advantages and disadvantages of outcome measures iapt

advantages and disadvantages of outcome measures iapt. 27 Toff&Loadstone This report is independent research. for this article. There has been much research into the role of potential patient-related factors that can predict treatment outcomes (Green et al., Reference Green, Honeybourne, Chalkley, Poots, Woodcock, Price and Green2015; Gyani et al., Reference Gyani, Shafran, Layard and Clark2013; Saunders et al., Reference Saunders, Cape, Fearon and Pilling2016; Saunders et al., Reference Saunders, Buckman, Cape, Fearon, Leibowitz and Pilling2019a), and potentially there may have been year-by-year changes in the presentation of patients to services which may have resulted in changes to service performance. Search for other works by this author on: Copyright International Society for Quality in Health Care and Oxford University Press 2001, Reducing last-minute cancellations of elective urological surgery - effectiveness of specialist nurse pre-operative assessment, Community Pantries: A Health Service of Great Quality for the Most Affected Ones, Hospital accreditation: an umbrella review, Implementing a screening algorithm for early recognition of sepsis in hospitalized children: a quality improvement project, Is evidence of effectiveness a driver for clinical decision support selection? For example, the use of specific types of interventions or sub-types of treatments may have changed within services, potentially increasing the use of computer-based interventions, or more/less group delivered treatments, which could be associated with changes in outcomes, and these could not be explored in the current study. and toff&loadstone / toffloadstone the implementation of outcome measures in child and adolescent mental health services (CAMHS) and because evidence suggests that there is a disparity between policy recommendations and the use of outcome measures in clinical practice. (1) Routinely collected information about how treatment is delivered can be used to highlight areas of improvement. Talking therapies are commonly used . http://creativecommons.org/licenses/by/4.0/, https://doi.org/10.1146/annurev-clinpsy-050817-084833, https://doi.org/10.1016/S0140-6736(17)32133-5, https://doi.org/10.1016/j.jad.2013.02.030, https://doi.org/10.1016/j.brat.2017.04.006, https://doi.org/10.1017/CBO9781107415324.004, https://doi.org/https://doi.org/10.1017/S1352465818000590, https://doi.org/10.1016/j.cpr.2018.07.005, https://doi.org/10.3109/09540261.2011.606803, https://www.england.nhs.uk/mental-health/case-studies/mh-islington/, https://www.england.nhs.uk/mental-health/case-studies/islington-icope-making-the-most-of-a-close-working-relationship-with-gps/, https://doi.org/10.1136/bmjopen-2014-006103, https://doi.org/10.1016/j.brat.2013.06.004, https://doi.org/10.1017/S1352465804001171, https://doi.org/10.1186/s12888-018-1838-0, http://www.ncbi.nlm.nih.gov/pubmed/11556941, https://www.england.nhs.uk/wp-content/uploads/2018/06/iapt-manual-resources-v2.pdf, https://doi.org/10.1016/S0005-7967(97)00022-3, https://www.england.nhs.uk/mental-health/case-studies/staff-wellbeing-is-everyones-responsibility-at-islington-icope/, https://doi.org/10.1016/J.JAD.2019.02.043, https://doi.org/10.1016/j.brat.2019.103505, https://doi.org/10.1016/j.jad.2016.03.011, https://doi.org/10.1017/S1352465812001063, https://doi.org/10.1001/archinte.166.10.1092, https://doi.org/10.1192/bjp.bp.112.113134. Using routine outcome measures as clinical process tools: Maximising Button, Katherine S. 1 Department of Psychology, University of Bath, 2 Bristol Medical School, University of Bristol, Your email address will not be published. Advantages and Disadvantages of Performance Management included service-level deprivation and the proportion of patients entering treatment who had a full course of treatment (i.e. Latest reports indicate that 52.1% of patients receiving a course of treatment recovered, up from 50.8% in the previous year (NHS Digital, 2019). However, the results might indicate a change in clinical practice that the treatment appointment scheduling should consider the time between treatment sessions. With 98.5% completion of pre- and post-treatment outcome measures (Clark, Reference Clark 2018 ), IAPT datasets have great potential to highlight potential areas of clinical practice . . Semi-structured interviews were conducted with nine CAMHS clinicians from a Mental Health Trust in South London. It is also common practice in some services for service users and their clinicians to sign an informal treatment contract in which the number of sessions and use of between-session activities (sometimes considered to be homework) are laid out. Awareness on the Advantages and Disadvantages of Outcome Based government site. One thing is certain in this debate: we cannot usefully direct mental health services to the dogged pursuit of particular outcomes until there is a broader consensus on which outcomes really matter. This finding might be due to some baseline dependency in the outcome, as those scoring higher have more available points on the symptom scores to drop and therefore meet criteria for reliable improvement (Saunders et al., Reference Saunders, Buckman and Pilling2019b). Of the other Consortium measures, little evidence was seen of the use of the GBO and CHI-ESQ in both audits. No Comments have been published for this article. Design: Please enable it to take advantage of the complete set of features! -, de Jong, K. , Conijn, J. M. , Gallagher, R. A. V. , Reshetnikova, A. S. , Heij, M. , & Lutz, M. C. (2021). Routine Outcome Measures (ROMs) - Associate Development Solutions Ltd Leibowitz, Judy Twittear. It is important to add that the findings of both the current analyses and those of Clark et al. Figure3 presents the yearly mean number of DNAs and cancellations (by the service) per patient over the course of their treatment. Cirkovic, M. