The Improving Access to Psychological Therapies (IAPT) Program in United Kingdom (UK)

Transcription

1 The Improving Access to Psychological Therapies (IAPT) Program in United Kingdom (UK) Dr. Cheryl So, Clinical Psychologist, Kwai Chung Hospital Dr. Martina Cheung, Clinical Psychologist, Castle Peak Hospital Dr. Amy Kwok, Clinical Psychologist, Prince of Wales Hospital Ms. Carole Li, Clinical Psychologist, Oasis, HAHO Dr. Wilson Tsui, Clinical Psychologist, Kowloon Hospital

2 Acknowledgement The training program and schedule was organized by Mood Disorders Center, University of Exeter, UK Professor David Richards Professor Eugene Mullan Working Group on Primary & Community Care, COC(CP) Hospital Authority

3 A. University of Exeter B. Devon (NHS IAPT Service) C. University of Reading (Child IAPT) D. Colchester (NGO IAPT Service) E. London (Rethink) Attachment in UK

4 Background The Improving Access to Psychological Therapies (IAPT) Program Large scale initiative from the UK government in May 2005 & funded in m ( ); 3660 new therapists 400 m ( ); 2400 new therapists New standalone psychological service in community settings Depression & Anxiety Disorders

5 Clinical & Policy Development 1. National Institute for Health and Clinical Excellence (NICE) Clinical guidelines (evidence-based psychological therapies) Cognitive Behavior Therapy (CBT) Aims to greatly increase the availability of these therapies in the National Health Service (NHS)

6 Clinical & Policy Development 2. Economists and clinical researchers An increase in access to psychological therapies would largely pay for itself other depression-and anxiety-related public costs (welfare benefits and medical costs) increasing revenues (taxes from return to work, increased productivity etc)

7 IAPT Program Governance 1. Well-trained Workforce (Accreditation & Qualification) The Department of Health (UK) commissioned and developed two national curricular for the training of the new workforce for IAPT service, based on competence frameworks derived from the NICE guidelines and evidence from large clinical trials. Postgraduate Certificate (1-year; Low Intensity CBT behavioral activation, problem-solving) Postgraduate Diploma (1-year; High Intensity CBT)

8 IAPT Program Governance 1. Well-trained Workforce (Accreditation & Qualification) All IAPT training courses are accredited by The British Psychological Society (BPS) / The British Association for Counseling & Psychotherapy (BACP) / The British Association for Behavioral & Cognitive Psychotherapies (BABCP) NHS siapt program Professional qualification (knowledge & skills) Individual registration

9 IAPT Program Governance 1. Well-trained Workforce (Accreditation & Qualification) 2. Management / Clinical Guidelines IAPT Guidance for Commissioning IAPT Training Guidance for Commissioning Supervisor IAPT Training Good practice guidance on the use of self-help materials within IAPT services IAPT Positive Practice Guides (for Black and Minority Ethnic Communities, Older People, PerinatalCare, Offenders, etc.) IAPT Supervision Guidance IAPT Key Performance Indicator (KPI) Technical Guidance for 2011/12

10 IAPT Program Governance 1. Well-trained Workforce (Accreditation & Qualification) 2. Management / Clinical Guidelines 3. Treatment Protocols Evidence-based treatments recommended by NICE Guidelines Specific treatment protocols

11 Process of Service Delivery The Stepped Care & Collaborative Service Model IAPT Step 1-3 Step 4 Specialist Mental Health Service Step 3 High Intensity Referral Least Burden principle Step 2 Low Intensity Step 1 Self-help, active monitoring Self-Correction principle

12 Successful Implementation of IAPT 1. Written clinical protocols covering assessment & treatment of each condition Based on the National Institute for Health & Clinical Excellence (NICE) Guidelines 2. Core of experienced staff (e.g., clinical psychologist) who are competent in relevant psychological therapies 3. All IAPT therapists are required to attend Weekly 1-hour Case Management Supervision Bi-weekly 1.5 hour Clinical Skills Supervision

13 Successful Implementation of IAPT Supervision structure in IAPT program

14 Successful Implementation of IAPT 4. Smart IT system for outcome measures and supervision Instant profile analysis Supervisor Alert

15 Effectiveness More than 40 Key Performance Indicators (KPIs) Patient Health Questionnaire Depression Scale (PHQ-9; Kroenke et al., 2001) Patient Health Questionnaire Generalized Anxiety Disorder Scale (GAD-7; Kroenke at el., 2007) Sick pay / illness-related benefit Recovery rate: 42.8% (over 120, 000 people) Over 23, 000 people came off sick pay/benefits

16 Recommendations 1. Quality Standards & Supervision Treatment protocols Continuous supervision

17 Recommendations 2. Training Program Structured training program (low intensity CBT) Close liaison between COC(CP), Institute of Advanced Allied Health Studies (IAAHS), academic psychologists, & relevant professional bodies (The Hong Kong Psychological Society)

18 Recommendations 3. Service Development Long Term Medical Conditions Diabetes, hypertension, coronary artery disease or chronic obstructive pulmonary disease (COPD) 3 or 4 times more: depression & anxiety disorders Savings in other costs to the NHS and to society COC(CP) COC(FM) COC(CP) COC(MED)

19 Recommendations 3. Service Development Improve Access to Psychological Therapies for Children & Young People Depression, eating disorders, self-harm, conduct problems, Attention-Deficit/Hyperactivity Disorder (ADHD) Early intervention treatment; prevent 2 nd psychological problems

20 Recommendations 4. Quality Improvement Care Delivery Model Integrated Mental Health Problem (IMHP) in general out-patient clinics; Common Mental Disorder Clinic (CMDC) in psychiatric settings Close collaboration between the psychiatric specialist & primary care services to provide seamless, coordinated mental health service COC (CP) / COC (Psy) / COC (FM)

21 The Stepped Care & Collaborative Service Model Care pathway Who should be seen By which service At which point in their care Step 1-3: Non-psychiatric settings Step 4 Psychiatric Care Step 3 Specialist Psychological Intervention Step 2 Early Intervention Beh activation; problem-solving Step 1 Early detection; Initial Assessment; Psychoed Experienced clinicians therapy; supervision; collaboration

22 Conclusion Concerted effort from different COCs Program plan Clinical governance Management / clinical guidelines Structured training curriculum Written protocols (assessment and treatment)

23 Questions & Answers Thank you!