMENTATION STRATEGY

6) IMPLEMENTATION OF MODEL

7) MARKETING

1) DEVELOPMENT OF OBJECTIVES

2) IDENTIFY RESTRICTIONS

3) CONSIDER WIDER IMPACT

OUTCOME: SUSTAINABLE SERVICE WHICH ACHIEVES OBJECTIVES

Objectives impact on all phases of

implementation

Impact of Objectives and Restrictions

• Maximum numbers of patients seen• Accessible across the region• Efficiency of patient access• Minimise DNA's

OBJECTIVES;

EFFICIENCY, MAXIMUM CAPACITY,

ACCESSIBLE, MINIMAL WASTAGE• Changes administration of services• May limit accessibility to service across

region, will impact on referrals• Limits growth and may lead to restricted

development of service• Limited access to clinical input

RESTRICTIONS;

FUNDING, ACCESS TO CLINICAL STAFF

Combination of Objectives and Restrictions provides foundation of service design and implementation

Example Models

Forth Valley and Tayside – Aims; efficiency, maximum capacity, accessible

Locations distributed across region

Clinical responsibility remaining with referrer

Different clinical models applied in psychology and GP’s

Phased developments with capacity expanding due to needs and readiness of service

Target time for referral to appointment

System working to maximum levels of patient throughput allowed by targets

Service part of matched/stepped care systems for added patient support

Additional Aim in Tayside – minimal wastage of treatments

Assign further appointment to patients that DNA

A Working Service

Access Across a Region

Location vary greatly in style but not

quality of service through combination

of right location, good training and

consistency of treatment.

Service proves accessible by

spreading machines across

entire region including rural and

deprived areas supported by

onsite administrators

Referral Routes

Systems run in parallel

Direct GP Access

Psychology and Other Mental Health Services

Point of Referral to Beating the

Blues

Patients attend treatment, referrers kept informed of progress with

Progress Reports

GPs have option of referring to psychology to

gain access

Patients assessed for suitability

Patients are given exit interview to determine success of program

Upon patients are either discharged or

offered further treatment

Multiple streams of referral can be developed with minimal variation in process

Central Processing

KEY ADVANTAGES

• Monitoring flow of referral

• Diverting patients to prevent waiting times

• Increased support of locations and patients

• Connection to psychology

• Addressing Suicide Alerts

REFERS

All refers use single point of access and standardised

referral form

Central Coordination of all initial appointments,

across all locations

MACHINE LOCATIONS

Patient contacted and asked to attend

appropriate location

Location contacted, appointment arranged

Key Aspects for Success

The Right Workforce

Clinical vs. Customer Services Experience

Costs of clinical staff is high

Clinical support is only required on few occasions

Assess support network and position of service

Non-clinical equals less threatening

Availability to staff is essential

Key Requirements

• Point of contact in relation to referral and enquiry

• Ability to address clinical issues and make informed decisions

• Co-ordinate and develop service

• Address IT issues as they arise

• Motivate and maintain high levels of communication

• Be available

Development of the correct intra-structure and systems will enable the minimisation

of staffing needs and therefore costs

Forth Valley employs a single co-ordinator to run service with customer

services and IT background

Communication With Referrers and Users

Good communication with referrers = flexibility in service and the ability to manage referral patterns, clinical issues and support for future work

Development of a clear understanding between referrers and service

Efficiency when dealing with referrer requests either on a service or patient basis

Recognition of referrer skills and abilities to determine best course of action for patient?

Maintenance of links through updates and continued contact

Good communication with patients = greater motivation, increased patience with program, better outcomes for patient

Development of a clear understanding of program, its benefits and the need to complete course (this particularly on getting them past first two sessions)

Support and assist users to overcome any barriers that prevent the completion of course

Be accessible at all times and have the required information and understanding at finger tips

Friendly, approachable and non-threatening

Marketing/Education

Marketing to referrer groups = increase in referrals

Requirements Outcomes/Actions

Marketing Strategy Development of clearer defined targets, messages and requirements based on original

service aims

Delivery of Key Messages Creates clear understanding of what BtB does, who it is for and how to access service. Delivery

of messages is dependant on scale

Scale Targets generated from objectives, will focus on the numbers of referrals to be generated and

desired impact of service

Timing Marketing to different groups and levels needs to be timed around service development to ensure

controlled increase of referral and use

Key outcome of marketing would be integration into clinical structures and practice

Our Advice

Genuine commitment to development and running service

Dedicated team with right individuals to implement and then run service

Allow focus to remain on patient by ensuring efficiency of process and administration

Do not over complicate the service and administration systems

Clearly defined responsibilities

Develop clear lines of communication with referrers and patients

Look to integrate service into exists structures

Get the right clinical and managerial support structures in place before you start

Do not underestimate complexity and subtly of task, having the right understanding and drive to develop the service within those involved is essential

Approaching the service with the right mind set is essentialClearly define objectives and requirements before thinking about logistics of service

The Local Impact

It has doubled the number of people receiving psychological therapy – 1100 new referrals a year to BtB

The waiting time for individual therapy has decreased. Before the start of the system, it was up to 2.5

years, now it is no more than 6 months

The waiting time for other forms of psychological therapy (non-individual) is lower than this, meaning

that a far higher proportion of people are meeting the 18 week waiting time target for psychological

treatment

Audit of BtB has revealed that referrals are appropriate and treatment is effective

The mild to moderate system is now having a significant impact on the population of Forth Valley.

There are about 12000 new case of depression and anxiety in per year about 2000 (or 1 in 6) are

receiving specialist psychological treatment, in addition to the people accessing Moodjuice (a total of

110,000 self-help resources are delivered through Moodjuice a year)

Preliminary data suggests that BtB is helping reduce the increase in antidepressant prescribing by GPs

Features of the Forth Valley Matched Care Model comments from Head of Primary Care Psychology

Greatest impact was achieved by integrating mild to moderate stepped care into existing service models and local structures such as GP Enhance Service.