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Federal government websites often end in .gov or .mil. The use of large individual patient data datasets such as the NCEL IAPT SIRN dataset can provide a means with which to feed back the impact of specific changes on clinical practice on patient outcomes, and provide a method of sharing best practice. This is known as Routine Outcome Monitoring (ROM). It does not dictate specific beliefs, instead, it tries to improve the meaning of life by pursuing happiness. Attention-deficit / hyperactivity disorder (ADHD), CAMHS (Child and Adolescent Mental Health Services), JCPP Editorial: Volume 64, Issue 03, March 2023, Social media use Ask the Expert (recording), Identifying and responding effectively to Traumatic Bereavement (recording). Using routine outcome measures as clinical process tools - PubMed Naqvi, S. A. advantages and disadvantages of outcome measures iapt south london football academy . Strength and Difficulties Questionnaire - SDQ. when trying to interpret the findings of the group level analyses for individual patients, ignoring heterogeneity within the groups that were the subject of analysis. You do not have to rely on others and can make decisions independently. Twenty CAMHS staff completed a survey around the time of the mandate being introduced, and again 6 months later. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The mean number of treatment sessions, duration of treatment, number of cancellations and DNAs, the proportion of missing and MADD problem descriptors and percentage of patients reaching recovery and reliable improvement were derived for each financial year. advantages and disadvantages of outcome measures iapt However, this does not reflect the variation in therapy type that may have occurred before the last sessions and therefore more detailed analysis would be required in order to use therapy type information. Furthermore, it was decided to use data from the 20122013 financial year (April to March) onwards as not all services were established by this time, and this allowed for a comparison of all services across all years. All rights reserved PDF IPNOSIS: a journal for the Independent Practitioners Network anxiety. (Reference Clark, Canvin, Green, Layard, Pilling and Janecka2018) as being important in predicting outcome, the duration of treatment was not explored in the previous analysis. The recovery and reliable improvement outcomes were calculated for each patient. Over half of our participants were Clinical Psychologists, who may have particular views of ROM due to their training, which arent necessarily consistent with the views of those with other professional backgrounds. an eating disorder. Manualised cognitive-behavioural therapy in treating depression in advanced cancer: the CanTalk RCT. Findings also showed that higher baseline PHQ-9 scores were associated with lower odds of reliable improvement, in both univariate and adjusted models, but higher GAD-7 scores were associated with increased odds of reliable improvement. IAPT services are mandated to collect routine outcome measures at each session, which results in high quality data that can be used to inform service improvement. The most likely explanation for using ROMs more appears to be the mandate to do so from management. IAPT; clinical feedback; collaborative conversational approach; depression; mental health; psychological practitioner; qualitative study; routine outcome measures; step 2; telephone treatment; wellbeing; wellbeing anxiety. Several initiatives focused on improving staffs understanding and accuracy in the routine recording of presenting problems. Results showed that there was a slight increase in the average number of sessions, and decreases in the length of time in treatment, as well as decreases in both the number of non-attended appointments and the use of inappropriate problem descriptors. Unauthorized use of these marks is strictly prohibited. Talking therapies can be helpful for lots of things, including: depression. That is, therapists did not become more positive or negative about using ROM as a result of doing it more. Tracking responses to items in measures as a means of increasing therapeutic engagement in clients: A complementary clinical approach to tracking outcomes. Patients with more cancelled appointments appeared to have greater odds of reliable improvement in the univariable model, but this was not the case when adjusting for other factors, suggesting that the initial effect was most likely due to more cancellations being associated with more sessions overall (having more sessions was significantly correlated with increased number of cancellations: r = 0.22, p < 0.001). It helps the society place more value on actions