www.england.nhs.uk
• Stephen McGowan, EIP Clinical Lead for Y&H CN and NHSE (North) (Chair)
• Dr Steve Wright, Consultant Psychiatrist, TEWV (Co-Chair)
• Sarah Boul, Quality Improvement Manager [email protected]
• Twitter: @YHSCN_MHDN #yhmentalhealth
• August 2019
Yorkshire and the Humber
Mental Health Network
Early Intervention in Psychosis Network
15 August 2019
www.england.nhs.uk
Yorkshire and the Humber
Early Intervention in Psychosis Network
Welcome and HousekeepingSarah Boul, Quality Improvement Manager,
Yorkshire and the Humber Clinical Networks
@YHSCN_MHDN
#yhmentalhealth
Housekeeping:
www.england.nhs.uk
Yorkshire and the Humber
Early Intervention in Psychosis Network
Regional EIP Work Programme Update and
Developing Teams to Level 3 Moggie McGowan, Co-Chair, Clinical Advisor, Y&H IRIS, Y&H Clinical
Network & NHS England North
www.england.nhs.uk
Yorkshire and the Humber
Early Intervention in Psychosis Network
Using Outcomes in EIP ServicesAlison Brabban, Expert Advisor to AMH Programme, NHS England
and Recovery Lead, Tees, Esk & Wear Valleys NHS Foundation Trust
and Sally Milne, Senior Project Manager, NHS England
www.england.nhs.uk
Regional EIP Work Programme
and Developing Teams to Level 3
Moggie McGowan
Regional Clinical Lead for EIP
NHS England and NHS Improvement
15th August 2019
www.england.nhs.uk
www.england.nhs.uk
5YFVMH:
By 2021 at least 60% of people with a first episode psychosis starting treatment with a NICE-recommended package of care with a specialist early intervention in psychosis (EIP) servicewithin two weeks of referral
3-D & 3 way stretch
www.england.nhs.uk
Access (53%)/NICE interventions/Outcomes
Regional summaries
Overall ScoreNumber of services
Percent at level 1
Percent at level 2
Percent at level 3
Percent at level 4
Percent level 3 and above
England 151 15.9% 63.6% 13.2% 7.3% 20.5%
London 27 0.0% 81.5% 7.4% 11.1% 18.5%Midlands and East 42 28.6% 59.5% 11.9% 0.0% 11.9%
North 49 22.4% 46.9% 16.3% 14.3% 30.6%
South East 19 5.3% 68.4% 21.1% 5.3% 26.3%
South West 14 0.0% 92.9% 7.1% 0.0% 7.1%
18/19 NCAP Results
www.england.nhs.uk
• Current Position
• Trajectory
www.england.nhs.uk
Contextual Standards
Timely, Effective
Treatment
Performance & Outcomes
www.england.nhs.uk
Development & Assurance
• ACCESS: Are access and waiting time standards being
met, is data being reported reliably and do Unify and
MHSDS data compare well?
• QUALITY: Are NICE approved therapies available to all
that need them with good levels of take up and is the
service provided to the full age-range and people with At
Risk Mental States?
• WORKFORCE & INVESTMENT: Is development of a
specialist service supported by CCG investment and Trust
spending? Do staffing levels and skill mix reflect the
workforce calculator, contextual standards and current
incidence?
