The Talking Therapies service in Slough works with 22 GP practices and is based in a central hub with a team of PWPs, Counsellors and HI CBT therapists working across various locations and GP surgeries. Challenges for Slough IAPT service: to increase access in line with diverse population whilst taking account of complex presentations; high incidence of trauma, higher than average incidence of deprivation. Clinical delivery challenges include the impact of deprivation on the lives of clients and the need for interpreters and therapists delivering treatment in other languages.
Slough Talking Therapies IAPT Service was set up in 2010 to deliver evidence-based psychological therapies to Slough residents. Slough is a multicultural town with a diverse population of population of 144,800 residents (2014 mid-year estimates of the Census 2011).
The Talking Therapies service in Slough works with 22 GP practices and is based in a central hub with a team of PWPs, Counsellors and HI CBT therapists working across various locations and GP surgeries. I joined the Slough Team in January 2014 as Team Manager and Senior Cognitive Behavioural Therapist. Part of my role was to set up an outreach programme which aimed to improve access to psychological therapies to all parts of the community.
Background information regarding Slough Demographics
- The demographic of the borough is constantly changing with trends showing a steady rise in the Black and Minority Ethnic (BME) population
- Slough was one of the most ethnically diverse local authority areas outside of London in the United Kingdom in 2011
- The borough is made up of a significantly younger than average population compared to any of the south east local authorities: approx. 40,400 (28%) 0-19 year olds live within its boundaries
- The town also has a higher proportion of young adults aged 25 to 44 which suggests that there are possibly a large number of young families living in Slough; conversely Slough has a much smaller older population than the national average
- Slough continues to attract high levels of refugees and asylum seekers, many of whom have opted out of the formal “dispersal” system which can make them vulnerable and in need of key services and this transient population can be hard to identify and reach
- In 2011, 15.5% of households in Slough contained no one with English as their main language (which ranks Slough the 11th highest across England and Wales)
- Since 2010 there has been a slight shift towards greater deprivation in Slough relative to the rest of England, particularly in relation to crime, barriers to housing and services and income deprivation affecting older people.
Challenges for Slough IAPT service: to increase access in line with diverse population whilst taking account of complex presentations; high incidence of trauma, higher than average incidence of deprivation. Clinical delivery challenges include the impact of deprivation on the lives of clients and the need for interpreters and therapists delivering treatment in other languages.
How It Worked
At the request of our clinical lead we set up the Slough outreach project in January 2014 as a quality improvement plan. This was co-led by our East Berkshire Service Manager, Slough Team Manager, Project lead and our Communications Officer.
Aim of the project:
To increase referrals and clients entering treatment in Slough locality & fostering good GP relationships.
- Low referral rate from Slough GPs to Talking Therapies
- Low opt in rates following referral.
- Historical poor referral patterns between some GP surgeries and TT
- To bring about an increase in referrals, and take up of our services through developing excellent relationships with GPs, practice managers, and Slough CCG.
- To develop excellent relationships with faith and community groups to increase our profile in Slough.
- Clients with common mental health problems in all areas of Slough receive appropriate evidence based psychological therapies according to the stepped care model
- Increased knowledge and understanding of our service amongst the population of Slough.
- Improvement in relationships between Talking Therapies and Slough CCG/GPs.
- Liaison with community groups, and third sector/local authority services.
- Development of strong relationships and trust between TT and faith/community
- Increased involvement of Slough team in the local community and sense of belonging and understanding the needs of the client
Risks and issues
- Time pressures on staff who need to meet their targets
- Keeping GPs informed of aims of project to increase referrals
- Availability of funding to meet the aims of the project
Quality Improvement project design
- Set up a project group to meet monthly and review monitor activity against milestones and plan project tasks
- Plan a quality improvement project plan where referrals will increase to meet CCG prevalence rates for anxiety and depression over the next financial year (working towards 15%)
- Financial plan -resources were reviewed to manage increase in referrals e.g. staff; clinical space; docking stations; phones; headsets
- Communication plan to increase GP and team communications, time for designing publicity materials; advertising, budget, printing and producing materials such as posters/leaflets
- Training of the team in communication skills and delivering presentations to large/small groups of health professionals/community groups and clients
- Increase training and communication in GP surgeries to foster good relationships with GPs/Practice Managers and attending practice meetings
Project activity -What we did
- Phoned or visited all GP surgeries; to find out what it working/what could be improved and improving our communication and increasing relationships with them
- Researched Slough wards and represented communities to explore named contacts to create a detailed community directory
- Scope and contact Faith Groups/community groups/third sector groups to increase cross cultural collaboration
- Set up a client forum and talk to potential clients about what they want/need from our service
- Liaised with local libraries to launch a Talking Therapies stand
- Attended Slough Working Well/Slough Community Business Partnership
- Visited local College to discuss setting up student mental health/coping with stress classes
- Inserted flyers/adverts in local newspaper to market the service
- Set up an information stand in a local larger supermarket to talk to customers and staff about the service on several occasions
- Liaised with a colleagues about setting up an Urdu/Punjabi Type 2 Diabetes Wellbeing Course
- Wrote an article for the Slough GP newsletter to invite referrals
- Produced a CD in different languages to inform clients about Talking Therapies when they are first referred for GP’s and others to hand out
It has taken time to achieve our original objectives and we are now coming towards the end of our third year.
We continue to meet monthly to review outreach we have undertaken and to plan outreach for the coming quarter. Our service project lead has set up an Access Project to support us in ensuring we meet our access targets. We have regular outreach events include Stress Control Taster Sessions for school and college students; bi-monthly visits to Children’s Centres; monthly visits to our local hospital post-natal ward, stands in our local libraries and shopping centres.
We also deliver talks to community/health groups including: Age Concern; Macmillan Cancer Volunteers, Patient Participation Groups and Meet ‘n Mingle.
In our quarterly Slough GP Newsletter we feedback referral rates from all our GP surgeries and RAG rate them so we know which GP surgeries to target if referral rates drop. We then set up a slot to speak at their practice meeting to update them about the service and encourage them to meet their referral targets.
Since November 2015 we set up Welcome/Drop in Clinics to help clients who may struggle with accessing our service in the usual way. This may be due to language barriers; cultural barriers of stigma and shame around mental health difficulties; physical disabilities; poor previous experience of accessing mental health services.
We have rolled out these clinics from our local community hospital into GP surgeries. Clinicians will set aside 30-60 minutes at the start or end of their booked clinic to see drop in clients and welcome them to the service.
Our access has improved significantly; so far in 2016 we have met our monthly access targets. (See diagram below)
In addition to the increase in access the Slough Talking Therapies team are now consistently achieving a 50% to 52% recovery rate.
Slough Talking Therapies Quality Improvement: Access
Our next project is in line with implementing the five year forward view for mental health; by 2020/1 increasing our access to at least 25% of people with common mental health conditions. In addition our focus will be on developing new integrated services between Talking Therapies and primary/community services to reach people with co-morbid physical and mental health conditions or persistent medically unexplained symptoms. This expansion will build upon our existing relationships with GPs and practice/community staff. We are particularly interested in the cultural aspects of mental health conditions in the BME clients and how these interact with long term physical health conditions.
Reference: Slough Borough Council: https://www.slough.gov.uk/downloads/The-Slough-Story.pdf March 2016