South Region Early Intervention in
Psychosis Service Self-Assessment &
Service Development
May 2015
1
Contents
The Early Intervention in Psychosis Service Development Framework ....... 3
Using the Self-Assessment & Action Planning Tool ........................................ 3
Section 2: NICE Concordance ....................................................................................... 5
Section 3: Performance & Outcomes ........................................................................ 6
Section 4: Workforce and Training ............................................................................. 8
Section 5: Scoring Matrix ............................................................................................... 9
Section 6: EIP Preparedness Summary & Action Plan ...................................... 12
2
The Early Intervention in Psychosis Service Development Framework
The fidelity with which an intervention is implemented affects how well it succeeds i. For instance, two studies examining programmes to help people with
mental health issues obtain employment found that employment outcomes among their study groups were weakest for those in poorly implemented
programmesii. Achievement of high fidelity is one of the best ways of replicating the success of interventions achieved by research that has led to NICE
guidelines. This Service Development Framework is aimed at helping NHS foundation trusts, NHS trusts and commissioners to understand the fidelity and
performance of their EIP servicesiii.
The framework is based on evidence drawn from:
1.
2.
3.
4.
NICE guidelines for Psychosis and Schizophrenia based on proven efficacy, effectiveness and acceptance
Expert opinions gathered through surveys of experts and literature reviews
Opinions of users of EIP and their advocates regarding what works
Site visits to a range of EIP services across the UK
Using the Self-Assessment & Action Planning Tool
The aim of the South Region EIP Preparedness Programme is to support organizations in identifying opportunities to develop their EIP services for improved
outcomes for people with first episode psychosis. The framework contains a set of general indicators for organisations to consider, followed by four more
detailed sections:
1. About you
2. NICE Concordance
3. Performance & Outcomes
4. Training and Workforce Development
5. Summary & Action Plan
Each section is intended to support organizations in assessing the extent to which EIP is successfully embedded on a scale of 1 to 3:
1.
Little evidence of a successfully embedded EIP service - Bronze
2.
Some evidence of a successfully embedded EIP service - Silver
3.
Strong evidence of a successfully embedded EIP service - Gold
3
Section 1: About You
Field
Name:
Free Text
Role:
Name of Trust/Organisation:
Name of Early Intervention in Psychosis Service:
Number of people with first episode of psychosis currently being served by EIP
service in the following age ranges:
Contact Details:
Address:
Email:
Telephone number:
4
0-18 years old
19-35 years old
36-60 years old
Section 2: NICE Concordance
The provision of NICE recommended treatments for psychosis and schizophrenia
Indicator
Indicator 2.1 – Cognitive Behavioural Therapy (CBT)
Number of people with psychosis or schizophrenia on the EIP caseload with evidence of receiving Cognitive
Behavioural Therapy (CBT)
Indicator 2.2 – Family Intervention
Number of people with psychosis or schizophrenia in EIP with family members, who received family intervention,
family work or family therapy
Indicator 2.3 –Clozapine
Number of people with psychosis or schizophrenia in EIP who have not adequately responded to treatment with
at least 2 antipsychotics, who are prescribed Clozapine
Indicator 2.4 – Vocation
Number of people with psychosis or schizophrenia on the EIP caseload who are receiving support to gain or
retain their employment and/or education
Indicator 2.5 – Physical Health
Number of people with psychosis or schizophrenia on the EIP caseload with evidence of receiving a physical
health check, including: Pulse, BP, Lipids, Glucose, Weight, Waist Circumferenc
Indicator 2.6 – Smoking
Number of people with psychosis or schizophrenia on the EIP caseload who smoke with a record of being
offered smoking cessation support in the last year
Indicator 2.7 – Carers
Number of carers of people with psychosis or schizophrenia on the EIP caseload who are offered carer-focused
education and support programmes e.g. Carer’s Assessment, Respite, Carers Support Group, Family Work
5
Level 1
Level 2
Level 3
Section 3: Performance & Outcomes
EIP services must ensure that <50% of people referred for first episode psychosis receive a NICE package of care within 14
days of referral. Services must continuously strive for the best possible outcomes for those accessing their services.
