Using outcome monitoring in therapy sessions and supervision - Dr Duncan Law

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  • Intros – various hat – HPFT, CORC IAPTWHAT WANTEDHOW HAS USED TOOLS
  • Who are you all? CYP-IAPT or PbR both , neitherWho have used outcomes and feedback tools at all?Who used session by session?What do you want to know? – in pairs
  • Evaluation vs clinical useSee- saw?
  • MENTION THAT THEY DON’T HAVE TO BE DIVIDED THIS WAY - JUST FOR EASE OF USEAnother way of looking at the measures – points at which they are useful, types of information you can get at each point
  • 5 minsModality: didactic (intro to task)Alternative supervisor version: Clinician = supervisor, YP= supervisee: Supervisor has to convince supervisee of importance of using measuresClinician=supervisor
  • 5-10 minsModality: Whole/small group discussionLO: 1/2/3Group discussion 10 mins
  • 5-10 minsModality: Whole/small group discussionLO: 1/2/3
  • Brainstorm in your groups, make notes on post-its and stick somewhere!Activity: Brainstorm and short whole group discussion about preconceptions about PROMS and PREMS10 minsModality: Discussion (whole group)Learning objective: 1Participants get their view about “forms” out in the open – hopefully share positive and negative views and experiences of “forms”
  • 10 minsModality: Whole group discussionLO: 1
  • MENTION THAT THEY DON’T HAVE TO BE DIVIDED THIS WAY - JUST FOR EASE OF USEAnother way of looking at the measures – points at which they are useful, types of information you can get at each point
  • Eg - sot when been a bad week – flag up need to talk
  • Trainer acts as supervisor, trainees advise on scores
  • What going on here?Need for triangulation SFQ15 year old anxietyGoals to get on with life and see friends – anxiety got in the way
  • Three sectionsAssessment Session by sessionDemographics and session dataScoring aids and clinical cutoffs
  • Who are you all? CYP-IAPT or PbR both , neitherWho have used outcomes and feedback tools at all?Who used session by session?What do you want to know? – in pairs
  • Q&A 5-15mins
  • Using outcome monitoring in therapy sessions and supervision - Dr Duncan Law

