Presentation on theme: "A 12 month review of outcome data in the York & Selby Early Intervention Team; The Monthly Audit Tool (MAT) Claire Robinson, Assistant Psychologist Tracey."— Presentation transcript:
A 12 month review of outcome data in the York & Selby Early Intervention Team; The Monthly Audit Tool (MAT) Claire Robinson, Assistant Psychologist Tracey Walker, Team Manager
EI General Overview Specialist teams working with young people aged (and their families) experiencing a first episode of psychosis, or who may be at risk of developing psychosis. Aims - to detect a persons psychosis as early as possible and offer evidence based interventions – reducing DUP. Assertive engagement over a three year period – bio-psycho-social approach. Team culture of providing a service which is enabling and empowering based on personal, social and occupational goals.
The early evidence base- 10 years of evidence in Australia Early Psychosis Prevention and Intervention Centre,(EPPIC)- Patrick McGorry In England - Birchwood et al (1997) National Policy provided the impetus for the development of EIP in the UK Modernising Mental Health Services (DH 1998) National Service Framework for Mental Health (DH 1999) NHS Plan (DH 2000) Policy Implementation Guide (DH 2001) The Development of EI
“ The early evidence base was not as robust as would have been desired” (Appleby, 2006) “EIP is the jewel in the crown of the NHS mental health reform” because…… Service users like it People get better It saves money Louis Appleby (National Clinical Director for Mental Health) Conference speech 29/04/09
There is now robust evidence to suggest that EI is clinically effective during the intervention period for first episode psychosis. Peterson et al 2005 –OPUS 1 year follow up study – lower positive and negative symptoms, low admission rates Cullberg 2006 – study of 3 year intervention – better symptomatic and functional outcomes, low admission rates Fowler et al 2009 – comparison of EI model Vs. partial EI Vs. CMHT – partial EI did not produce the favourable outcomes seen with dedicated EI model. Evidence Base
YES…. McCrone et al LEO 18 month follow up – suggests EI is cost effective with QOL and vocational measures Phase IV DOH report, McCrone et al 2010 in publication – DOH commissioned report – predicts much more saving due to reduced admissions, better employment outcomes, reduced suicides, and evidence for sustained outcomes post EI Is early Intervention cost effective?
A move away from measuring activity in mental health services… Favours measures of recovery and social achievement – employment and educational outcomes. This will place a demand on services to be effective and demonstrate effectiveness… “a tougher challenge than demonstrating activity”… Need a move to develop research and audit programmes… NEW HORIZONS (DOH 2009)
EIP in North Yorkshire and York has developed research and audit programmes. Measures have been produced to demonstrate effectiveness in relation to outcomes derived from policy and targets…. The early Intervention movement welcomes this shift in focus…
Outcome measures for EI Duration of Untreated Psychosis (DUP) PATHWAYS TO CARE ENGAGEMENT RATES OF FAMILIES AND INDIVIDUALS USE OF MENTAL HEALTH ACT READMISSION RATES OCCUPATION HOUSING STABILITY SUBSTANCE MISUSE RECOVERY RATES SELF HARM/SUICIDE OFFENDING RATES PHYSICAL HEALTH SATISFACTION Introducing the Monthly Audit Tool…
The MAT Monthly Audit Tool Completed by: Care Coordinators Completed for: Every Client Every Month One side of A4
What does it do? The MAT Captures a “snapshot” of a client presentation for each month every month: Client Status Engagement Relapse Death / Suicide Employment Substance Misuse DLA Victim of Crime Perpetrator of Crime Housing Status Family Contact Medication Discharge Information
Detailed client data (even if client leaves before 3 years) Helps workers identify patterns of behaviours / stressors / relapse signatures Informs formulation Helps evaluate individual care and service provision Provides information that is comparable for clients at key points throughout recovery Promotes regular reflective practice within the team Why Monthly?
The MAT – How does it help us? Informs Accurate Service Evaluation and Quality Improvement Integrates clinical governance activity into teams work, reduces pressure on evidence gathering Monitoring of outcome objectives and targets for EI services Early access to treatment ( reducing DUP) Access to full bio-psycho-social assessment by PSI trained practitioners Employment, education and occupational activity Return to primary care
…how does it help us Adherence to NICE guidelines NICE guidelines for Psychosis with coexisting substance misuse (draft 2010) Nice Guidelines for Schizophrenia (2009) Standardises Information collected over 3 locality teams Supports the longitudinal research project within the locality.
