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i / d / c + CBT
Ensuring safe delivery and risk management
Vlad iorga, MSc, PgCert LI CBT,
NELFT B&D IAPT PWP & Quality Lead HEE – digital health literacy workgroup
NHSx – IAPT Digital triage workgroup
Visiting Lecturer – Teesside university
© Vladut-Mihai Iorga 2019
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Today’s Structure
Risk (Suicide, DSH)
Part 2 - Ensuring safe iCBT and managing risks in iCBT
• issues around self referral
• understanding the impact of iCBT for depression and anxiety in the longer term
• the importance of effective risk assessment for iCBT
• our experience
© Vladut-Mihai Iorga 2019
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Background & Policy on suicide
© Vladut-Mihai Iorga 2019
Definition : In England and Wales, suicide is
legally defined as death given an underlying
cause of intentional self-harm or
injury/poisoning of undetermined intent.
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What does “risk” mean ?
© Vladut-Mihai Iorga 2019
Originally a sailing term from
Portuguese ->
RISK = “The likelihood of an event
happening with potentially harmful
or beneficial outcomes for self and
others” Morgan (2000)
versus
DANGER = “the damage or harm
that may occur from an event”
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Structure of a Risk formulation :
© Vladut-Mihai Iorga 2019
Past events
Presenting
Event
Mental State
Impulse control
Historical Current
Intent
Protective factors
Safety plan
Past triggers
Past coping
Past lethality
Help seeking
behaviours
Problem
solving
Future
Plans
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Getting the #digitalIAPT journey right
© Vladut-Mihai Iorga 2019
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Assessment of Risk at referral
© Vladut-Mihai Iorga 2019
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Assessing Risk at referral / sign-up
© Vladut-Mihai Iorga 2019
Are you currently or have you ever had
thoughts of ending your life? Y/N
Are you currently or have you ever had
thoughts of harming others? Y/N
Are you currently or have you ever been at
risk of any harm from others? Y/N
Are your current difficulties impacting on
your ability to look after yourself? Y/N
Have you attempted suicide or self-harmed in
the past 2 months? Y/N
Risk assess / Duty
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Monitoring Risk- in treatment
© Vladut-Mihai Iorga 2019
(9-5) Duty call
(out-of-hours) Support page high intent >5 Call / SMS from MHD
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© Vladut-Mihai Iorga 2019
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Function of cCBT
© Vladut-Mihai Iorga 2019
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Key points: Establish good triage / assessment
Have clear suitability criteria
Have clear Terms and Conditions
Have a nominated clinician responsible / Duty
Signpost to Support (dial 112 / 3rd sector)
Always signpost to Duty / Access (out of hours)
Be transparent, normalise risk
Embrace positive risk approach
Sign post to Safety *
Be flexible (Stepped care)
Monitor and reach out (call, email, sms)
© Vladut-Mihai Iorga 2019
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Happy to collaborate, consult and work together,
connect with me :
@psylligent / 075 81 82 0 882
© Vladut-Mihai Iorga 2019