Measuring: the real life challenges
Lessons and reflections the NHS Lothian
Early Implementer Site
Linda Irvine
Strategic Programme Manager, Mental
Health and Wellbeing
Overview of Presentation
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DCAQ Phase 1 learning and Phase 2
progress
DCAQ and A12
DCAQ, A12 and Outcome Measures
Learning and Reflections
DCAQ Phase One
Phase One Deliverable
Progress
Develop a high level understanding of
service processes.
Completed
Identify and implement immediate service
improvement opportunities.
Partially completed - improvement
opportunities identified but none
implemented to date.
Gather appropriate information to
undertake a detailed DCAQ analysis.
Partially completed - some of the data to
complete a full analysis is not currently
available. This report makes
recommendations on how to address going
forward.
Complete the DCAQ analysis and agree
further areas for service improvement
activity.
Partially completed - not able to complete
full analysis due to lack of data, however
partial analysis completed and a range of
improvement opportunities recommended
in this report.
Phase I : Outcomes
Partially completed because DCAQ data…
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not collected
or
not collected consistently
or
not reflective of reality
or
Conflicting – more than one source
DCAQ Phase 2
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Addressing the data issues
Solid project governance
Challenges
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Amount of work required to improve data
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Identifying where to invest the time
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Providing the right frame of reference for
DCAQ
Timescales and availability
Testing and Making Changes to
practice
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New information process
Opt-in
Case review (one off and ongoing
process)
DNA and CNA policy
Activity Audits completed
Admin processes
Use of Groups
And more!
DCAQ and A12
Agreement on core data set (i)
Primary Focus
of Treatment
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Abnormal Grief Reaction
Agoraphobia
Anger Management
Autism Spectrum
Bipolar disorder with
psychosis
Bipolar disorder without
psychosis
Borderline Personality
Disorder
Depression
Dementia
Eating Disorder
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Generalised Anxiety
Disorder
Health Anxiety
Obsessive Compulsive
Disorder
Other (please Detail)
Other Personality Disorder
Other Psychosis
Panic Disorder
Post-Traumatic Stress
Disorder
Psychosexual difficulties
Schizophrenia
Sleep problems
Social Phobia
Specific Phobia
DCAQ and A12
Agreement on core data set (ii)
Psychological
Therapies List
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Acceptance and Commitment
Therapy
Behavioural Family Therapy
Cognitive Analytical Therapy
Cognitive Behaviour Therapy
Cognitive Behavioural Analysis
System of Psychotherapy
Counselling
Dialectical Behaviour Therapy
Eye Movement Desensitization
and Reprocessing (EMDR)
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Solution Focused Brief Therapy
Interpersonal Therapy
Mentalisation
Mindfulness Based Cognitive
Therapy (MBCT)
Motivational Interviewing
Psychodynamic /
psychoanalytic Psychotherapy
Schema Focused Therapy
Solution Focussed Therapy
Systemic Therapy
Other - to be reviewed after
4 weeks
DCAQ and A12
Agreement on core data set (iii)
Group Work
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Manage your mood CBT
Manage your anxiety CBT
Introduction to
Therapy
Mindfulness - CBT
Survive and Thrive
Recovery and Support
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Relaxation
Coping Skills Anxiety
management - CBT
Overcoming
depression - CBT
Assertiveness - CBT
Beyond sexual abuse
Survive and Thrive
(planned)
DCAQ, A12 and Mental Health
Transformation Station
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Mental Health Transformation
Station – using outcomes measures
in routine clinical practices
Understanding why
Understanding how the team works
Collective ownership and
understanding – recognising the
values
Simple, transferable solutions
DCAQ and A12
and Outcome Measures
Agreement on core data set (iv)
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Use of CORE 34 for all conditions
Use of additional outcome measures
for depression
And other measures for specific
conditions as we progress
Supported by I M & T – PIMS
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Adding Primary reason for treatment as
coding type – alongside DSM4 and ICD10
Psychological therapy specific waiting lists
Capture of CORE 34 scores on individual
patient records – date stamped
Process mapping – training – patience!
Data inputted using new model – 22
August
reflections
What you may hear…
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“Not sure how you are
going to meet your
target”
Be in your interest to
tighten up referral
criteria have less
people referred
Really hard to
describe what we do
under one model
The data reports we
get are wrong
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Ownership
Ensuring people get
the therapy that
will most benefit
them
Rubbish in rubbish out
What you need to remember
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Priority is the person being seen
Fear of lifting the stone
Different pressures
How to measure the therapeutic relationship
Positioning of psychological therapies over other
intervention/ treatment
Fidelity to psychological model
People don’t always “get better”
Breadth of change - It’s not about you
Care and understand what it must feel like to be on
a waiting list
Different languages people use
Being grounded…
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How many people need
psychological therapies?
How many people are referred for
them?
How long have they been waiting?
What are they waiting for?
Why that therapy?
And is the / has the therapy made a
difference?
Learning to date
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The data now matters to everyone – the
service users, the teams, the organisation
The value of the right level of oversight
(ie project sponsor to make things
happen, assistant to take pressure off
clinicians and who can deliver quickly)
Strengthened relationships and
sustainable skills and interfaces with
other projects
DCAQ not a one-off – model for delivery
of A12
Outcome
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How many people need psychological therapies?
How many people are referred for them?
How long have they been waiting?
What are they waiting for?
Why that therapy?
And is the / has the therapy made a difference?
We will be able to answer that question for
East and Midlothian
Actively review the dataset – and assess
fitness for purpose