76% engaged without difficulty 24% engaged with difficulties 95% of clients showing no signs of relapse 95% of clients were not experiencing suicidal ideation 38% of clients were in employment 19% in Full Time employment 19% in Part Time employment 62% not in employment 14% were not seeking work 14% were seeking work 14% were doing voluntary work 14% In Education / Training 5% Homemakers The MAT - What does it show? Data analysed of clients at an 18 month point with the team 21 clients
76% family members engaged informally 33% of clients receiving DLA 43% of clients were in education / training 19% Full Time education / training 24% Part Time education / training 0% of offending rates or victims of crime 95% of clients in stable housing 5% in accommodation with Mental Healthcare support 5% engaged in structured family work 10% clients declined family contact 5% no family 5% NA At 18 months continued…
57% smoke cigarettes 38% problematic alcohol use 10% smoke cannabis 5% Class A 5% Class B 19% Not prescribed any antipsychotic medication 5% Mood Stabilizer 5% Depot 62% prescribed and taking antipsychotic 10% prescribed and not – taking antipsychotic 72% were prescribed antipsychotic medication At 18 months continued…
F/T Employed P/T Employed Unemployed - Seeking Unemployed - Not Seeking Longitudinal progression of a clients employment status Individual trends…..
Use reported No use reported Relationships…..
Discharge Destinations…. 36 Clients
Future developments Recent evaluation of the MAT highlighted areas for development which included… How to record data specific to activities of daily living How to improve NICE concordance which would include, use of CBT and improved physical health monitoring. How to collect data which allows for accurate DUP calculation. A revised MAT will be agreed and implemented across the locality teams in the coming months to increase accuracy and usefulness of the data collected.
Questions and Comments.
References Appleby, L. (2006). Quoted in: Early Intervention in Psychosis in England – report from a day seminar on research policy and practice. London: CSIP. Birchwood, M. & McGorry, P. & Jackson, H. (1997). Early intervention in schizophrenia. British Journal of Psychiatry, 170, 2-5. Cross-government strategy: Mental Health Division, New Horizons: A shared vision for mental health. HM Government Cullberg, J. & Mattsonn, M. & Levander, S. & Holmqvist, R. & Tomsmark, L. & Ellingforsc, C. & Wieselgren, I. M. (2006). Treatment cost and clinical outcome for first episode schizophrenia patients; a 3 year follow up of the Swedish parachute project and two comparison groups. Acta Psychiatrica Scandinavica, 114, Department of Health (1999). National Service Framework for Mental Health. London: Department of Health. Department of Health (2000). The NHS Plan – a plan for investment, a plan for action. London: Department of Health. Department of Health (1998). Modernizing Mental Health Services. London: Department of Health. Department of Health (2001). The Mental Health Policy Implementation Guide. London: Department of Health. Department of Health (2008). NHS Next Stage Review. London: Department of Health. Department of Health (2009). New Horizons: a shared vision for mental health. London: Department of Health.
References continued…. Fowler, D. & Hogdekins, J. & Howells, L. et al., (2009). Can targeted early intervention improve functional recovery in psychosis? a historical control evaluation of the effectiveness of different models of early intervention service provision in Norfolk 1998 – Early Intervention in Psychiatry, 3; 282 – 288. McCrone, P. & Craig, T. K. J. & Power, P. & Garety, P. (2010) Cost effectiveness of an early intervention service for people with psychosis. British Journal Of Psychiatry. 196: National Institute for Health and Clinical Excellence. Psychosis with coexisting substance misuse: assessment and management in adults and young people. Draft for consultation, August National Institute for Health and Clinical Excellence. (2009). Schizophrenia. Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. London, Holborn: National Institute for Health and Clinical Excellence Petersen, L. & Jeppensen, P. & Thorup, A. et al., (2005). A randomized multicentre trial of integrated versus standard treatment for patients with first episode psychotic illness. British Medical Journal. 331, 602.