Findings so far from outcomes data and looking to the future - Dr Miranda Wolpert, National CYP IAPT Informatics Lead
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Findings so far from outcomes data and looking to the future - Dr Miranda Wolpert, National CYP IAPT Informatics Lead

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  • KATE TO UPDATE- EXPLICITNESSREFER TO CONSULTATION ON GOOD OUTCOMES FOR PRUWHAT’S GOOD ENOUGH / EXPECTATIONS OF BEING “CURED”The overarching message from YP is that if you are good at working with them collaboratively then forms can actually be very helpful. If not, thay won’t be.Forms can help YP to communicate something they may be “scared to say” – It can be easier to tick a box and hand it over than to say it out loud – it’s a way of getting a conversation started
  • Refers to two or more “symptom or general outcome measurement time points” (this could be RCADS plus one or more symptom trackers, two or more symptom trackers, SDQ plus one or more impact measure, two impact measures, two RCADS or two SDQs) , from the same perspective (Child or Parent) where case seen on 3 or more occasions[2] Refers to two or more “symptom or general outcome measurement time points” (thiscould be RCADS plus one or more symptom trackers, two or more symptom trackers, SDQ plus one or more impact measure, two impact measures, two RCADS or two SDQs) , from the same perspective (Child or Parent) or CORS where case seen on 3 or more occasions[3]Refers to two or more “symptom or general outcome measurement time points” (this could be RCADS plus one or more symptom trackers, two or more symptom trackers, SDQ plus one or more impact measure, two impact measures, two RCADS or two SDQs) , from the same perspective (Child or Parent) AND EET from one time point where case seen on 3 or more occasions[4] Refers to two or more “symptom or general outcome measurement time points” (this could be RCADS plus one or more symptom trackers, two or more symptom trackers, SDQ plus one or more impact measure, two impact measures, two RCADS or two SDQs) , from the same perspective (Child or Parent) or CORS AND EET from one time point where case seen on 3 or more occasions
  • New measuresConsult on further measures spring 2014New annual report summer 2014
  • Data uploaded every quarterCurrent no cases taken on: 6397Current no of closed cases: 1244Closed with outcome data: 405 Next Annual report summer 2014Continue to collect :WHO: presenting problem, ethnicity, complexity factorsOUTCOMES: paired normed data

Findings so far from outcomes data and looking to the future - Dr Miranda Wolpert, National CYP IAPT Informatics Lead Findings so far from outcomes data and looking to the future - Dr Miranda Wolpert, National CYP IAPT Informatics Lead Presentation Transcript

  • Findings so far from outcomes data and looking to the future Miranda Wolpert CYP IAPT National Informatics Lead Chair Outcomes and Evaluation Group Director CAMHS Outcomes Research Consortium (CORC) Director Evidence Based Practice Unit (EBPU) UCL & AFC http://www.iapt.nhs.uk/cyp-iapt http://www.corc.uk.net
  • Acknowledgments Outcomes and Evaluation Group • • • • • • • • • • • • • • • • • • • • • Duncan Law- Clinical and outcome monitoring expertise in CAMHS and lead for COOP Margaret Murphy- Clinical and outcome monitoring expertise in CAMHS David Clark - Adult IAPT measurement and analysis expertise Kate Martin – Young Minds, service user participation expertise Jessica Deighton – CAMHS measures and psychometric analysis expertise Paul Wilkinson – CAMHS Psychiatrist with focus on outcome evaluation Barbara Rayment – Youth Access, Young people’s counselling services expertise Margaret Oates – Adult IAPT data collection and collation expertise Cathy Troupp – Research in use of ROMS in psychotherapy David Trickey – Service Lead and expert in PTSD Paul Stallard - CBT and service development expertise Stephen Scott – Parenting expertise Ro Rossiter – Learning Disabilities Emma Morris - Service lead, Cultural issues Philippe Mandin - Cultural issues Rabia Malik - Cultural issues Anne York – CAMHS S specialist Anne O Herlihy - Service transformation David Lowe - expert in use of proms in Family therapy Peter Stratton – Family work Cathy Street – CYP participation CORC Nexus consortium • • • • • • • • Dr Isobel Fleming, CORC Programme Lead Jenna Bradley, CORC Project Manager Rachel Argent, CORC Research Assistant Dr Dan Brown, MegaNexus Operations Lead Lee Murray, MN Project Manager Phanindra Kaza, MN Senior Software Engineer Nadia Kuftinoff, MN Project Support Dan Reader-Powell, MN Systems Administrator Data managers • • • • • • • • • • • • • • • • • Alex Papdakis Andrea Shand Barbara Snaith Bill Clarke Claire Newall Craig Colling David Markwick Diana Viscusi Elaine Blagden Emma Broda Fatima Blade Hannah Mendoza-Wolfsaon Husman Rafiq Jacqui legge Jess Parsons Julia Yu Laura Cunnen • • • • • • • • • • • • • • • • Liam Connolly Maris Vainre Mark Coughlin Mark Lowe Mary Urquhart Mel Jarvis Michelle McFarlane Michelle Adams Lesley French Mike Presneill Muhammad Akram Paul Fry Paul Townley Sara Barnes Sarah Oliver Wendy Geraghty