ACCESS QUALITY WORKFORCE DEADLINE
Team name QI Meeting 14 days, data quality NICE, ARMS, >35s Workforce/Investment 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24
Bradford & Airedale 12/03/2019 1 2 3 3
Aspire Leeds 12/02/2019 2 2 3 3
York and Selby 09/01/2019 1 1 1 1 3
Psypher 27/11/2018 2 3 2 2 3
Doncaster 04/07/2019 2 2 3 3
Rotherham 04/07/2019 2 2 3 3
North Lincs 04/07/2019 2 2 3 3
Sheffield 24/01/2019 2 2 2 2 3
NAViGO 18/11/2018 2 2 3 3
Northumberland 23/01/2019 2 2 2 3
North Tyneside 23/01/2019 2 2 2 3
South Tyneside 23/01/2019 2 4 3 3
Gateshead 23/01/2019 2 2 2 3
Newcastle 23/01/2019 2 3 2 3
Sunderland 23/01/2019 2 2 2 3
Scarborough, W&R 14/06/2019 1 1 1 1 3
Harrogate, H&R 14/06/2019 1 1 1 1 3
South Durham 23/01/2019 1 2 2 3
North Durham & 23/01/2019 2 2 3 3
Middlesborough 23/01/2019 2 2 2 3
Hartlepool 23/01/2019 2 2 2 3
Stockton on Tees 23/01/2019 2 2 3 3
Redcar & Cleveland 23/01/2019 2 2 3 3
Cumbria (AMAZE) 23/01/2019 2 3 3 3
Halifax 10/05/2019 2 4 3 3
North Kirklees 10/05/2019 2 4 3 3
Huddersfield 10/05/2019 2 3 3 3
Wakefield 10/05/2019 2 4 3 3
Barnsley 10/05/2019 2 4 3 3
Actual Actual Predicted Predicted Predicted Predicted
83% 31%
N C A P
KEY:
Greatest Need for Improvement
Needs Improvement
Performing Well
www.england.nhs.uk
• Current Position
• Trajectory
www.england.nhs.uk
Access: 74%
NICE: Level 2
Outcomes: Level 1
NCAP rating:Level 2
Stand-alone team
3-Year service:33m
Caseloads: 15
ContextualStatus
Provision for Children
Demand/Capacity:130/120
Investment:£7,900 pp
ARMS Pathway
Age range:14-65
Data Quality
www.england.nhs.uk
What have we learned:• ARMS pathways, over 35s, physical health and collecting
outcomes data are the main clinical challenges
• Workforce shortages are impacting on quality performance.
• FI, physical health and outcome measurement seem particularly sensitive to team capacity
• AWT performance is less sensitive but performance has deteriorated in some areas.
• Under-investment means we are not on trajectory in some areas.
• Partial investment is also a problem.
• 2019 contracting round will be critical for EIP – 60% of NHSE funding to be allocated
• The workforce is remarkably resilient!
www.england.nhs.uk
Network Offer
• Needs analysis/QI reviews
• Support for commissioning
• Support for clinicians and teams with clinical challenges
• System support for service development and business planning (NB- IST)
• Increased focus on delivery and assurance
• Targeted support to areas of greatest need
ACCESS QUALITY WORKFORCE DEADLINE
Team name QI Meeting 14 days, data quality NICE, ARMS, >35s Workforce/Investment 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24
Bradford & Airedale 12/03/2019 1 2 3 3
Aspire Leeds 12/02/2019 2 2 3 3
York and Selby 09/01/2019 1 1 1 1 3
Psypher 27/11/2018 2 3 2 2 3
Doncaster 04/07/2019 2 2 3 3
Rotherham 04/07/2019 2 2 3 3
North Lincs 04/07/2019 2 2 3 3
Sheffield 24/01/2019 2 2 2 2 3
NAViGO 18/11/2018 2 2 3 3
Northumberland 23/01/2019 2 2 2 3
North Tyneside 23/01/2019 2 2 2 3
South Tyneside 23/01/2019 2 4 3 3
Gateshead 23/01/2019 2 2 2 3
Newcastle 23/01/2019 2 3 2 3
Sunderland 23/01/2019 2 2 2 3
Scarborough, W&R 14/06/2019 1 1 1 1 3
Harrogate, H&R 14/06/2019 1 1 1 1 3
South Durham 23/01/2019 1 2 2 3
North Durham & 23/01/2019 2 2 3 3
Middlesborough 23/01/2019 2 2 2 3
Hartlepool 23/01/2019 2 2 2 3
Stockton on Tees 23/01/2019 2 2 3 3
Redcar & Cleveland 23/01/2019 2 2 3 3
Cumbria (AMAZE) 23/01/2019 2 3 3 3
Halifax 10/05/2019 2 4 3 3
North Kirklees 10/05/2019 2 4 3 3
Huddersfield 10/05/2019 2 3 3 3
Wakefield 10/05/2019 2 4 3 3
Barnsley 10/05/2019 2 4 3 3
Actual Actual Predicted Predicted Predicted Predicted
83% 31%
N C A P
KEY:
Greatest Need for Improvement
Needs Improvement
Performing Well
www.england.nhs.uk
Response categories:
1. On target: Level 3 and on trajectory level 2 teams - Light-touch follow up and ad-hoc support from network
2. Not on target: Level 1s and under-performing level 2s (i.e. not on trajectory): Formal letter from Region to Trust and CCG CEOs (copied to STP/ICS leads and NHSE/I delivery directors) requiring a recovery plan and quarterly updates. Active follow up and support from network. NB- additional focus on ARMS pathways and >35s.
