BtB - Computerised CBT
The Matched Care Model
STEP 4
STEP 3
STEP 2
PSYCHOLOGY
BRIEF THERAPY
BEATING THE BLUES
STEP 1
MOODJUICE
GPs
BtB – Clinical Outcomes
2.50
2.00
Core Score
1.50
Before
After
Clinical Cut-Off
1.00
(CORE-OM Manual,
1998)
0.50
0.00
Well Being
Problems
Functioning
Risk
Mean
Mean - Risk
Measured
Core OM scores taken at beginning of
Average score taken from 77 patients.
1st
and end of
8th
sessions.
Systems Success
NUMBERS OF REFERRALS
30/04/2006
181
1400
30/04/2007 30/04/2008
836
339
30/04/2009
1040
30/04/2010
1154
30/04/2011
1133
1200
Number of Referrals
1154
1133
30/04/2009 30/04/2010
30/04/2006 30/04/2007 30/04/2008
1040
31
29
33
42
Waiting Days 34
Average1000
9
11
13 sent
letter
26
referral and appointment
Average Days between 24
30/04/2011
32
11
836
800
600
400
339
200
181
0
2006
2007
2008
2009
2010
2011
Reporting year (1st May to 30th April)
The percentage DNA for 1st sessions = 28.7%.
The percentage DNA overall = 11.7%.
Average waiting time for treatment = 31 days
Number of Primary Care Doctors (GPs) = 220
Percentage of Psychology Referrals = 46%
The Cost
COST PER PATIENT
£350.00
£300.00
£250.00
£200.00
Column B
£150.00
£100.00
£50.00
£0.00
1
2006
2
2007
3
2008
4
2009
2010
System becomes more efficient with increased use
2011
Where to Start
Phases of Implementation
1)
2)
3)
DEVELOPMENT OF OBJECTIVES
IDENTIFY RESTRICTIONS
CONSIDER WIDER IMPACT
Objectives impact on all
phases of
implementation
4)
5)
DESIGN OF SERVICE MODEL
DEVELOP IMPLEMENTATION STRATEGY
6)
7)
IMPLEMENTATION OF MODEL
MARKETING
OUTCOME: SUSTAINABLE SERVICE
WHICH ACHIEVES OBJECTIVES
Impact of Objectives and Restrictions
OBJECTIVES;
RESTRICTIONS;
EFFICIENCY, MAXIMUM CAPACITY,
ACCESSIBLE, MINIMAL WASTAGE
•
•
•
•
Maximum numbers of patients seen
Accessible across the region
Efficiency of patient access
Minimise DNA's
FUNDING, ACCESS TO CLINICAL STAFF
• Changes administration of services
• May limit accessibility to service across
region, will impact on referrals
• Limits growth and may lead to restricted
development of service
• Limited access to clinical input
Combination of Objectives and Restrictions provides
foundation of service design and implementation
Example Models
Forth Valley and Tayside – Aims; efficiency, maximum capacity, accessible
Locations distributed across region
Clinical responsibility remaining with referrer
Different clinical models applied in psychology and GP’s
Phased developments with capacity expanding due to needs and readiness of service
Target time for referral to appointment
System working to maximum levels of patient throughput allowed by targets
Service part of matched/stepped care systems for added patient support
Additional Aim in Tayside – minimal wastage of treatments
Assign further appointment to patients that DNA
A Working Service
Access Across a Region
Service proves accessible by
spreading machines across
entire region including rural and
deprived areas supported by
onsite administrators
Location vary greatly in style but not
quality of service through combination
of right location, good training and
consistency of treatment.
