www.england.nhs.uk

• Andy Wright, IAPT Advisor, Heather Stonebank, Lead PWP Advisor and Sarah Boul, Quality Improvement Manager

• andywright1@nhs.net, heather.stonebank@shsc.nhs.uk and sarah.boul@nhs.net

• Twitter: @YHSCN_MHDN #yhmentalhealth

• April 2018

Yorkshire and the Humber

Mental Health Network

Senior PWP Network

24 April 2018

www.england.nhs.uk

@YHSCN_MHDN

#yhmentalhealth

Housekeeping:

www.england.nhs.uk

Yorkshire and the Humber

Senior PWP Network

Welcome, Introductions and

Apologies

Andy Wright, IAPT Advisor, Yorkshire and the Humber

Clinical Network

www.england.nhs.uk

Yorkshire and the Humber

Senior PWP Network

Raising Self-Awareness and

Wellbeing

All

www.england.nhs.uk

Raising Self-Awareness and Wellbeing

www.england.nhs.uk

Happin

ess

Life Approach

Since January 2018 plot your emotional highs and lows –

things, situations, people that had an impact.

What was the situation? How did you feel at the time?

Raising Self-Awareness and Wellbeing

www.england.nhs.uk

• With the person next to you talk through your life

line.

• What did you learn from those experiences?

• Were there any patterns or themes?

• How are you going to take that learning positively

into the future?

Raising Self-Awareness and Wellbeing

www.england.nhs.uk

Choose your future!

Challenges and difficulties will

happen.

It is about how you respond/react

Raising Self-Awareness and Wellbeing

www.england.nhs.uk

Yorkshire and the Humber Senior PWP Network

Time for a break?

15 minutes only please!

www.england.nhs.uk

Yorkshire and the Humber

Senior PWP Network

Provider Presentation: York and Selby Improving Access to

Psychological Therapies Service

Jasmine Turnbull and Lorraine Fourie,

Senior PWPS, York and Selby IAPT

York and Selby IAPT Service

Jasmine Turnbull and Lorraine Fourie

Senior PWPs

Who we are: Part of Tees, Esk and Wear Valleys NHS as of October 2015

We cover: York

Selby

Easingwold

Tadcaster

Pocklington

Population upwards of 351,000

Commissioned by the Vale of York CCG

Vale of York

Mainly rural aside from York city centre with small market towns

Generally affluent area

Small pockets of deprivation

Higher proportion of 20-24 year old due to the two universities

Higher percentage of the population than the national average is aged

50+

What happened in 2017 Lots of changes in the service:

Long waiting times for clients

Involvement of IST

Development of ‘Interim Pathway’ - combination of 1-1 sessions and

psychoeducational course sessions for clients

Pathway in place for all modalities: PWP, CBT, Counselling

New Pathway then developed:

Wellbeing Course first intervention to be offered for all clients aside from

exceptions:

PTSD, social anxiety, under 18’s, communication difficulties

Development of the Wellbeing Course

in 2017 Lots of changes in the service

Previously 3 groups

Stress Control (Jim White)

Improve your mood (BA group)

GAD (Dugas model) interactive group 2hrs in length

All 6 weeks and lecture style format with some group involvement

Evaluated groups and decided to continue due to recovery and

attendance rates

Problems: Staff sickness, annual leave and shortness of staff

Wellbeing Course 2017

Rolling course - clients could start at any point

8 weeks in duration (Minimum of 6 to be attended)

Made it difficult to monitor attendance

Large course numbers (70)

Low rate of response for reviews

Clinicians felt improvements could be made & the course condensed –

concerns about accessibility of an 8 week course for clients

No data due to incorrect tracking and PARIS input

Rapid Process Improvement Workshop

(RPIW) November 2017

Aims to improve the process of clients accessing the service

Focus on the Wellbeing Course as the main point of entry for most

Courses had a start and end date for monitoring purposes – although no gaps in

delivery for 2 week target

Evening course provided to improve access

Course workbook developed

Feedback forms improved for effective monitoring

Risk management protocol discussed in detail

Clients at higher risk of suicide or self harm now an exception for the course

Wellbeing course 2018 6 week course

3 groups run simultaneously (One evening and two day - 2 week’s

apart)