Indicator
Indicator 3.1 – Access
Number of people with psychosis or schizophrenia who are seen by the EIP service, as compared to predicted
cases of psychosis in your area (www.psymaptic.org)
Indicator 3.2 – Duration of Untreated Psychosis (DUP)
Number of people on the current EIP caseload with a DUP of
 0-29 days
 30-59 days
 60-89 days
 90 days of more
Indicator 3.3 - Duration Without Early Intervention
Number of people with psychosis or schizophrenia on the EIP caseload with a length of psychotic symptoms
before allocation to an EIP care coordinator spanning:
 0-29 days
 30-59 days
 60-89 days
 90 days or more
Indicator 3.4 – Waiting Time
Number of people with psychosis or schizophrenia allocated an EIP care coordinator within 14 days after
referral
Indicator 3.5 – Admission Rates
Number of people with psychosis or schizophrenia under an EIP team admitted to a mental health acute ward
in the past 12 months
6
Level 1
Level 2
Level 3
Level 4
Indicator 3.5.1 – Informal Admissions
Number of people with psychosis or schizophrenia under an EIP team admitted to a mental health acute ward
informally
Indicator 3.5.2 – Informal Admissions
Number of people with psychosis or schizophrenia under an EIP team admitted to a mental health acute ward
formally under the Mental Health Act
Indicator 3.5.3– Bed Stay
Number of people with psychosis or schizophrenia under the care of an EIP team admitted to a mental health
acute ward who are admitted for 28 days or more
Indicator 3.5.4 – Readmissions
Number of people with psychosis or schizophrenia under an EIP team who were re-admitted to a mental health
acute ward within 30 days or less of discharge
Indicator 3.7 – Employment
Number of people with psychosis or schizophrenia in employment (paid, unpaid, part or full time and voluntary
work) or education
Indicator 3.9 – Accommodation
% of people with psychosis or schizophrenia in settled accommodation
Indicator 3.9 – Recovery Rates
Number of people with psychosis or schizophrenia discharged to a primary care or third sector provider who
have no contact with secondary mental health services 12 months after discharge from EIP
7
Section 4: Workforce and Training
Clinicians must have the time, knowledge, attitude and skills to provide care based on best practice evidence
Indicator
Indicator 4.1 – Team Capacity
What is the total number of clinicians and allied health professionals (including pharmacists, support workers etc)
currently working in your EIP team? (please do not include admin staff for this indicator)
Indicator 4.2 – Consultant Psychiatrists
Whole Time Equivalent (WTE) of Consultant Psychiatrist time dedicated to the EIP service
Indicator 4.2.1 – Staff Grade Psychiatrists
Whole Time Equivalent (WTE) of Consultant Psychiatrist time dedicated to the EIP service
Indicator 4.3 – Consultant Psychologists
WTE of Consultant Psychologist time dedicated to the EIP service
Indicator 4.3.1 –Psychologists
WTE of Psychologist time dedicated to the EIP service
Indicator 4.4 –Team Managers
WTE of Team Manager time dedicated to the EIP service
Indicator 4.5 –Care Coordinators (>Band 6)
WTE of the EIP team who have care coordinating responsibilities
8
Level 1
Level 2
Level 3
Indicator 4.6 – Clinicians with a Foundation Qualification in Cognitive Behavioral Therapy (CBT)
WTE of EIP clinicians who have been trained in CBT for common mental health problems or a similar CBT
foundation course
Indicator 4.7 – Clinicians with Cognitive Behavioral Therapy (CBT) for Psychosis Qualification
WTE of EIP clinicians who have attained externally validated competency (through a University Post Grad
Diploma or Degree or Masters) in delivering CBT for Psychosis
Indicator 4.8 – Family Interventions
WTE of all EIP clinicians who have attained post graduate diploma, degree or masters competency in Family
Work/Family Interventions via a training programme such as Psycho-Social Intervention (PSI) or THORN
Indicator 4.9 – Vocational Support
WTE of EIP staff working as Support Workers with accredited Individual Placement and Support (IPS) training or
equivalent
Section 5: Scoring Matrix
Section
Field
Section 1
First Name, Last Name*:
About you
Your Role*:
*Mandatory Fields
Organization/Trust*:
Free Text
Address*:
E-mail*:
9
Telephone*:
Total EIP Caseload*:
Calculating Total Average Levels
Section 2 & 3
NICE Concordance &
To determine the percentage for each sub-indicator e.g. indicator 2.1, the inputted number should be divided by the
total number of people accessing the EIP team. This figure should be multiplied by 100 to get a percentage which
will indicate a level for each sub-indicator e.g. Indicator 2.1 = 51% = Level 2 = a Silver Service.