  • Outcomes for practice Outcomes for evaluation
  • Outcomes for practice and evaluation
  • Findings so far: outcomes for practice
  • Outcomes for practice Assessment/Choice Partnership/ongoing work Review & Close • What’s the problem?” (assessment) This is understanding the issue the young person or family have come for help with • “What do you want to change?” (goals or aims of therapy) – this is understanding the specific goals the young person or family have - the things they want to work on in coming to a service • How are we getting on together?” (engagement or alliance) It is important to get things right from the start • “How are things going?” (Symptom/goal tracking) – this is tracking to see if things are progressing during and intervention • Have we done as much as we can/need to?” (collaborative decision to close or refer on) – re-review of question 1 e.g. Time2 SDQ (if not used as tracker in long-term case) • “How has this experience been generally?” (experience of service overall).
  • Practice rules The 4M principles Minimal Burden No unnecessary form-filling. Multiple Perspectives Consider collecting different people’s views. Meaningful Use Only select forms that could provide meaningful information that will be used by somebody. Missing Something? Consider whether any of the forms could fill a gap that you may not have covered in some other way that might be useful to know about.
  • Practice rules Some Do’s and Don’ts of using clinical outcome tools Do Make sure you have the forms you need, ready before the session Do Always explain why you are asking anyone to fill out a form Do Look at the answers Do Discuss the answers with service users Do Share the information in supervision Do Always use information from the forms in conjunction with other clinical information Don’t Give out a questionnaire if you think the person doesn’t understand why they are being asked to complete them Don’t Give use any forms if you don’t understand why you are using it Don’t Insist on someone filling out forms if they are too distressed Don’t See the numbers generated from outcome tools as an absolute fact Don’t See your clinical judgment as an absolute fact
  • Findings in practice: young peoples’ views PROMs help make the balance of power more equal. Gives us a shared understanding of …where we’re starting from. …where we’re heading to. …how we’re going to get there. Enables us to get an in-depth understanding of what we’re feeling, why we’re feeling it and what we can do about it. It means if we go off track or get a bit lost along the way, we can both figure out how to find the way back again. Makes us feel like it’s a shared experience between us and the clinician... like we’re in this together. It is important to monitor outcomes to make sure the person feels better not worse It makes us feel like there is a point to our therapy Quotes from young people from YoungMinds consultation in Devon. Reference : Talking About Talking Therapies/Devon CAMHS Views of members of VIK Young Minds
  • Findings in practice “Using outcome measures in a therapy session needs to be done in a collaborative way with the young person and they must feel that it is important. Looking at the data and assessing it both with the young person and away from the session is key. Don’t just gather the information; use it to make the therapy better!” Young person with experience of service use To join the conversation and see user perspective go to.. http://www.myapt.org.uk
  • Findings so far from outcomes for evaluation data
  • Outcomes for evaluation
  • Evaluation rules The dreaded 90%! Time 1 Patient Reported Outcome Measure (PROM) PROM with clinical norms. [1] [2] Time 2 PROM Education, employment and training (EET) PROM from same EET information reporter using same recorded by questions as Time 1 practitioner The last recorded measure at point of closure will be used in calculations of outcome If EET is recorded only once this will be taken as both T1 and T2 measure
  • Evaluation rules: PROMs with clinical norms •SDQ (and/or impact scale separately) •RCADS (and/or subscales for depression and different forms of anxiety) •C/ORS •Impact of Event Scale •Behavioural difficulties child and parent measures.