1 hour sessions

Introduction to CBT and Goal setting

Understanding Anxiety and Lifestyle Factors

How our Behaviours Affect our Wellbeing

Thought Challenging and Worry Management

Relaxation and Sleep

Maintaining Progress and Review

Clients offered a review of therapy after session 6

Data from group Day groups

Average 48 people on register before start and 38 attending

31.5% recovery rate

59% reliable improvement

Evening groups

65 people on the register before start and 44 people attending

38% recovery rate

62% reliable improvement

Data from group Similarities of groups

20-25% drop out/cancelled before sessions started

70-75% completion rate

25-28% drop out rate during the group

25-30% of people accepted reviews after course

Of those people 20-30% were stepped up for further treatment

77% of attendees scored Moderate – Severe for GAD 7 at start of group

51% of attendees scored Moderate – Severe for PHQ 9 at start of group

Data from group Positives:

Drop out rate low

Feedback from clients consistent with Data for attendance rates

Completed treatment rate high and people being stepped up is low

Positive changes can be made from data

Negatives:

Inconsistent data capture

Reason for discharge

Lack of admin support

Missing data values

No current theme or significant correlation between groups

Feedback from service users It conceptualised my situation, put it into words and made me feel less

alone/isolated

Really grateful for this course and being able to get on it so quickly when I was in

a very dark place

The course has been really well presented and I’ve looked forward to attending.

All of the presenters are very knowledgeable and empathetic

Still think it’s such a shame that our ideas are not shared in the session. I feel

talking and sharing is so important in mental health but I understand that some

people would be uncomfortable to share! Loved today’s session though, very

useful. I will definitely be challenging my thoughts from now on!

Informative but overwhelming

SWOT Analysis

Strengths Reasonably quick access for clients

Evening course for those who work full time

Amazing team

New senior management

Retaining staff

Trainee placements

New groups (Step 2 and 3)

Treatment choices

Same building as other services

Weaknesses Recruitment – difficult location and university doesn’t

offer training in York

PARIS

Backlog pathway and transition to new pathway

Opportunities New pathways (LTC, perinatal, students)

Development of groups

Self-referral platform

Website

Threats Newly qualified staff team

Access rates

Agency staff (remote working and training needs)

Thank you for listening! Any Questions?

http://www.valeofyorkccg.nhs.uk/about-us/about-the-ccg/

http://www.valeofyorkccg.nhs.uk/about-us/about-the-vale-of-york/

www.england.nhs.uk

Yorkshire and the Humber Senior PWP Network

Time for some lunch?

www.england.nhs.uk

Yorkshire and the Humber

Senior PWP Network

IAPT LTC Service Presentation

Liz Ruth, Senior PWP, Sheffield IAPT

Sheffield’s Integrated IAPT Team

Sheffield – a diverse city

• pop: 575,400 (2016) • 19% BME communities – Caribbean,

Indian, Bangladeshi, Somali, Yemeni, Eritrean and Chinese

• ‘City of sanctuary’ • Student population • Variation in depravation • NHS in Sheffield

IAPT in Sheffield

• Established in 2008 • Working in GP practices and community

venues • Across 4 sector teams • Achieves 18% access target – rising to 23%

in 2018 • Front line interventions Improving Wellbeing Sessions Stress Control cCBT (Silvercloud)

Five Year Forward View for

Mental Health

IAPT Expansion

National Top-up

training curriculum

underway for

PWPs and CBT –

for LTC/MUS

Top-up

training

By 2020/21

1.5 million

people

entering

treatment in

IAPT

1.5 million

people

2/3rds of this expansion –

integrating physical and mental health:

development of Integrated IAPT

Integration

Maintaining

integrity to the key

characteristics of

IAPT and

implementing

national guidance

Evidence-base

Early Implementer Wave 2 Site

Sheffield IAPT-LTC

NHSE

investment &

CCG

commitment

to recurrent

funding

Building on

Pathfinder with

additional

investment

Ambitious

and

transformati

onal bid to

create

systemic

change

Ambitious

bid

Establishment of a

Health and Wellbeing

Service: integrating

with primary care

health and medical

psychology

Establish new

service

Whole pathway

approach to

LTC/MUS from

Step1-Step 4:

Pathway

approach

Context

• LTC spending accounts for ~ 70% total NHS budget1

• At least 30% of people with a LTC also have a co-morbid MH problem2

• Comorbid MH problems interact with and exacerbate physical health problems - raising health care costs by at least 45%3

1. DoH, 2010, in Centre for MH Report 2. Cimpean and Drake, 2011, cited in IAPT Building the Business Case 3. Naylor et al, Kings Fund, 2012

The reality … is that we are seeing more and more people with two or more long term conditions at a time… I suggest it is this expansion of multi morbidity, both in terms of overall numbers and at earlier ages, that is not only impacting on healthy life expectancy but is also the key factor in driving the increase in the demand for health and social care services. Director of Public Health Report for Sheffield 2017

Sheffield

• Almost 40% population have at least one LTC

• 94,110 people have 2 or more LTCs

• Multi-morbidity – increasing and key factor driving increased health and social care demand

• 18% least deprived people in Sheffield have developed a LTC by their 50s cf 40% most deprived

Director of Public Health Report, 2017

Sheffield’s Integrated IAPT

Team • Clinical lead

• Operations manager

• Lead CBT and Lead Clinical Psychologist

• 3 Psychologists working at Step 4 – pathway leads

• 2 psychologists and 11 CBT therapists at Step 3

• 3f/t Senior PWP (4 staff)

• 9 PWP

• Evaluation lead

Key Principles

Mental health promotion

Increase identification of

anxiety and depression in

physical health settings enhanced by

joint training

Integration greater parity of

esteem- part of the multidisciplinary teams within and across the

pathways

Partnership working work with CCG, primary care

and ‘neighbourhoods’ to understand local populations/

key priorities. Developing further partnerships with STH,

specialist services & third sector

Close to home Deliver psychological

therapy at ‘Neighbourhood’ level

Whole pathway approach

Integrate Step 1 to 4 psychological

interventions within condition specific

pathways

Health and Wellbeing Service

Step 1

Joint

Training

Screening/

Identification

Psycho-

education/

Self-Help

Information

Leaflets

Health and

Wellbeing

Online booking/

patient portal in

development

Self-Help and

Training

Resources

Adapted Stress

Control

A range of ‘living

well with’ groups

for LTC/PPS

Silvercloud: LTC

cCBT

Condition-

specific

Guided Self-

Help

Condition-

specific

Group

Interventions

(Co-delivery)

Condition-

specific CBT

1:1

Condition-

specific CBT

Groups eg

CBT for

Health

Anxiety

Transdiagnostic

Group

Interventions eg

MBSR pilot,

MBCT, ACT

Psychological Assessment,

Formulation, Intervention

Consultation, Case Review

Care Planning

MDT

assessment

&

intervention

Step 2

‘First Line’

Step 2

PWP

Step 3

CBT

Step 4

Psychology

Specialist

MDTs

Stepped Interventions for LTC/MUS

10 Condition Pathways

1 Pain/MSK

2 COPD

3 CHD (including non cardiac chest pain)

4 IBS

5 CSF/ME

6 Generic Long Term Conditions (including dermatology)

7 Health anxiety

8 Diabetes (Type 1 and 2)

9 Generic MUS/PPS

Cancer (following successful treatment) 10

The PWP role

The Bio-Psycho-Social

Model Biological factors

(disease & other bodily changes)

Social factors (family, relationships,

support)

Psychological factors

(thoughts feelings & behaviours)

The experience of illness

Living well after cancer

treatment – psycho education

course

To book a place: Website: www.iaptsheffield.shsc.nhs.uk Telephone: 0114 271 6568

Case study

• GR – female, 34 years old

• 10 year history of depression

• 1 year history back pain – herniated disk

• Managed with medication and awaiting surgery

• Unable to work 9 months

• Living well with back pain course (co-facilitated with physioworks)

• 3x PWP appointments – sleep

• PHQ-9: 19-9 GAD-7: 10-7 Brief Pain inventory: 21/59 -12/29

Outcome Measurement • Mental health outcomes: session by session outcome measures will be completed as usual

• Perception of physical health: it is important to measure service users’ perceptions of their LTC as the

therapy progresses in order to ensure that treatment focuses on the whole person

• Healthcare utilisation: it is expected that the treatment of mental health problems will reduce a person’s

use of other health service resources. Documenting this effect will be important for sustaining IAPT- LTC

services. The Client Service Receipt Inventory (CSRI) will help to document reduction in health care

costs. In the longer term, this self-report measure will be complemented by linking the national IAPT

database with other National NHS datasets

• Patient-reported experience measures (PREM): will measure the quality of a person’s experience of

the service.