3. Unknowns: Some level 1 teams not engaged with regional network and/or support offer to date. As well as a formal letter a joint IST/Deep Dive review is proposed.
Team name NCAP 18/19 Level 3? ResponseBradford & Airedale 2 20/21 1
Aspire Leeds 2 20/21 1York and Selby 1 22/23 2Psypher 3 21/22 2
Doncaster 2 20/21 1Rotherham 2 20/21 1
North Lincs 2 20/21 1Sheffield 2 21/22 2
NAVIGO 2 19/20 1Northumberland 2 20/21 1North Tyneside 2 20/21 1
South Tyneside 4 20/21 1Gateshead 2 20/21 1
Newcastle 3 20/21 1
Sunderland 2 20/21 1
Scarborough, W&R 1 23/24 3
Harrogate, H&R 1 23/24 3
South Durham 2 20/21 1
North Durham & 2 20/21 1
Middlesborough 2 20/21 1
Hartlepool 2 20/21 1Stockton on Tees 2 20/21 1
Redcar & Cleveland 2 20/21 1Cumbria (AMAZE) 3 20/21 1
Halifax 4 20/21 1North Kirklees 4 20/21 1Huddersfield 3 20/21 1
Wakefield 4 20/21 1Barnsley 4 20/21 1
Team name NCAP 18/19 Level 3? 14-65 ARMS ResponseBradford & Airedale 2 20/21
Aspire Leeds 2 20/21York and Selby 1 22/23Psypher 3 21/22
Doncaster 2 20/21Rotherham 2 20/21
North Lincs 2 20/21Sheffield 2 21/22
NAVIGO 2 19/20Northumberland 2 20/21North Tyneside 2 20/21
South Tyneside 4 20/21Gateshead 2 20/21
Newcastle 3 20/21
Sunderland 2 20/21
Scarborough, W&R 1 23/24
Harrogate, H&R 1 23/24
South Durham 2 20/21
North Durham & 2 20/21
Middlesborough 2 20/21
Hartlepool 2 20/21Stockton on Tees 2 20/21
Redcar & Cleveland 2 20/21Cumbria (AMAZE) 3 20/21
Halifax 4 20/21North Kirklees 4 20/21Huddersfield 3 20/21
Wakefield 4 20/21Barnsley 4 20/21
**NEWS**NEWS**NEWS**NEWS**
• Long-term plan
• IRIS website
• Map
• y-QUIT
• Sailing to Recovery
• Miriam’s research
• Training needs – Plus CAARMS, PSI etc.
**NEWS**NEWS**NEWS**NEWS**
• Long-term plan
• IRIS website
• Map
• y-QUIT
• Sailing to Recovery
• Miriam’s research
• Training needs – Plus CAARMS, PSI etc.
**NEWS**NEWS**NEWS**NEWS**
• Long-term plan
• IRIS website
• Map
• y-QUIT
• Sailing to Recovery
• Miriam’s research
• Training needs – Plus CAARMS, PSI etc.
**NEWS**NEWS**NEWS**NEWS**
• Long-term plan
• IRIS website
• Map
• y-QUIT
• Sailing to Recovery
• Miriam’s research
• Training needs – Plus CAARMS, PSI etc.
