Published on March 11, 2014
Improved, Integrated and Accessible Services - What can IAPT tell us? Netta Hollings, Programme Manager – Mental Health and Community Care 1
Role of information • Improved services – What does good look like? • Integrated services – Data from all parts of the pathway • Accessible – Personal characteristics – Describe what is happening
Improving Access to Psychological Therapies • Started in 2010 • Multi-million pound investment by successive governments • Access to talking therapies • Get people off benefits and back to work • Measure outcomes • Targets – 12.4% access; 50% recovery
Data Set • First collected April 2012 • Collected from providers • C.50 data items • NICE guidance
Data Quality (http://www.hscic.gov.uk/catalogue/PUB13339/psyc-ther-ann-rep-dq-2012-13.pdf ) • Always issues with new data sets • Have to assess – relevance – accuracy and reliability, – timeliness and punctuality, – accessibility and clarity, – coherence and comparability – output quality trade-offs, – user needs and perceptions, – performance cost and respondent burden, – confidentiality, transparency and security
Data Quality dimensions • Relevance • Accuracy and reliability – Referral details – Coverage – complex provider landscape – Duplicate referral IDs – Untraceable patients and appointments • Timeliness and punctuality • Accessibility and clarity
Data Quality dimensions • Coherence and comparability – Two data sources in 2012/13 • Key Performance Indicators (commissioner, aggregate) • Data Set (provider, record level) – Issues • Output quality trade-offs – the extent to which different aspects of quality are balanced against each other – It’s new so it’s not perfect
Data quality dimensions • User needs and perceptions – Depends who you ask – Please give us feedback – we do pay attention • Performance, cost and burden – Always tricky • Management information as a by-product of clinical information • Confidentiality, transparency and security
Psychological Therapies – key findings • A total of 883,968 new referrals were received by IAPT service nationally, representing 761,848 people. • 434,247 referrals entered treatment, accounting for 49% of the number of referrals received. – In order to enter treatment a referral must have a first treatment appointment in the period. Being referred to IAPT services does not necessarily mean an individual will enter treatment, as they may be referred elsewhere, be discharged or decline treatment for a number of reasons before treatment is provided. • Of those referrals that received treatment in the year, 274,975 referrals (63%) were seen within 28 days or less, while 92% (400,786 referrals) received a first treatment appointment in 90 days or less. http://www.hscic.gov.uk/article/2021/Website-Search?productid=13995&q=IAPT+annual&sort=Relevance&size=10&page=1&area=both#top
Psychological Therapies – key findings • 54,430 referrals nationally were able to achieve recovery in 2012/13. – In order for a referral to exhibit recovery they must have a score that is less than the caseness threshold on both the PHQ9 and ADSM measures used at their last score taken. • This represents 43% of those records that were eligible for outcome assessment and were at caseness at the beginning of treatment (127,060 referrals). Three Local Area teams met the national target, having 50% of referrals (which were eligible for assessment and who were at caseness) moving to recovery. – In order to be classed as at “caseness” a referral must have either a PHQ9 or ADSM score which is above the threshold required to be classed as a case. Please see the Appendix for more details on threshold scores for each measure. • 534,721 referrals ended in the year, with 50% of ended referrals attributed to patients either declining or dropping out of treatment (268,998 referrals).
Psychological Therapies – key findings • In the year 144,210 referrals closed, having received at least two treatment appointments, rendering them as eligible for outcome assessment. – This is also referred to as “Completed Treatment” in this report and in Quarterly reports. • This represents 16% of the referrals which began in the year and 27% of all referrals that ended in the year. • In 2012/13, 82,910 referrals showed reliable improvement, representing 57% of the number of referrals eligible for assessment in the year. – In order to show reliable improvement, a referral must show a positive change in scores which is greater than the measurement error of the questionnaire used, for either the PHQ9 or ADSM (or both), without showing deterioration on the other measure used.
Psychological Therapies – key findings • 51,900 referrals showed reliable recovery. This equates to 41% of those referrals eligible for assessment which were at caseness at the start of treatment. – A referral is classed as having reliable recovery if it has met the conditions for both recovery and reliable improvement. • Of the 761,848 people being referred to IAPT services in the year 36% (274,409) were male and 62% (474,963) were female (gender was not recorded in 2% of cases), with most people being referred to services between the ages of 20 and 49 (71% of people were referred in this age group). – One individual may have multiple referrals across providers or at different times throughout the year, and so there are more referrals received than distinct people referred to IAPT services. • The data show that in 2012/13 84% of those accessing IAPT, excluding those whose ethnicity was unknown or not stated (which account for 30% of the total number of people referred), were categorised as “White British”, making up the majority of IAPT users. The number of people categorised as having ‘Mixed’ ethnicity was the highest in proportion to the number of people in the general population with the same ethnic status. The ethnic category with the next highest proportion was ‘Black or Black British’.
Improved, Integrated, Accessible • Improved – definitely increased the number of people with access to talking therapies; in line with NICE guidelines (good) • Integrated – Not quite sorted the pathway identifiers • Accessible – Age – Gender – Ethnicity – Other protected characteristics (poor data quality)
Role of information • How to describe things? • Can be linked “after the fact” – Primary vs. secondary use of data • Data collection – should IAPT be separate? • Data collection burden on clinicians • Data collection burden on service users • Pathway vs. payment
Useful information • www.hscic.gov.uk/iapt • firstname.lastname@example.org • Quarterly reports - http://www.hscic.gov.uk/article/2021/Website- Search?q=title:"routine+quarterly+improving+a ccess+to+psychological+therapies"&area=&siz e=10&sort=Relevance