The aim is to improve access for people with learning disabilities to the Surrey IAPTservice and help make reasonable adjustments within the IAPT programme so that successful outcomes can be achieved. Surrey and Borders Partnership was chosen as part of a national Action Research project hosted by the Foundation for People with Learning Disabilities to address the problems faced by people with learning disabilities when accessing IAPT services.
What We Did
The aim is to improve access for people with learning disabilities to the Surrey IAPTservice and
help make reasonable adjustments within the IAPT programme so that successful outcomes can be achieved. Surrey and Borders Partnership was chosen as part of a national Action Research project hosted by the Foundation for People with Learning Disabilities to address the problems faced by people with learning disabilities when accessing IAPT services. This meant that two members of the Surrey Community Team for People with Learning Disabilities (CTPLD) and Surrey IAPT team joined other Trusts from across the country at Action Learning programme meetings to share best practice and identify areas to be improved.
Estimates show that 20-40% of people with learning disabilities will experience some form of mental illness. Factors such as living in poverty, having fewer friends and experiencing other long term health problems and disabilities means that people with learning disabilities are prone to conditions such as anxiety and depression but often find it difficult to access services that can provide treatment. Reasons for access difficulty include non-user friendly referral forms for people with learning disabilities and initial telephone screening calls that some people with learning difficulties struggled to engage with.
As part of the Improving access to IAPT for people with learning disabilities project, Surrey and Borders Partnership created a reference group to act at a local level to ensure that any information shared at national Action Learning groups was, if appropriate, implemented in Surrey. The reference group is made up of Trust directors, managers, Surrey IAPT and CTPLD staff, GPs and commissioners. It identifies issues in the access processes, as well as within the IAPT programme itself and since its formation has implemented a number of changes to benefit people with learning disabilities when accessing Surrey IAPT.
The referral form for GPs to refer people has been amended to flag that a person has learning disabilities or learning difficulties. This allows the practitioner to prepare and adapt their therapies to suit the individual; Implementing screening tool created by Cumbria Partnership NHS Foundation Trust. This tool flagged up people with learning disabilities and the IAPT service and was able to improve data recording on the IAPTUS system; Easy Read Appointment letters and materials when on the programme; Initial screenings for people with learning disabilities held face to face instead of telephone screening calls; Group activities jointly run by the IAPT team and the CTPLD on a number of different topics; Easy Read Materials were produced for IAPT workers with information on different types of therapy, Common Mental Health problems and for complaints; The Surrey CTPLD given permission to refer people straight to the service, as opposed to sending them to their GP to be referred; IAPT staff were given extensive training on working with people with learning disabilities. This training was videoed and overall staff confidence increased from 5.6 to 7.96.
The project has streamlined referral processes and made access to IAPT services for people with learning disabilities more appropriate. The IAPT service itself has benefited from better quality staff training and improved co-working between CTPLD and IAPT. The reference group in Surrey allows the project to keep momentum and due to the fact it includes directors, managers and commissioners, keeps it at a high level agenda.
Wider Active Support
Surrey and Borders Partnership worked with a number of partners to ensure the project was a success. By working with the Foundation for People with learning Disabilities and being involved in the project Action Learning programme, the CTPLD and IAPT teams have been able to benefit from sharing best practices with a number of Trusts nationally. This includes taking on the Cumbria Partnership NHS Foundation Trust screening tool, which allows the IAPT service to identify people with learning disabilities and prepare a specialist programme to suit their requirements. Surrey and Borders are also working with the GP Federation to ensure that Surrey GPs are aware that the IAPT service is now more accessible for people with learning disabilities. By including commissioners, GPs and healthcare experts in the local reference group, the project has constantly been positively influenced by a wide range of stakeholders to ensure it is relevant to its local community.
People who use services were included in the project as ‘experts as experience’. These experts attended the project Action Learning programme and input information to provide a voice for those using the service. People with learning disabilities and their carers also attended sessions throughout the project to give feedback on a number of areas, such as effectiveness of easy read materials, how appropriate the IAPT programme is for people with learning disabilities and any changes that could be made. All feedback was fed in to how the final programme is run.