EIP UK Voyage of Recovery, 2020
• Circumnavigating the UK• 12 one week legs, June-August • 12 teams of 10 Young people +
up to 5 Leaders
Contact: [email protected]
Also see:https://cirdantrust.org/
Please get in touch if you are interested and would like to find out more
**NEWS**NEWS**NEWS**NEWS**
• Long-term plan
• IRIS website
• Map
• Sailing to Recovery
• Miriam’s research
• Training needs – Plus CAARMS, PSI etc.
www.england.nhs.uk
A survey which will collect information about how EIP services are being delivered across England. This information will be used to describe EIP fidelity nationally (i.e. how closely EIP services across England adhere to the intended EIP model), examine whether EIP services have reduced suicide and hospitalizations and assess whether ‘fidelity’ to the EIP model of care influences this relationship.
**NEWS**NEWS**NEWS**NEWS**
• Long-term plan
• IRIS website
• Map
• Sailing to Recovery
• Miriam’s research
• Training needs – Plus CAARMS, PSI etc.
www.england.nhs.uk
http://www.iris-initiative.org.uk
http://www.yhscn.nhs.uk/mental-health-
clinic/mental-health-network/EIP/EIPMaps.php
NHS England and NHS Improvement
Early Intervention in Psychosis –Measuring and reporting patient/clinician reported outcomes
Support pack
36 |36 |
• Introduction to outcome measure
• QPR, DIALOG and HoNOS
• Using the data
• Tips, hints and resources
Contents
Presentation title
37 |37 |
INTRODUCTION TO OUTCOME MEASURES
Presentation title
38 |38 |
• The Five Year Forward View for Mental Health outlined the need to measure clinical outcomes routinely in mental health and to capture this activity through the Mental Health Services Data Set (MHSDS).
• The primary aim of this drive for outcome collection is to ensure services are meeting the needs of service users and aid service improvement.
• There is the expectation that all service providers should be transparent and be commissioned based on the impact they are having.
• Guidance published by NHS England outlined clarity on expected service user outcomes is key to measuring and monitoring the effectiveness of EIP services.
National context
Presentation title
39 |39 |
Outcomes context
Presentation title
1
Greatest need
for
improvement
2
Needs
improvement
3
Performing
well
4
Top
performing
Percentage of service users for whom two or
more outcome measures (from
HoNOS/HoNOSCA, DIALOG and QPR) were
recorded at least twice (assessment and one
other time point)
<25% ≥25% ≥50% ≥75%
As a result of a number of services finding it difficult to achieve the levels required for outcome measurement NHS England convened a working group to address the barriers to collecting outcome measures in EIP services.- Developed a support pack to outline why outcome measures are important and tips
on how to use them
- E-Learning module on the use of outcome measures in EIP services
- Sharing the MHSDS data on outcomes through the EIP Triangulation tool and starting to consider how to demonstrate clinically meaningful change
40 |40 |
NCAP 2018/19
Presentation title
41 |41 |
• When we measure outcomes we are looking at measuring change.
• In the context of clinical outcomes we are looking at what difference the intervention/service is making.
• What change is measured depends on what service users want to gain from services.
• In EIP we are interested in what impact the service has on an individual’s
• personal recovery
• Quality of Life
• Individual needs.
Understanding outcomes
Presentation title
42 |42 |
• To work out what change the intervention is making we need to compare a rating that was
made before and after the intervention (these are called paired outcome measures).
• The baseline measure (before the intervention) should give clinicians an idea of how the
person is at that point in time and indicate certain issues or areas which might need attention.
• Any outcome assessment should be done collaboratively and include a discussion about
what the person has reported. The assessment can be used to identify areas to work on and
can help with care planning.
• The two main types of outcome assessment are:
• Those where service users rate themselves known as Patient Reported Outcome
Measures or PROMS
• Those where clinicians make the judgement, these are known as Clinician Reported
Outcome Measures or CROMS.
• In EIP there is a requirement to use both Patient Reported and Clinician Reported Outcome
Measures:
• Clinician reported (e.g. HoNOS)
• Patient reported (e.g. QPR and DIALOG)
• This pack focuses on these three outcome measurement tools, but there are other outcomes
that can be collected when important to the clinician and service user.
More on Outcome Assessment
Presentation title
43 |43 |
Why is it important to measure outcomes?
Presentation title
For service users
• To help identify service user needs and areas to focus on.
• To aid care planning.
• To recognise if progress is being made or not and in what area.
• To provide a more systematic approach to identifying needs/monitoring change.
• When used appropriately they promote shared decision making.