  • Annual Report Evaluation data : who seen Y1 Jan-Dec 2012 • • • • 1366 cases opened, 255 cases closed Mean age 11.9 (SD=4.2; peaks at 8 and 15 yrs) 41.9% male, 57.7% female (0.4% missing) 59.2% White British, 11.6% other ethnicity (29.2% missing) • 18.4% of closed cases were only seen once – of these, 42.6% closed on professional advice
  • Annual Report Evaluation data : What sort of problems (NB mainly from CYP IAPT trainees) N= 565, Missing N= 678 Behaviour difficulties Family relationship difficulties Substance abusing Depression, low mood Panic disorder Anxious socially Compelled to do or think ADHD Severe inter-personal difficulties Anxious away from home Traumatic event Avoids specific things Anxious generally Carer management difficulty Habit problem Attachment difficulties Eating difficulties Self harming Avoids going out Toilet difficulties Gender discomfort Selective mutism Psychosis Mild Moderate Severe 0.0 5.0 10.0 15.0 Percentage 20.0 25.0 Note high proportion of missing data. Not sure this is representative of all data submitted.
  • Annual Report Evaluation data : Interventions Offered (NB mainly from CYP IAPT trainees) N= 688, Missing N= 678 Note high proportion of missing data Note: Categories are not mutually exclusive.
  • Annual Report Evaluation data : Information about outcomes Closed cases seen at least three times with a measure completed at assessment Percentage Frequency % (of all closed cases) Minimum cases sent by individual site (percentage of closed cases in submission) Maximum cases sent by individual site (percentage of closed cases in submission) Closed cases with a symptom specific outcome 149 85.1 0.0 100.0 Closed cases with symptom or general functioning outcome 154 88.0 0.0 100.0 Closed cases with symptom and education outcome 42 24.0 0.0 84.6 Closed cases either symptom or general outcomes and educational outcome 44 25.1 0.0 84.6
  • Annual Report Evaluation data : emerging outcomes • Significant improvement in average scores between first and last time points for: – – – – – – – CYP rated panic CYP rated OCD CYP rated separation anxiety CYP rated generalized anxiety CYP rated general wellbeing (CORS) Parent rated depression Goals • No significant improvement in average scores between first and last time points for: – CYP rated depression
  • Looking to the future: Evaluation reports
  • Looking to the future: Practice Guidance The guide to collecting and using service user feedback and outcomes information Editors: Duncan Law and Miranda Wolpert Contributors include: • • • • • • • • • • • • • • • • David Trickey Cathy Street Peter Stratton Cathy Troup Gill Walker Barry Nixon Andy Fugard David Low Emma Kawartzki Melanie Jones Jenna Bradley Celia Beckett Mark Dadds Shona Falconer Peter Fonagy Evette Girgis • • • • • • • • • • • • • • • • Sajid Humayun Karl Huntbach Steve Kingsbury Duncan Law Claire Maguire Anita Marsden Susannah Marks Nick Midgley Scott D. Miller Emma Morris Kate O’Hara Kathryn Pugh Rebecca Putz Barbara Rayment Stephen Scott Brigitte Squire • • • • • • • • • • Sarah Stewart-Brown Cathy Street Frances Taggart Nick Waggett Sally Westwood Paul Wilkinson Miranda Wolpert Matt Woolgar Ann York Young Sessional Workers from the GIFT Team
  • Looking to the future: practice and evaluation