Lessons from the IAPT
Programme to Date
David M Clark
National Clinical Advisor
(david.clark@psy.ox.ac.uk)
Where are we up to?
• IAPT is delivered by 96% of PCTs and covers 56% of the
population
• Currently see approx 460,000 per year
• Stepped care (42% low intensity only, 17% low & high, 32% high
only. Average step-up rate 30%)
• Average recovery approx 43% BUT the most severe cases
improve most. Reliable improvement 64%. Reliable deterioration
approx 7%
• Better outcomes linked to providing NICE compliant therapy, in
adequate adequate dose, using stepped care, by a team with a
substantial number of experienced therapists plus employment
advisers. (see Enhancing Recovery rates report at www.nhs.uk).
Training & Trainees
•Aligned to treatments in NICE RCTs (not generic CBT)
•National Curriculae & Competencies Framework
•Extensive (30-60 days), accredited courses.
•Aim for trial therapist competence (essential in SMI given smaller
effect sizes than depression/ anxiety literature)
•Modelling of therapy by experienced clinicians
•Competitive selection of the best trainees (not in-service
training).
Outcome Monitoring (essential for continued political
support)
•Pre-post data from everyone (<90%) who is treated (liberally
defined as ≥ 2 sessions).
•Well-validated measures, condition specific as well as
generic.
Why getting complete data matters.
Improvement
(Clark, Layard, Smithies, Richards, Suckling & Wright, 2009)
10
9
8
7
6
5
4
3
2
1
0
Pre-Post Complete
Post Missing
PHQ
GAD
Services require:
• Core of experienced staff who are competent in relevant
therapies
• Written clinical protocols covering assessment & treatment
of each condition
• IT system for outcome measures and supervision
• Weekly outcome focused supervision for trainees & other
staff
• Assertive outreach to referrers
• Self-referral
• Ambition, desire for innovation, openness to what the data
tells you about your service.
Delivering an effective national programme
•
•
Economic Argument: Crucial. Do NOT ignore.
Project Management
– Signed-off plans, detailed national documents, governance (DH in
partnership with NHS)
•
Stakeholder engagement
– Clinical leadership & national advisors
– Charities and Professional bodies
– Users, the public, the media
•
Policy and political alignment
– Reflect and enable big policy agendas
•
Momentum and making it work
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–
–
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Early wins
Clear aims
Deliver to political timetable
Communications
Thank You