For services• To understand the needs of the service users they’re serving.• To understand the difference they are making• To ensure they are meeting the needs of service users • To identify where there are gaps in the service. • To demonstrate the effectiveness of the service.• To compare their effectiveness with similar services. • To help to guide service improvement and delivery.
Click here for more guidance on choosing and using outcome measurement tools
44 |44 |
QPR, DIALOG AND HoNOS
Presentation title
45 |45 |
Which measurement tools should be used in EIP?
Presentation title
DIALOG QPR
HoNOS/HoNOS-CA
46 |46 |
• QPR and DIALOG have been chosen because they measure what service users
want to get from EIP, namely personal recovery and improved quality of life
• Both QPR and DIALOG have been well-researched and have been shown to
have good reliability and validity plus they are brief and practical to use in routine
clinical settings.
• HoNOS has been developed as a CROM, and is currently used in services to
support clustering.
• Although the EIP Access Standard recommends QPR, DIALOG and HoNOS,
services should not feel limited to use only these measures. It may also be
helpful to use supplementary measures at times.
• A common sense approach should be used when administering PROMs and
assessors need to use their clinical judgement. It may not be appropriate to ask
service users to complete assessments if they are particularly distressed or
finding it difficult to concentrate.
• All these tools are freely downloadable so there is no licencing cost to the
service. They can be found at https://digital.nhs.uk/services/national-clinical-
content-repository-copyright-licensing-service
Why these tools?
Presentation title
47 |47 |
• Outcome measures should be used routinely throughout an individual’s care. They help to guide treatment and track progress.
• As a minimum, these should be used:
• during assessment, the baseline measure should be taken as early as possible to identify the needs of the individual, aid care planning and enable the impact of the intervention to be measured
• at six and 12 months
• Annually
• upon discharge.
• However, services should be working towards routine use of these three measures (at every clinical session if possible). This will serve to support ongoing monitoring of service users to determine whether shared treatment goals are being achieved, to reinforce the therapeutic alliance and to ensure a full pre and post-treatment outcome for 100% of all cases.
• If only a small number of cases have outcomes data, the mean scores may be skewed by atypical results meaning it is not very representative (e.g. if only 5 service users in a team have completed these results and these 5 have not done particularly well, it would bias the outcome scores as these would suggest service users in that team are not improving.)
When should I be using each measure?
Presentation title
48 |48 |
How to use HoNOS
Presentation title
• HoNOS is a clinician reported outcome measure and, as such, should be completed by
the clinician, based on their observation of the service user.
• Other tools, such as DIALOG and QPR can support the clinician in the completion of
HoNOS.
Taken from Hampshire Partnership NHS Foundation Trust
• 12 items, each with 5-point severity scales (0-4)
0 = no problem
1 = minor problem requiring no action
2 = mild problems but definitely present
3 = problem of moderate severity
4 = severe to very severe problem
• More information and training on how to use HoNOS can be found on the RC Psych
website
• More information on how to rate HoNOS can be found in the HoNOS glossary
49 |49 |
• DIALOG was originally developed as a tool to help structure communication between clinicians and service users and to improve outcomes (not measure them).
• Research showed it could improve quality of life, satisfaction with services and service users reported having fewer unmet needs.
• It has since been tested and shown to be a sufficiently robust patient reported outcome measure (as well as a tool to help identify needs).
DIALOG
Presentation title
50 |50 |
• DIALOG considers satisfaction with a 8 key domains linked to Quality of Life.
• It is made up of 11 items including 3 that focus on the person’s experience of care (patient reported experience measures -PREMs).
• Each question is rated on a 1 to 7 scale (1 being totally dissatisfied and 7 being totally satisfied).
• As well as completing each scale, the person should then be asked if they want help in this particular area.
• Once fully completed a discussion should take place to prioritise the 3 priority areas to work on.
DIALOG
Presentation title
51 |51 |
• The original trial found that many practitioners struggled to use DIALOG to best advantage and the research team went on to develop DIALOG+
• DIALOG+ focuses on the administration of DIALOG in a structured manner to ensure it is more therapeutic.
• DIALOG+ uses a freely available app and is delivered in line with Solution Focused Therapy.