that bring happiness. We pay our respects to their ancestors, elders and emerging leaders and extend our respect to Aboriginal and Torres Strait Islander people from all nations Unable to load your collection due to an error, Unable to load your delegates due to an error. inconsistent wording); (2) outcome measures administered as a stand-alone inflexible task (e.g. The reduction in year by year DNAs might be explained by the better use/availability of patient liaison capabilities from the commonly used electronic patient record systems in IAPT which are now able to send automatic reminders to patients (through email and text messaging) about upcoming appointments and to ask them to complete their routine outcome measures. Such is the perceived success of the programme that countries such as Australia (Cromarty et al., Reference Cromarty, Drummond, Francis, Watson and Battersby2016) and Norway (Knapstad et al., Reference Knapstad, Nordgreen and Smith2018) have adopted versions of the IAPT model for delivery in their own healthcare systems. In some services this took the form of changing the way messages were given to patients about attendance in letters and text message reminders prior to a session taking place, with information on the impact of DNAs and last-minute cancellations for other patients waiting to be seen being emphasised in those messages. These changes appear to have had a considerable impact when looking at the decreases in missing and inappropriate problem descriptor use over the last few years. Routine Outcome Measurement in CAMHS - ACAMH By selecting an appropriate problem descriptor, it is expected that the IAPT clinician has considered the presenting problem(s) and therefore matched the clinical issue to appropriate evidence-based NICE guidelines and CBT protocol (Clark, Reference Clark2018). Establishing Presenting and Using Outcome Measures Outcome measures are important to accreditation and other forms of evaluation.Outcome measures are quantifiable indicators that gauge productivity in this case productivity of a school or graduate program of public health. Taken together, the results indicate that the delivery of more sessions, provided at more frequent intervals, reduced cancellations and the correct identification of a patients presenting problem are associated with better outcomes in IAPT services, and that the year-by-year changes in these factors is associated with improving outcomes being reported nationally. Goldsmith, Kimberley A. The univariable models presented in the left-hand columns show that all variables were significantly associated with reliable improvement. The initial increase in the weeks in treatment between 20122013 and 20132014 was found to be statistically significant, as were the decreases between 20142015 and 20152016, between 20162017 and 20172018, and between 20172018 and 20182019. Treatment outcomes across Improving Access to Psychological Therapies (IAPT) services in England have improved year-on-year, with the national average proportion of patients in recovery at the end of treatment now exceeding the 50% target. Author affiliations. Any interruptions and extra meetings from others so you can focus on your work and get it done faster. It should also demonstrate that a choice of date, time and venue has been offered and whether information about the service was available. IPNOSIS: a journal for the Independent Practitioners Network Quantitative research is an incredibly precise tool in the way that it only gathers cold hard figures. sixth amendment memes. To achieve these levels of performance in the face of increasing pressures, IAPT services have had to evolve local practices in order to meet demands, yet little is known about how services have done this. Such measures capture the patients own perspective of disease and health. Teamwork creates more moments where individual members can cross-train one another to create new skills and strengths in time. (2) More treatment sessions, delivered in a more condensed period of time, was associated with better outcomes. The analysis was also limited with regard to the variables considered, and other factors not considered may have influenced findings. Keywords: Around 5 in every 10 (51%) improve so much they are classified as recovered. These measures and the collection of data are Many Child and Adolescent Mental Health Services (CAMHS) in the UK routinely evaluate change in a service users presenting difficulties, functioning and progress towards their goals over the course of treatment. and transmitted securely. Benefits of talking therapies - NHS Process measures are appealing because (1) they are easy to evaluate and benchmark at the same time as the clinical care they are measuring, (2) they are responsive to incentives, and (3) they do . PDF Attitudes toward outcome measures in CAMHS 1 The ROMs that were most frequently used measured symptoms of anxiety and depression, the Revised Childrens Anxiety and Depression Scale (RCADS). The factors highlighted in both the manual and the current analysis suggest that small changes to clinical practice can have positive benefits to outcomes in IAPT services. The North and Central East London IAPT Service Improvement and Research Network (NCEL IAPT SIRN) was established in order to use routinely collected IAPT data from all