TalkingSpace Plus – Oxford Health NHS Foundation Trust – NCCMH – Increasing Access to IAPT

TalkingSpace Plus, is an IAPT service hosted by Oxford Health NHS Foundation Trust. As a wave 1 early-implementer, TalkingSpace Plus is developing ‘IAPT-LTC’ services for people with long-term physical health conditions (LTCs) including cardiac disease, chronic obstructive pulmonary disease and diabetes and medically unexplained symptoms (MUS) including Chronic Fatigue Syndrome.

Co-Production

  • From start: No
  • During process: Yes
  • In evaluation: No

Evaluation

  • Peer: No
  • Academic: Yes
  • PP Collaborative: No

Find out more

 

Overview

TalkingSpace Plus, is an IAPT service hosted by Oxford Health NHS Foundation Trust. As a wave 1 early-implementer, TalkingSpace Plus is developing ‘IAPT-LTC’ services for people with long-term physical health conditions (LTCs) including cardiac disease, chronic obstructive pulmonary disease and diabetes and medically unexplained symptoms (MUS) including Chronic Fatigue Syndrome.

 

Access

Last year, 515 people with LTCs and MUS were seen by the IAPT-LTC arm of the service. This included people with cardiac disease, diabetes, COPD or chronic fatigue syndrome. A wider group of people with LTCs and MUS were also seen by core clinicians.

IAPT (whole service) referrals 1232291% of patients began treatment within 6 weeks of referral and

99 % began treatment within 18 weeks of referral.

Note – referral figures for 2016/17

 

Access and assessment

Within one week of referral, routinely a step 2 psychological wellbeing worker completes a telephone screening assessment. As part of the screen, the person is asked about their physical health, including if they have a chronic health condition. Details about how the patient is managing their condition including medications, treatments and who is providing their physical health care is obtained to promote integration.

 

NICE recommended care

In line with NICE recommendations, the service uses a stepped-care model. This ensures that the person is able to access an appropriate evidence-based psychological interventions, at the most appropriate step (level of intensity). Care delivered includes:

  • psychoeducation, co-delivered with cardiac rehabilitation nurses at the John Radcliffe and Horton Hospitals and in leisure centres across Oxfordshire routinely as part of the Heart2Heart cardiac rehabilitation programme
  • adapted anxiety and depression groups for people with long-term conditions delivered by psychological wellbeing practitioners
  • computerised CBT supported by and IAPT-LTC clinician
  • 1:1 CBT and high intensity therapies adapted for people with long-term conditions e.g., cardiac disease and heart failure, diabetes, COPD, delivered from physical healthcare settings e.g. cardiac rehabilitation gym alongside the nurses and exercise physiologists and can be delivered at the patient’s home for those unable to travel.
  • anxiety and depression groups for people with long term health conditions facilitated by two high intensity CBT therapists
  • mindfulness-based CBT classes for people with comorbid relapsing depression and an LTC led by a two mindfulness trained high-intensity therapists.

 

Workforce

Clinical leads and managers1 integrated IAPT lead (band 8c), 1 operations manager (band 8a), 2.2 locality leads (band 8a)
Clinicians2.6 high intensity CBT therapists (band 7) 1 senior psychological wellbeing practitioner (band 6), 8 trainee CBT therapist (band 6), 7 trainee psychological wellbeing practitioner (band 4), 1.5 assistant psychologist (band 4)
Other1 data lead (band 5)

Note – the workforce numbers above are whole-time equivalents and are exclusive to the new IAPT LTC service

Staff regularly receive a combination of individual and group supervision, with additional in service training and support. Qualified clinical staff working in the IAPT-LTC service have all attended LTC top-up training to work in the IAPT-LTC for psychological wellbeing practitioners (5 days at University College London) and high-intensity therapists (10 days at Royal Holloway University, London).

 

Outcome measures

In addition to the routine collection of outcome measures in line with the IAPT Mental Health Services Data Set, the IAPT-LTC team collect disorder specific measures including the Diabetes Distress Scale for patient with diabetes, the CAT for patients with COPD, the Chalder Fatigue Scale for patients with CFS/ME. The nurses routinely use the Minnesota living with Heart Failure Quality of Life measure for patients with heart failure and the Dartmouth Primary Care Cooperative Information Project (COOP) quality of life measure for patients with coronary heart disease.

 

Working with the wider system

IAPT-LTC clinicians liaise closely with healthcare staff working with people with LTCs or MUS. For patients with cardiac disease for example, this includes working closely with the cardiac rehabilitation nurses, exercise physiologists, heart failure nurses, other cardiac specialist nurses, genetic cardiac counsellors, cardiologists, GPs, practice nurses, district nurses and community Integrated Locality Team workers. This helps to provide a seamless service for people with cardiac disease and their carers. To support joint-delivery IAPT-LTC workers are co-located in leisure centres and the hospital gym for cardiac rehabilitation.

IAPT-LTC clinical supervisors provide clinical support and supervision to physical healthcare workers via monthly supervision sessions which is case-focused to enable joint learning and skills development. The clinical leads meet regularly with mental health, physical health and GP commissioners and key providers, such as the Acute Hospital Trust cardiac, diabetes and respiratory services, emergency department, liaison psychiatry, and clinical health psychology services, to promote the development of the IAPT-LTC pathways.

 

Key learning and achievements 

The cardiac pathway has been shortlisted and highly commended by the Health Service Journal Awards for incorporating IAPT workers into the cardiac secondary service redesign and more recently for providing value in health care after demonstrating cost-savings as well as improvements in mental health outcomes for cardiac patients.

Patient experience feedback is extremely positive, with up to 95% recommending the service. Patients report a seamless service experience with their “mental and physical health care needs being met by one team”. One patient said “Anxiety was more disabling to me than my heart attack or the surgery; thank goodness for seeing you – I would never have gone to a psychologist had it not been part of my cardiac care. Now I feel mentally able to go back to work, thank you”.  Cardiac nurses have also provided positive feedback on their experiences of CBT supervision and working with the IAPT team.

Further details

Commissioning Oxfordshire CCG
ProvidersOxford Health NHS Foundation Trust
Operating hours8 am to 5 pm on Monday and Friday

8 am to 8 pm on Tuesday, Wednesday and Thursday

Population sizeCirca 680,000

 

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