• Links to the DIALOG+ app can be found at: https://dialog.elft.nhs.uk/Resources
DIALOG & DIALOG+
Presentation title
52 |52 |
• QPR is a measure of personal recovery.
• It was developed by people with lived experience of psychosis.
• It is comprised of 15 items that map onto the 5 CHIME factors associated with recovery (Connectedness, Hope, Identity, Meaning and Empowerment).
• It can be used to identify possible areas to work on as well as to track progress (measure outcomes).
The Process of Recovery Questionnaire (QPR)
Presentation title
53 |53 |
• When completing the QPR the person should base their ratings on how they have been over the last 7 days.
• Each item on the QPR is scored on a 0 – 4 scale.
• The QPR is a single scale and therefore the total score should be reported.
• An increase in the overall QPR score is indicative of an improvement.
QPR
Presentation title
54 |54 |
• All outcome tools should be completed collaboratively.
• Clinicians should always explain the purpose of the tool when they first introduce it.
• Service users should be given a choice of whether to complete the questionnaire/tool or not. It they don’t want to, this decision should be respected.
• Practitioners should use their clinical judgement about the appropriateness of asking someone to complete a questionnaire. Don’t ask someone to do this if they are very distressed.
• Always look at what the person has reported at the time of completing the tool and discuss the results and the implications. Never file/put away a completed form without looking at it and discussing it.
Administering outcome measures
Presentation title
55 |55 |
FLOWING AND USING DATA
Presentation title
56 |56 |
Using data from outcome tools – Submitting to the MHSDS
Presentation title
MHSDS Table to be
completed
Information used
MHS102 Service or team
type referred to
Date the referral was rejected
MHS201 Care contact - Date of the contact
- Whether the person attended
- The medium that was used in the consultation
MHS204 Indirect activity Date of the indirect activity
MHS606 Coded scored
assessment (referral)
- Coded assessment tool type – this will be entered in SNOMED CT
- Score on the assessment
- Date the assessment tool was completed
MHS607 Coded scored
assessment (contact)
- Coded assessment tool type – this will be entered in SNOMED CT
- Score on the assessment
The table below shows the information that is drawn from the MHSDS to analyse outcome use and
scores, and the tables that the information should be entered in.
SNOMED-CT Codes can be found on the MH Assessment tab of the technical output specification
from NHS Digital
57 |57 |
TIPS, HINTS AND RESOURCES
Presentation title
58 |58 |
• Explain what the measure is, why you are using it, and who will see the results.
• Have follow up discussions with the service user about the information that they have given in the questionnaire.
• Depending on the context and the stage of engagement you might want to reflect on:
• how scores have changed over time
• how scores relate to average population scores, or other research about norms or thresholds for that measure
• how the service user interprets the score
• whether the score has any implications for the support they are receiving e.g. should anything change or stay the same?
Tips for using outcomes in a clinically meaningful way
Presentation title
59 |59 |
How to use outcomes in a clinically meaningful way – variables in the data
Presentation title
User Clinician Service
Motivated to respond accurately (e.g.