individual patients that have been seen in the local services, for the purpose of sharing best practice and improving the care these services provide. (2015). Martland, Natasha Unlike the previous study, the current study has used individual patient data from IAPT services greatly increasing the power of the analyses allowing the inclusion of data from nearly 88,000 patients, instead of using pooled statistics from just over 200 services. Recovery in IAPT is measured in terms of 'caseness' - a term which means a referral has severe enough symptoms of anxiety or depression to be regarded as a clinical case. This was used by 70% of the participants. Answer (1 of 7): The prevailing education system defines well all the reforms needed to make a healthy learning environment that can foster development for almost all the students out there. Child and Adolescent Mental Health. The finding resonates with the expected delivery of cognitive behavioural interventions, where it is expected that the first four sessions are delivered within two weeks, moving to weekly then fortnightly sessions (Beck, Reference Beck2011), whereas the time pressures in IAPT services, as in most routine treatment services, might mean that twice-weekly CBT sessions are not possible. Rimes, Katharine A. Depression symptom severity was measured using the Patient Health Questionnaire 9-item version (PHQ-9; Kroenke et al., Reference Kroenke, Spitzer and Williams2001), where scores of 10 or above indicate caseness for depression, and a reduction of 6 or more points on the scale indicates reliable improvement in depression symptoms (NHS Digital, 2016, 2017). a phobia. Outcomes - NDRS - NHS Digital Some involved improving relationships with GPs to improve the appropriateness of referrals, and seeing patients within GP surgeries to make attendance easier for the patients, thus reducing DNAs (Foustanos et al., Reference Foustanos, Morgan, Gray and Minton2018). These factors include the proportion of missed appointments across the service, the average number of treatment sessions delivered by the service, average waiting time between referral and entering treatment, and the index of multiple deprivation of the catchment area of the service, all of which were associated with reliable recovery and improvement. Published by Cambridge University Press on behalf of British Association for Behavioural and Cognitive Psychotherapies. which our office in Australia stands. Singh, Satwant Dom, Gabriele Multiple logistic regressions were run to include all six treatment-delivery factors alongside baseline depression and anxiety symptom severity, as these are known to predict recovery and reliable improvement (Saunders et al., Reference Saunders, Cape, Fearon and Pilling2016), as well as the service code to control for potential differences between services. This has developed my confidence, interpersonal and therapeutic skills. Stott, J. Furthermore, we are grateful to the service leads for their support with the NCEL project and to the local data managers for their time and dedication. advantages and disadvantages of outcome measures iapt Remission and relapse in a longitudinal cohort study, Attentional control as a predictor of response to psychological treatment for depression and relapse up to 1 year after treatment: a pilot cohort study, Risk factors for relapse and recurrence of depression in adults and how they operate: a four-phase systematic review and meta-synthesis, Social phobia: Diagnosis, Assessment, and Treatment, Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience, Psychometric properties of the social phobia inventory (SPIN). Hostname: page-component-7fc98996b9-rf4gk All analyses were conducted in stata15 (StataCorp, 2017). Patient-reported Outcomes: Pros and Cons | European Health - EHPS The views expressed in this publication are those of the authors(s) and not necessarily those of the NHS, The National Institute for Health Research or the Department of Health. Published online by Cambridge University Press: The mean number of service-related cancellations per episode has fluctuated from a mean of 0.28 cancellations in 20122013 up to 0.39 in 20182019, indicating an increase of nearly 40%. Leaders can take preventative measures against risks while increasing company capabilities. Although outcome measures of quality represent the desired end results of health care, validated process of care measures provide an important additional element to quality improvement efforts, as they illuminate exactly which provider actions could be changed to improve patient outcomes. Further analysis indicates that the reduction in the number of treatment sessions per episode was statistically significant (at p < 0.05) between the years 20122013 and 20132014, and that the increases between 20152016 and 20162017, and between 20162017 and 20172018 were also statistically significant (see Supplementary material, Appendix, Table A1). (2015). -. All these factors were associated with recovery and reliable improvement in univariable models. It is important to know that simply using ROM does not necessarily change how therapists view ROMs. Sign up for news, offers, and details of our online magazine The Bridge, ACAMH 2022. Davies, Molly R. Well-tilled seedbed. She has worked a variety of mental health settings, including adult mental health, a