Integrated IAPT - Ambitious programme Contributions to:

• Ensuring parity of esteem between MN and PH by 2020; increased access to talking treatments (FYFW)

• Effective management of long term conditions and personalised care (FYFW)

• Challenging organisational and conceptual division between mental and physical health, as a barrier to improvement in health care (Annual Report of CMO, 2013; Kings Fund)

• Educating and training physical health practitioners in mental health (Closing the Gap, 2013)

Outcomes so far

• Small numbers so far

• Outcomes from ‘Living Well with…’ are Comparable with Stress Control

• Ongoing evaluation

Qualitative feedback • ‘Yes the cancer’s gone, but I’m not alright...[this course]

makes it more normal to be feeling like this.’

• ‘The emotional side of your treatment plan is as important as radiotherapy and surgery, this course is fantastic’.

• ‘What you’ve described [about the impact of Living after cancer treatment] is true…this is what it’s like.

• ‘I’m learning more about myself and what I can do’

• ‘You explain it [how I feel] in a way that I can relate to…so that I can understand and work through it.’

• ‘If I wasn’t here I would be sat wallowing at home. I’ll be sad when it ends…talking and listening to other people helps.’

• ‘I start to understand what the problems are and some strategies

The future: opportunities and challenges

• Access targets

• Data collection

• BME access

• Small PWP rescource

• Integration with physical health teams

• Patient awareness

Thank you for your time

Any questions? Kerry.montgomery@shsc.nhs.uk

Ian.mitchell@shsc.nhs.uk

Sian.wray@shsc.nhs.uk

Elizabeth.ruth@shsc.nhs.uk

www.england.nhs.uk

Yorkshire and the Humber Senior PWP Network

Time for a break?

15 minutes only please!

www.england.nhs.uk

Yorkshire and the Humber

Senior PWP Network

Promoting Resilience and

Self-Reflection

All

www.england.nhs.uk

Aim of the Session

To understand more about

resilience and look at how to use

different strategies to be resilient

and self-reflective in the Senior

PWP role.

www.england.nhs.uk

What is resilience?

Resilience is the ability to bounce

back from difficult situations and to

see problems as opportunities for

learning and growth.

www.england.nhs.uk

What is self-reflection?

Self reflection is like looking into a

mirror and describing what you see.

It is a way of assessing yourself and

your ways of working.

www.england.nhs.uk

Why is resilience and self-reflection important

in the Senior PWP role?

Resilience helps us to be:

• Happier

• Healthier

• Adaptable

• Able to achieve what we want to achieve

Self reflection is an is an important part of learning.

Spending time thinking about your own skills can help you

identify changes you might need to make.

www.england.nhs.uk

Resilience and Self-Reflection Discussion:

Consider the following questions, in the context of

your role as a Senior PWP, and capture your

thoughts on the template provided on the table:

1. On a scale of 1-10 (1 low; 10 high), how resilient

are you?

2. In what situation do you find it most difficult to be

resilient?

3. How could you become more resilient?

www.england.nhs.uk

Courage does not always roar.

Sometimes courage is the quiet voice at

the end of the day saying,

“I will try again tomorrow”.

www.england.nhs.uk

Yorkshire and the Humber

Senior PWP Network

Feedback from the IAPT Providers’

Network

Heather Stonebank, Lead PWP Advisor,

Yorkshire and the Humber Clinical Networks

www.england.nhs.uk

Questions for discussion

• Are you getting the most out of your SPWP’s for example they are really interested in the data

• How are you encouraging the integration of learning from the SPWP network in your service?

• How can we develop SPWPs leadership potential?