not worried about consequences,
understand why it’s useful to them, trust
in clinician)
Able to access the relevant
questionnaires (e.g. paper forms need
to be printed, electronic forms may
need wi-fi, if using DIALOG+
clinician/user has access to app)
The ability to collect data on the same
measures at least at assessment,
6months, 12 months and annually
Immediate influence such as mood
fluctuations and context, method of
delivery, understanding of questions
and ability to match feelings to
response, environment, literacy,
intuitiveness of interface,
developmental stage
Understands how to use questionnaires
and usefully use them in a session as
well as how to effectively feedback
information (incentivised by clinical
utility rather than arbitrary targets)
IT/admin systems that support data to
be extracted securely and with minimal
burden
If the user is feeling a lot better, they
may not keep attending services and so
time 2 on or post discharge may be
difficult to organise. Likewise if the user
is unhappy with their experience with
the service or is not able to complete on
discharge
Has the time/resource/know-how to
score, interpret and feedback data in
session, use in supervision and input
onto data entry systems
All users of the service fill out
questionnaires (avoid biasing data
towards those who have
improved/deteriorated)
Has support from commissioners,
management and colleagues to
incorporate new ways of working into
their practice (e.g. more admin time
than before)
Support from commissioners etc. to be
able to share data without it being
misinterpreted, taken out of context or
unfairly penalised
Adapted from Using clinical outcomes for service improvement
60 |60 |
Tips and hints
Presentation title
Some DOs and DON’Ts of using clinical outcome tools
Do Make sure you have the forms you need ready before the session
Do Explain why you are asking someone to fill in the form
Do Look at the answers
Do Discuss the answers with the service user
Do Share the information in supervision
Do Always use the forms in conjunction with other clinical information
Don’t Give out a questionnaire if you think the person doesn’t understand why they are being asked to complete it
Don’t Use any form if you don’t understand why you are doing it
Don’t Insist on someone filling out forms if they are too distressed
Don’t See the numbers generated from outcome tools as absolute fact
Don’t See your clinical judgement as absolute fact
Adapted from Using clinical outcomes for service improvement
61 |61 |
Tips and hints
Presentation title
Have you explained? Yes No
What feedback you would like to gather, why, and how it can improve the therapy or treatment you
are offering
That if a service user doesn’t understand a question, or is unsure about it, they can ask for help,
and that they don’t have to answer a question if they don’t want to
How will you monitor feedback or outcomes data over time and how service users can be involved
in this
That if the service user has other issues or concerns that are not covered by the questionnaire, it’s
fine to raise these
If and how carers might be asked for feedback too – remember their involvement may make it
difficult for some service users to fully express themselves
Have you considered? Yes No
Using different ways of gathering and then sharing feedback (not all feedback should be gathered by questionnaires since they may not allow for qualitative, more in-depth answers)
How to make the feedback at the end of the session personal to the service user so it is relevant to them
How to share data feedback with service users in a way that is accessible and understandable to them
How you balance gathering feedback in the time available (it’s important service users feel listened to and that gathering feedback doesn’t dominate the session; on the other hand, they shouldn’t feel pressured into filling in the forms quickly at the end of the session)
How you might need to vary how and when you request or share feedback, given that every person is different and should be treated as an individual.
Adapted from Using clinical outcomes for service improvement
62 |62 |
• Delivering the Five Year Forward View for Mental Health: Developing quality and outcomes measures
• Effective patient-clinician interaction to improve treatment outcomes for patients with psychosis: a mixed methods design
• HoNOS training and application in clinical practice
• Using clinical outcomes for service improvement
• HoNOS glossary
More resources
Presentation title
www.england.nhs.uk
Yorkshire and the Humber
Early Intervention in Psychosis Network
Time for a break?
www.england.nhs.uk
Yorkshire and the Humber
Early Intervention in Psychosis Network
Introduction to the Group Discussion
Dr Steve Wright, Co-Chair, Consultant Psychiatrist, TEWV & Clinical Advisor,
Y&H Clinical Network
Early Intervention in Psychosis
Network - August 15th 2019
Group Discussion:
The unintended consequences of the Access & Waiting Time Standards
Steve Wright
NHS England (North) Yorkshire & the Humber EIP Network
What did AWT standards ever do
for us? (service users & carers)
• Improved access
• Prevention
• Equity/Equality
• Improved physical health (NCAP)
• Higher standards of evidence-based care
• Greater consistency of evidence-based
care
Benefits & side/effects?
• Fidelity / (NCAP contextual factors)
• Confusion! (for EIP & other teams)
• Dilution of youth focus?
• Process over personalisation?
• Peer support and social recovery work?
• Groups?
What else happened?
• In what areas (outwith AWT) has it been
hardest to sustain the quality of care?
• Which (if any) elements of recovery
work have fallen in terms of team
priorities to make way for AWT?
• What new pathways and interventions
have you had to develop to adapt to the
post AWT world?
www.england.nhs.uk
Yorkshire and the Humber
Early Intervention in Psychosis Network
Summary & CloseDr Steve Wright, Co-Chair, Consultant Psychiatrist, TEWV & Clinical Advisor,
Y&H Clinical Network
www.england.nhs.uk
Yorkshire and the Humber
Early Intervention in Psychosis Network
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