    1. 1. Making the CYP-IAPT Feedback and Outcomes Monitoring Clinically Useful: A Workshop Duncan Law 5th Nov 2013 CYP-IAPT National Conference Hertfordshire Partnership University NHS Foundation Trust © Duncan Law
    2. 2. Feelings about routine feedback & outcomes monitoring? Hate them 0 Mixed feelings 5 © Duncan Law Love them 10
    3. 3. Values behind outcomes and feedback 1. Demonstrate/celebrate/prove effectiveness of interventions and service 1. Enhance collaborative practice: – Better service user voice in therapy – Facilitates good clinical practice © Duncan Law
    4. 4. Feedback & Outcomes Monitoring Demonstrating success © Duncan Law
    5. 5. Demonstrating effectiveness • 90% target – at least two time points with repeated normed measure – Plus, at lest one report of Education Employment and Training (EET) – http://www.iapt.nhs.uk/silo/files/90.pdf © Duncan Law
    6. 6. It’s not (just) about measurement, it’s about a culture of collaboration ©Tom Frost © Duncan Law
    7. 7. Feedback & Outcomes Monitoring Young peoples views © Duncan Law
    8. 8. Video • http://www.youtube.co First, a word from the m/watch?v=SOayZgia people who matter M7U © Duncan Law
    9. 9. Young peoples views: “Knowing when and how to use the outcome measures is important. They must become an integrated part of the session - not something that is kept as an abstract form-filling exercise.” “Outcomes tools can be really useful, not only for the therapists but for the young people. They allow you to evaluate where things are going well and where they could be improved. Feedback is important for us to learn and grow. However, I do think you must use outcomes tools with the correct intention and in the right way.” © Duncan Law
    10. 10. Young peoples views: “Whenever I was doing a questionnaire, it felt like a tick box exercise. I didn’t know why I was doing it. In fact no one seemed to understand the point of the questionnaire, it was just a standard process. Eventually I stopped thinking what I wrote on it as it just seemed pointless.” “Young people never get any feedback about what the information they have given has been used for or how it has been implemented in services. This makes it seem like the questionnaires are just so that they can tick a box to say they have used outcome tools without actually using the information given.” © Duncan Law
    11. 11. Feedback & Outcomes Monitoring The evidence base © Duncan Law
    12. 12. Mike Lambert • • • • Feedback to clinicians on outcomes trajectories Reduced drop-out Better outcomes No advice given to clinicians on how to use the feedback • Lambert, M. J. (2007). PRESIDENTIAL ADDRESS: A program of research aimed at improving psychotherapy outcome in routine care: What we have learned from a decade of research. Psychotherapy Research, 17, 1-14. © Duncan Law
    13. 13. Len Bickman • • • • Big RCT (28 sites in 10 states) ‘real world CAMHS’ Feedback weekly or every three months Faster improvement with weekly feedback Even better if clinicians looked at the feedback! (paraphrased) • Bickman, L., Kelley, S., Breda, C., De Andrade, A, & Riemer, M. (2011): 
Effects of routine feedback to clinicians on youth mental health outcomes: A randomized cluster design, Psychiatric Services, 62(12), p.1423-1429 © Duncan Law
    14. 14. Feedback & Outcomes Monitoring Making them clinically useful © Duncan Law
    15. 15. 6 useful questions that forms can help with Assessment/Choice Partnership/ongoing work Review & Close • “What’s the problem?” • “What do you want to change?” • “How are we getting on together?” • “How are things going?” • “Have we done as much as we need to?” • “How has this been generally?”
    16. 16. Feedback & Outcomes Monitoring Clinicians views © Duncan Law
    17. 17. clinicians talking about their experience http://www.youtube.com/watch?v=5srUEXW wMKU © Duncan Law
    18. 18. How it can feel to try out new ideas and approaches Apprehension Integrated in practice Feeling Clunky Learning taken from the Closing the Gap Project Neus Abrines Jasmine Hoffman
    19. 19. Let’s give it a go! © Duncan Law
    20. 20. In pairs, one clinician, one young person Clinicians: try explain to the young person: – the importance of completing a measure – to complete it as openly and honestly as possible Young people: during the role play, consider what the clinician said or did that made you: – Appreciate the importance of completing the measure – want to fill the measure in openly and honestly – DO NOT share this detail with your partner yet © Duncan Law
    21. 21. How did that feel? Young people: • What did your partner do that made you feel that completing the measure was: – Important – Worthwhile – Useful – Helpful • What did your partner do to convince you to complete the measure as honestly as possible? © Duncan Law
    22. 22. How did that feel? Clinicians: • Did you feel confident in what you were saying to the young person? • What techniques did you try to use to convince them? • What would have helped you to feel more confident? © Duncan Law
    23. 23. Feedback & Outcomes Monitoring Making them clinically useful © Duncan Law
    24. 24. Forms, forms and more forms! Let’s brainstorm: what are all these forms for? © Duncan Law
    25. 25. Barriers to using measures (with thanks to UPROMISE)
    26. 26. Balancing the seesaw of service and therapeutic need (with thanks to UPROMISE) SERVICE EVALUATION CLINICAL MEANINGFULNESS SDQ RCADS CGAS Goals Symptom rating scales Session rating scales CHI-ESQ
    27. 27. 6 useful questions that forms can help with Assessment/Choice Partnership/ongoing work Review & Close • “What’s the problem?” • “What do you want to change?” • “How are we getting on together?” • “How are things going?” • “Have we done as much as we need to?” • “How has this been generally?”
    28. 28. At Assessment/ Choice “What’s the problem?” • SDQ and/or • RCADS “What do you want to change?” • Goals (GBO) and • ORS/CORS © Duncan Law
    29. 29. Session-by-session “How are things going?” • Symptom Tracker (in collaboration with child/family) or • Impact Tracker “how are you doing” or ORS/CORS and • Goals Based Outcomes (GBOs), or ORS/CORS © Duncan Law
    30. 30. An Example of a Symptom Tracker Worries (GAD) © Duncan Law 2012 Hertfordshire Partnership NHS Foundation Trust
    31. 31. Goals Based Outcome Tool: What does it look like? Hertfordshire Partnership NHS Foundation Trust
    32. 32. Session-by-Session “How are we getting on together?” • SRS or • Session Feedback Questionnaire © Duncan Law
    33. 33. Introducing the RCADS: 2 ways • In the following video, a clinician will introduce the RCADS to a young person and ask her to complete it in two different ways: http://vimeo.com/57925678 While watching, consider • What are the pros and cons of asking a young person to complete measures in these ways? • What might you do differently? • What questions might the young person have?
    34. 34. Interpreting RCADS Scores • What do you make of this? • What might you want to discuss in supervision? • What do you want to know? • What questions would you ask?
    35. 35. Feeding back scores to clients • The following video clip shows a therapist discussing scores on a measure with a young person: http://vimeo.com/57925681 • Do you think this was done in a collaborative manner? • How could it have been more collaborative?
    36. 36. What’s going on here? © Duncan Law
    37. 37. 16 Subscale Score 14 12 10 8 6 4 2 0 Session 1 Session 2 Session 3 Session 4 Session © Duncan Law Session 5 Session 6
    38. 38. The stats bit! Clinical Cutoffs A score below (or sometimes above) which a person is unlikely to have a problem measured by a tool Reliable Change A change in scores is reliable if it is larger than that expected by measurement error With thanks to Andy Fugard © Duncan Law
    39. 39. What’s going on here? © Duncan Law
    40. 40. Depression symptom tracker - 17 year old boy Reliable Change = 6 Clinical cutoff = 12 © Duncan Law
    41. 41. Service User Feedback & Outcomes Monitoring Resources and Further Information © Duncan Law, Stephen Butler, & Alex Goforth
    42. 42. CYP-IAPT Service user feedback and outcomes framework © Duncan Law
    43. 43. CYP-IAPT Resources http://www.iapt.nhs.uk/silo/files/apractical-guide-to-using-serviceuser-feedback--outcome-tools.pdf © Duncan Law http://www.iapt.nhs.uk/cy p-iapt/routine-outcomemonitoring-as-part-ofiapt/
    44. 44. Other Resources • www.corc.uk.net • www.myapt.org.uk • www.youtube.com/channel/UCVr_XGnjA229P5b UgfZ-y3w • www.vimeo.com/tag:cyp+iapt • Information on using feedback and outcomes including training videos, information © Duncan Law
    45. 45. Feelings about routine feedback & outcomes monitoring? Hate them 0 Mixed feelings 5 © Duncan Law Love them 10
    46. 46. © Duncan Law
    47. 47. Thanks for coming along We hope you found this presentation useful Feel free to use all are parts of it to help train other staff in your organisation & to further implement CYP-IAPT If you do use it please reference: ‘Duncan Law’ These slides must not be used in training for commercial gain © Duncan Law

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