A large variety of staff have been involved in the project. On a national level, the Service Manager and a High Intensity Worker from IAPT and the Team Manager and a Psychologist from CTPLD joined the Action Learning group to share best practice and develop ideas. More locally, Trust directors, managers, Surrey IAPT and CTPLD formed the reference group to ensure that the project momentum did not stop. Staff from Surrey CTPLD and Surrey IAPT worked in unison for the first time, offering support and training and helping to deliver a successful service.
Looking Back/ Challenges Faced
Clinical co-working between Surrey CTPLD and Surrey IAPT did not progress at as early a stage as it could have done. There was a perceived lack of permission to begin working clinically. More members of the Multi-Disciplinary team could have been included in the project.
One of the main challenges faced in the project is ensuring the minimum data set is as accessible and understandable as it can be for people with learning disabilities. The data set is a series of questions given to any user of the IAPT service at the end of the programme which identify how the person is feeling. People with learning disabilities have struggled with this, and to overcome this, prompt sheets have been developed for IAPT staff to help people with learning disabilities complete the data set.
Another issue faced has been working with local commissioning groups. Originally, only GPs were able to refer people with learning disabilities to the IAPT service, however the Surrey CTPLD succeeded in changing this, and consequently have been able to refer people themselves to the IAPT service.
One final challenge was adapting the IAPT model to the needs of people with learning disabilities. The model is designed to provide short treatments and produce quick turnarounds, which would often not be suited to the needs to someone with learning disabilities. The general manager of Surrey IAPT identified this and ensured training was provided for staff. Shorter timed sessions were applied and more 1:1 time was implemented.
The reference group will ensure that the project is maintained at a high-level agenda. Its formation of directors, managers and commissioners, as well as members of both IAPT and CTPLD, will mean that the momentum of the project does not slow down. Development of accessible leaflet and posters means that the IAPT service will be promoted to people with learning disabilities. Further liaison between IAPT and CTPLD is continuing and both teams will continue attending each other’s meetings. A College programme (4 sessions) is also being rolled out to all colleges in Surrey to boost awareness of the service to ensure people with learning disabilities at education level are aware of the IAPT service.
Since the project began in 2013, 66 out of 217 people with learning disabilities have completed the IAPT programme. 50% of these completions took place in the 2015/16 period, showing that as the project has evolved, and staff are becoming more confident and treatment more appropriate, completion rates are increasing.
Since the project began, recovery rates for people with learning disabilities completing the treatment have also risen from 25 to 46% (approximately 45% of people without learning disabilities demonstrate full recovery after completing the programme).
Training – An evaluation form was used to measure the impacts of a training session for IAPT therapists on working with people with learning disabilities. Three questions were used to measure confidence before and after the training session. Each of the questions used a Likert rating scale, ranging 1 through 10, to measure confidence levels, with 1 representing extremely low confidence and 10 representing extremely high confidence. The questions were administered before and after the training session. 24 of the 24 evaluation forms were completed and returned, giving a return rate of 100%.
Overall pre-training confidence scores ranged between 2 and 10, with a mean of 5.65. The most frequent pre-training overall confidence score was 6.
Post-training overall confidence scores ranged between 5 and 10, with a mean of 7.96. The most frequent post-training overall confidence score was 8. This indicates an overall increase in confidence with working with people with learning disabilities post-training.
Qualitative feedback from the sessions included:
…Improved my confidence. Thank you Very interesting. Especially differences between L. Disability vs L. Difficulties. Typical barriers to therapy. Thank you One of the best pieces of training we have ever had. Wish we could have more.
The training format involved a two hour presentation, utilising group exercises and case studies.
College workshop – The feedback received for the college workshop was very positive. The workshop ran for 3 sessions covering understanding low mood, anxiety and then the last session was reviewing and staying well and completing individual ‘Feel Good plans’. The workshop was attended by up to 7 students from the college all of whom were described as having mild learning disabilities or functioning in the ‘borderline range’.
The Co-Director of Services for People with Learning Disabilities, is currently writing up this work for publication. Surrey and Borders is also working with the GP Federation to ensure that Surrey GPs are aware that the IAPT service is now more accessible for people with learning disabilities. By working with education support advisors in colleges, knowledge of the improved IAPT service for people with learning disabilities is spreading. The Foundation for People with learning Disabilities has disseminated much of the work done in Surrey, and examples of Surrey and Borders’ best practice has also been included in the IAPT Learning Disabilities Positive Practice Guide.