childrens inpatient unit, and various community CAMHS. The association of treatment-delivery factors and baseline symptom severity with both recovery and reliable improvement in individual patients was then explored in the next set of analyses. advantages and disadvantages of outcome measures iapt Many therapists thought that ROMs could be valuable for therapists, particularly if used meaningfully in sessions, and could encourage mutual feedback within therapy. Advantages and disadvantages of Utilitarianism.docx (Reference Clark, Canvin, Green, Layard, Pilling and Janecka2018). Results: Lack of therapeutic use of item and total scores. Being aware of the advantages and disadvantages of a business partnership is a crucial step to take before venturing into a partnership. Nguyen, Jen King, Sophie 2, with the yearly percentage of patients reaching recovery and reliable improvement superimposed. A total of n = 87,963 patients met inclusion criteria and provided data for the current analyses. Using thematic analysis in psychology. Aguirre, Elisa Whereas the Conners' scale (a standard ADHD assessment scale) [] was the most frequently used condition-specific measure in the original audit, use of these scales has significantly decreased in favour of more generic measures.Instead, the re-audit revealed that the RCADS was the most . Advantages and disadvantages of Utilitarianism One of the advantages of Utilitarianism is it tries to reduce harm and increase happiness. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); You can use your RSS reader to keep up to date with all of our Research Digests. Identifying the barriers to using ROMs from the therapists perspective can help services to support implementation by problem-solving. advantages and disadvantages of outcome measures iapt. Buckman, Joshua E. J. The objectives might include attending additional training for working with particular disorders, a change in the use or frequency of supervision, partnering with another (usually more experienced) staff member to answer questions about coding and recording of data on the electronic patient record system, or in some cases agreeing to more regular oversight of the quality of routinely collected data by a given staff member with reminders of best-practice in order to support them to improve their recovery rates (Foustanos, Reference Foustanos2018). More importantly, by examining associations at the level of each IAPT patient rather than associations aggregated across services we can be more confident that the results are not biased by the ecological fallacy, i.e. Advantages of Performance Management. However, it is interesting that this only exists for GAD-7 scores and not for PHQ-9 scores, suggesting a differential impact of baseline depression and anxiety scores on outcomes. It was introduced in South Africa on the assumption that it would Others involved removing arbitrary caps on the maximum numbers of clinical sessions offered, particularly at high intensity, and changing attendance policies so that there were differences in how patients were notified about expectations of attendance and the consequences of non-attendance. HHS Vulnerability Disclosure, Help Pilling, Stephen ROMs which track specific symptoms and ROMS that capture functioning were used less often (20%). Advantages and Disadvantages of Linear Programming A qualitative descriptive study of senior hospital staff, About International Journal for Quality in Health Care, About the International Society for Quality in Health Care, Receive exclusive offers and updates from Oxford Academic, Copyright 2023 International Society for Quality in Health Care and Oxford University Press. A number of services made a point of focusing on patient recovery and reliable improvement outcomes, introducing training and workshops with staff to share best practice, and in two services they introduced 6-monthly one-to-one meetings with a line manager (recovery consultations) which included an in-depth look at a number of cases where patients the staff member had worked with did recover and a number of cases where their patients did not recover, in order to highlight commonalities and discrepancies. (3) The correct identification of specific IAPT-related presenting problems and reduced non-attendance was linked to a higher likelihood of recovery and reliable improvement. Overall the results highlight the importance of correctly identifying the presenting problem and selecting the appropriate evidence-based treatment protocol for the identified disorder. Commonly used ROMs. There has been a clear reduction in missing problem descriptor information over the last 7 years, with around 45% missing in 20122013, down to less than 10% missing in 20182019. Firstly, the dataset includes individual patient data from seven IAPT services, and although the trends in outcome seem to mirror those nationally, the treatment-delivery factors explored may operate differently in other IAPT services outside of the NCEL SIRN. And as demand for outcome measurement proliferates across health care . These decreases were significantly different between each year from 20132014 (see Supplementary material, Appendix, Table A3). The advantages of linear programming include the following: Linear programming assists in maximizing the utilization of useful resources.