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

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

Background & Policy on suicide

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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.

What does “risk” mean ?

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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”

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

Getting the #digitalIAPT journey right

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Assessment of Risk at referral

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Assessing Risk at referral / sign-up

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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

Monitoring Risk- in treatment

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(9-5) Duty call

(out-of-hours) Support page high intent >5 Call / SMS from MHD

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Function of cCBT

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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

Happy to collaborate, consult and work together,

connect with me :

@psylligent / 075 81 82 0 882

vlad.iorga@nhs.net

© Vladut-Mihai Iorga 2019