Performance
Sections 4
Workforce & Training
Section
To determine the percentage for each indicator e.g. indicator 2.1, the inputted number should be divided by the
total number of people working in the EIP team. This figure should be multiplied by 100 to get a percentage which
will indicate a level for each indicator e.g. Indicator 2.1 = 51% = Level 2 = a Silver Service.
Indicator
Percentage
Level
Percentage
Level
Percentage
Section 2
2.1
0-50%
51-80%
81-100%
NICE Concordance
2.2
0-50%
51-80%
81-100%
2.3
0-50%
51-80%
81-100%
2.4
0-50%
51-80%
81-100%
2.5
0-50%
2.6
0-50%
51-80%
81-100%
2.7
0-50%
51-80%
81-100%
1
51-80%
10
2
81-100%
Level
3
Section 3
3.1
0-50%
51-80%
81-100%
Workforce and Training
3.2
0-50%
51-80%
81-100%
3.3
0-50%
3.4
0-50%
51-80%
81-100%
3.5
0-50%
51-80%
81-100%
3.6
0-50%
51-80%
81-100%
3.7
0-50%
51-80%
81-100%
3.8
0-50%
51-80%
81-100%
Section 4
4.1
0-50%
51-80%
81-100%
Performance & Outcomes
4.2
0-50%
51-80%
81-100%
4.3
0-50%
51-80%
81-100%
4.4
0-50%
51-80%
81-100%
4.5
0-50%
51-80%
81-100%
4.6
0-50%
4.7
0-50%
51-80%
81-100%
4.8
0-50%
51-80%
81-100%
4.9
0-50%
51-80%
81-100%
1
1
51-80%
51-80%
11
2
2
81-100%
81-100%
3
3
Section 6: EIP Preparedness Summary & Action Plan
The below scoring matrix (page 12) will provide a summary or the EIP service’s development level on a scale of 1 to 3:
1. Little evidence of a successfully embedded EIP service - Bronze
2. Some evidence of a successfully embedded EIP service - Silver
3. Strong evidence of a successfully embedded EIP service – Gold
The summary page will list the areas with the most and least achievement with a prompt for the user to address the areas of least achievement.
The summary page will also list the indicators with against which the user has scored highest; this will be used to reinforce and share good
practice. Organizations will be asked to use the framework findings to inform their Preparedness Action Plans. The EIP Preparedness Programme
Board will review each organization’s EIP Preparedness Action Plan to ensure it reflects the organisation’s findings and priority areas for
allocating the Preparedness funds.
Indicator
e.g. 2.1
Summary
Average score indicates little/some/strong
evidence of a successfully embedded EIP
service with a rating of Bronze/Silver/Gold
The highest scores were against indicators
XXX whilst indicators XXX showed the
most need for improvement
Action
Who By
Initiation Date
Dusenbury L, Brannigan R, Falco M, Hansen W: A review of research on fidelity of implementation: Implications for drug abuse prevention in school settings.
Health Educ Res 2003, 18:237-256.
i
Dane A, Schneider B: Program integrity in primary and early secondary prevention: Are implementation effects out of control.
Clin Psychol Rev 1998, 18:23-45.
ii
Elliot D, Mihalic S: Issues in disseminating and replicating effective prevention programs.
Prev Sci 2004, 5:47-53
iii
12
Completion Date