• What key messages does the provider forum want to send to the SPWP network?

www.england.nhs.uk

Are you getting the most out of your SPWP’s

for example they are really interested in the

data

• Acknowledgement that it is important to share

recovery rate data with Senior PWPs and PWPs

• Data needs to be shared with Senior PWPs and PWPs in the form of key messages

• The narrative of data needs to be shared with PWPs to demonstrate and help understanding of the links to the wider picture and service change

www.england.nhs.uk

How are you encouraging the integration of

learning from the SPWP network in your

service?

• Clinical leads and managers really value the network and your attendance and feedback

• Services need to implement a feedback process/meeting to and from the Senior PWPs

• Feedback key messages to PWPs

• Service managers and clinical leads need to invest in the Network, encourage people to attend and then ensure the learning is spread through the service

www.england.nhs.uk

Key message

• Service managers and clinical leads value your

attendance and keen to integrate learning from the

network into service

What next…

Five W’s and How

• who, what, why, when, where and how

www.england.nhs.uk

How can we develop SPWPs

leadership potential?

• How can people access leadership training courses?

• Ensure career path is clear and create room for ambition

• Enabling SPWPs to build on experience e.g. project

management

• Mentoring in place for those taking the step up from PWP

• Create opportunities for Senior PWPs to be involved in

recruitment

• Recognition the PWP role should be recognised as a core

profession

• Invite and include in senior forum meetings

www.england.nhs.uk

Key message

• Service managers and clinical lead keen to support

leadership and development in the role

What next…

• Reflection, what are you already doing, what are the

opportunities

• PDR/LDR - future leadership development

opportunities

www.england.nhs.uk

What key messages does the

provider forum want to send to the

SPWP network?

• Senior PWPs are doing a great job

• It’s can be a challenging role, you work really hard and we really appreciate you

• Recognition of the importance of the Senior PWP role as a role model for others and brilliant support for PWPs

• Seniors should be part of the decision making process

• Senior PWPs to work closely with data analysts

• We want the network to continue and grow

• We will continue to support/encourage Senior PWPs to attend.

• Senior PWPs are important in developing quality of step 2

• How do we retain Senior PWPs? What do you need in terms of development?

www.england.nhs.uk

www.england.nhs.uk

Reflection

Feedback

• How do you feedback learning from the network?

• Have you integrated any learning which has improved your practice/service?

Data

• Are you having conversations about data?

• What’s working well?

Leadership

• What are you already doing?

• What are the leadership development opportunities?

• What do you need in terms of development?

www.england.nhs.uk

Yorkshire and the Humber

Senior PWP Network

Thank you for listening!

www.england.nhs.uk

Yorkshire and the Humber

Senior PWP Network

Any Other Business

Video Selfies

Feedback from the National Team

(BIT, Yammer & NHS Choices)

CASPER Plus Training

cCBT Update

www.england.nhs.uk

Yorkshire and the Humber

Senior PWP Network

Promoting the PWP Role: Video

Selfies!

Sarah Boul, Quality Improvement Manager,

Yorkshire and the Humber Clinical Networks

www.england.nhs.uk

The National IAPT Programme have concluded

that:

PWPs are an invaluable part of IAPT

services and the mental health

workforce.

The PWP Role:

National Recognition

www.england.nhs.uk

Apparently not!

As a relatively new role, we hear that

healthcare professionals outside IAPT, and

the general public, often don’t know what a

PWP is or what wonderful work you do.

The PWP Role:

But does everyone know what you

do?

www.england.nhs.uk

That’s right – video selfies – 60-90 seconds long covering:

• Your name

• Role

• Where you work (you could give us a little tour)

• The type of work you do and the patients you see

• What a typical day looks like

• An example of a piece of clinical work you’ve done or a group you’ve run (whilst maintaining patient confidentiality)

• How you work with GPs and other healthcare professionals.

The PWP Role:

How can we raise awareness?

www.england.nhs.uk

And there’s more!

The national team would also like – video selfies – 60-90 seconds long covering:

• PWPs who are working in specialist areas or

leading innovative projects. For example, this

might include PWPs working in LTC teams, with

BAME communities, in prisons, in management

roles or with older adults.

