The IAPT-SMI EIP demonstration sites aim to increase access to NICE-recommended psychological therapies for psychosis. One site is located within South London and Maudsley (SLaM) NHS Foundation Trust and the other is in Lancashire Care NHS Foundation Trust. The sites provide CBT for psychosis and family intervention, treatments that are inline with quality statements 2 and 3. This service is included in NCCMH guidelines.
Demonstrating positive practice in relation to statement 2 and 3 of the Psychosis and Schizophrenia in Adults NICE quality standard:
Demonstration site population and incidence for 16–64 year olds
2. Adults with psychosis or schizophrenia are offered cognitive behavioural therapy for psychosis (CBTp).
3. Family members of adults with psychosis or schizophrenia are offered family intervention.
South London and Maudsley NHS Foundation Trust
Lancashire Care NHS Foundation Trust
Predicted cases per year*
89.4 – 120.5
5.3 – 23.9
Incidence per 100,000 people aged 16-64 years*
*range across the trust
The IAPT-SMI EIP demonstration sites aim to increase access to NICE-recommended psychological therapies for psychosis. One site is located within South London and Maudsley (SLaM) NHS Foundation Trust and the other is in Lancashire Care NHS Foundation Trust. The sites provide CBT for psychosis and family intervention, treatments that are inline with quality statements 2 and 3. Sessions are implemented in accordance with NICE recommendations and are provided by staff with the appropriate competencies; these competencies are outlined on the University College London website and include factors relating to both general therapeutic and specific CBT competencies.
Another essential component of the provision of high-quality NICE-recommended care is protected time to prepare for sessions, see service users and receive close clinical supervision. In order to achieve this, the SLaM EIP service uses a job plan template to determine expected caseloads and the amount of direct clinical time required. The typical job plan for a 1.0 WTE band 8a EIP psychologist includes six sessions of direct clinical work and one session for administration. Clinical work includes up to 15 weekly therapy slots (including two to three service users and up to two families and one group per session, depending on task and travel time). A psychologist is expected to see 30 people annually; this includes assessments, short- term interventions, indirect work and CBT for psychosis and family intervention.
Lancashire Early Intervention Service has implemented a three-tier, matched care model. Tier 1 provides CBT-informed case management and carer support; Tiers 2 and 3 provide CBT and family intervention. In Tier 2, the level of intervention refers to formulation-based work, targeted at problems such as anxiety disorders or depression, or where there is a discrete need. In Tier 3 provision is for service users with multiple or more complex needs. Therapists work across the tiers, providing either supervision (Tier 1 and 2) or direct clinical work (Tier 3); typically a band 7 therapist would provide six clinical sessions and a band 8a therapist would deliver five. Therapists also contribute to service development; psychosocial interventions training and a number of other projects (thereby reducing the amount of direct clinical sessions that they are able to offer).
As part of successful implementation of the NICE quality standard, both sites are also committed to gathering routine outcome data (see section 4.4 of the guidance document).
These include patient-reported clinical outcomes, service user experience and service utilisation data. Routine outcome measures from the SLaM site have indicated that service users within the EIP pathway who completed therapy reported significantly higher levels of wellbeing and functioning and lower levels of distress and symptomatology. This was accompanied by a reduction in the frequency and duration of admissions to inpatient services and crisis teams (during therapy). Furthermore, 32 out 45 service users from the Lancashire site improved over the course of therapy. Strong service user involvement and satisfaction were also reported for the two demonstration sites, with 84% and 100% of Lancashire and SLaM site service users, respectively, saying that they would recommend the service to a family or friend.
The project leads from both the SLaM and Lancashire sites also identified a number of key learning points that facilitated the successful running of the demonstration sites. These include:
• Dedicated, ring-fenced, funding and time. This has been essential both for recruiting new therapists and for enabling the therapists to deliver high quality psychological therapies (including time for regular and frequent clinical supervision and service user contact). As part of this, the right ‘service context’ (the existing critical mass of staff, appropriate care and referral pathways, supervision, and support at managerial, clinical, administrative and business/finance levels) needs to be in place to ensure that these resources can translate rapidly into increased delivery.
• The routine measurement of outcomes. This includes sessional outcomes, which are feasible and acceptable provided that they are brief and are applicable to the population.
The SLaM site also recommends the use of independent assessors in outcome measures, such as psychology assistants. As well as being cost-effective (compared with using therapist time), the process ensures assessment completion is prioritised and enables detailed feedback reports for GPs and teams. For the service users there is also an opportunity to provide feedback in an independent manner, removed from therapists’ demands.
The Lancashire site also recommends the use of technology, particularly mobile tablet devices, to facilitate the collection of data in sessions with service users. As well as facilitating the sessions (in terms of goal setting, engagement and rapid feedback of scores in sessions), the process also allows effective data extraction and reporting when communicating with performance/reporting departments in the trusts.
Further information about the IAPT-SMI demonstration sites can be found on the IAPT website.