Referral Routes
Systems run in parallel
Direct GP Access
Point of Referral
to Beating the
Blues
Upon patients are
either discharged or
offered further
treatment
GPs have option of
referring to psychology to
gain access
Psychology and Other
Mental Health Services
Patients attend treatment, referrers
kept informed of progress with
Progress Reports
Patients assessed
for suitability
Patients are given exit interview to
determine success of program
Multiple streams of referral can be developed with minimal variation in process
Central Processing
MACHINE LOCATIONS
Location contacted,
appointment arranged
Central Coordination of
all initial appointments,
across all locations
Patient contacted and
asked to attend
appropriate location
All refers use single point of
access and standardised
referral form
KEY ADVANTAGES
• Monitoring flow of referral
• Diverting patients to prevent waiting times
• Increased support of locations and patients
• Connection to psychology
• Addressing Suicide Alerts
REFERS
Key Aspects for Success
The Right Workforce
Key Requirements
• Point of contact in relation to referral
and enquiry
• Ability to address clinical issues and
make informed decisions
• Co-ordinate and develop service
• Address IT issues as they arise
• Motivate and maintain high levels of
communication
Clinical vs. Customer Services Experience
Costs of clinical staff is high
Clinical support is only required on few occasions
Assess support network and position of service
Non-clinical equals less threatening
Availability to staff is essential
• Be available
Development of the correct intra-structure
and systems will enable the minimisation of
staffing needs and therefore costs
Forth Valley employs a single coordinator to run service with customer
services and IT background
Communication With Referrers and Users
Good communication with referrers = flexibility in service and the ability
to manage referral patterns, clinical issues and support for future work
Development of a clear understanding between referrers and service
Efficiency when dealing with referrer requests either on a service or patient basis
Recognition of referrer skills and abilities to determine best course of action for patient?
Maintenance of links through updates and continued contact
Good communication with patients = greater motivation,
increased patience with program, better outcomes for patient
Development of a clear understanding of program, its benefits and the need to complete
course (this particularly on getting them past first two sessions)
Support and assist users to overcome any barriers that prevent the completion of course
Be accessible at all times and have the required information and understanding at finger tips
Friendly, approachable and non-threatening
Marketing/Education
Marketing to referrer groups = increase in referrals
Requirements
Outcomes/Actions
Marketing Strategy
Development of clearer defined targets,
messages and requirements based on original
service aims
Delivery of Key Messages
Creates clear understanding of what BtB does,
who it is for and how to access service. Delivery
of messages is dependant on scale
Scale
Targets generated from objectives, will focus on
the numbers of referrals to be generated and
desired impact of service
Timing
Marketing to different groups and levels needs
to be timed around service development to
ensure controlled increase of referral and use
Key outcome of marketing would be integration into clinical structures and practice
Our Advice
Genuine commitment to development and running service
Dedicated team with right individuals to implement and then run service
Allow focus to remain on patient by ensuring efficiency of process and administration
Do not over complicate the service and administration systems
Clearly defined responsibilities
Develop clear lines of communication with referrers and patients
Look to integrate service into exists structures
Get the right clinical and managerial support structures in place before you start
Approaching the service with the right mind set is essential
Clearly define objectives and requirements before thinking about logistics of service
Do not underestimate complexity and subtly of task, having the right
understanding and drive to develop the service within those involved is essential
The Local Impact
Features of the Forth Valley Matched Care Model comments from Head of Primary Care Psychology
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It has doubled the number of people receiving psychological therapy – 1100 new referrals a year to BtB
The waiting time for individual therapy has decreased. Before the start of the system, it was up to 2.5
years, now it is no more than 6 months
The waiting time for other forms of psychological therapy (non-individual) is lower than this, meaning
that a far higher proportion of people are meeting the 18 week waiting time target for psychological
treatment
Audit of BtB has revealed that referrals are appropriate and treatment is effective
The mild to moderate system is now having a significant impact on the population of Forth Valley. There
are about 12000 new case of depression and anxiety in per year about 2000 (or 1 in 6) are receiving
specialist psychological treatment, in addition to the people accessing Moodjuice (a total of 110,000 selfhelp resources are delivered through Moodjuice a year)
Preliminary data suggests that BtB is helping reduce the increase in antidepressant prescribing by GPs
Greatest impact was achieved by integrating mild to moderate stepped care into existing service
models and local structures such as GP Enhance Service.