The PWP Role:

How can we raise awareness?

www.england.nhs.uk

These videos will showcase the breadth of PWP

roles and skills to:

• Commissioners,

• Service leads and

• Other PWPs to encourage their career

development.

The PWP Role:

But why video selfies?

www.england.nhs.uk

• You read the: “Quick guide to filming with a camera phone or small camera”;

• You complete a consent form, which will enable us to use your PWP video-selfie for NHS England communication purposes;

• You get filming for 60-90 seconds;

• You email your completed video selfie to kevin.smith6@nhs.net via wetransfer.com;

And then you will be…

The PWP Role:

So how do I make a video selfie?

www.england.nhs.uk

www.england.nhs.uk

• NHS England is collaborating with Behavioural Insights Team (BIT) and the Equality and Human Rights Commission (EHRC) to examine how behavioural insights could be used to increase access IAPT services for underrepresented groups.

• The project will explore inequalities in access to IAPT, particularly by age, gender and race.

• BIT will conduct a review of the behavioural literature, undertake qualitative research for 2 identified population groups, and use the findings to consider how best to increase IAPT usage in the identified groups. A final report will summarise the findings, providing suggestions for behaviourally-informed interventions and how these could be evaluated. We hope that, if feasible, this project will lead to a rigorous trial of one or more of our suggested behavioural interventions to test their effectiveness.

• BIT and the EHRC have agreed the project will focus on BAME groups and older adults.

• BIT are currently in the explore phase and would like to interview staff working in IAPT and service users from the two focus groups. If you want to be involved in this project please email: victoria.fussey@bi.team

Feedback from the National

Team - BIT

www.england.nhs.uk

• We have been experiencing some technical difficulties on Yammer due to the move from the nhs.net server. Some members with an @nhs.net email address were no longer able to access Yammer. This has included members of the IAPT national team and the only solution for this problem is to be re-approved using an email address other than x@nhs.net. If you have experienced this problem please let us know by contacting england.mentalheath@nhs.net.

• In order to re-access Yammer, you will need to be added with an alternate email address to an @nhs.net account. For NHS England colleagues the @england.nhs.uk can be used, or for provider colleagues an @[trust].nhs.uk email address will suffice. Please email england.mentalhealth@nhs.net with the new email address to receive a new invite to join the IAPT Yammer network.

• So in short, the IAPT Yammer network is still in use. We apologise for any inconvenience and we hope for the issue to be resolved soon.

Feedback from the National

Team - Yammer

www.england.nhs.uk

• The National IAPT Programme are working with Ros Hewitt who is the product manager for the mental health project focussing on improving IAPT self-referral on NHS Choices / NHS.UK.

• The work is currently underway and is set to run for 8 weeks during which there will be redesign work, updating content and a “beta” testing of the web pages.

• Ros is looking for a few providers (clinical leads, clinicians, data leads or admin) who would be interested in reviewing and testing the pages.

• Would you like to be involved and is your service information correct?

Feedback from the National

Team – NHS Choices

www.england.nhs.uk

• 3x full day CASPER Plus training sessions held across Yorkshire and the Humber – 90 PWPs/Senior PWPs trained in:

• Collaborative Care (CC)

• Behavioural activation (BA) - working with long term health conditions & older adults

• Functional Equivalence

• Using Functional Equivalence to accommodate long term conditions and role changes

• Staying well

Follow up work with the University of York is also being undertaken – watch this space!

CASPER Plus Training

www.england.nhs.uk

cCBT Workshop: Enhancing Treatment with Digital Technologies

• The Yorkshire and the Humber Clinical Network, in conjunction with SilverCloud, is delighted to be hosting an event focussing on the use of cCBT within IAPT services.

• The event intends to enable attendees to develop their understanding of digital technologies; hear first-hand how SilverCloud has been implemented in a local service, learn how to manage the cultural shift required for cCBT and learn how to utilise data to model an optimised service.

• The event will be held: Wednesday 16 May 2018, 09:30-15:30, Novotel, Leeds.

(Currently fully booked)

cCBT Training Day 16.05.18

www.england.nhs.uk

Yorkshire and the Humber

Senior PWP Network

Thank you for Attending!

Please remember to fill out

your evaluation forms!