Devon Partnership NHS Trust (DPT) Dan Exley & Antonia Ames Implementing Silvercloud - The Benefits and Challenges Devon Partnership NHS Trust (DPT) Dan Exley & Antonia Ames

Presentation Overview What is ‘Silvercloud’? Who is it for? Why does DPT offer Silvercloud? Challenges Benefits A Patient’s Story Implementing cCBT - Lessons Learnt

What is ‘Silvercloud’? cCBT package with numerous programmes Supported by PWP via flexible online reviews Customisable content Varied content – formulations, videos, quizzes

Who is it for? Covers a wide range of presentations and includes the core IAPT low intensity interventions Patients that are sufficiently motivated and confident in using computerised guided self-help Those with low risk Antonia - Demo

Choice of Programmes There are several different programmes available, depending on the patient’s needs. All have similarities and there are some very similar ones (e.g. GAD and anxiety) but it can be worth reminding yourself of the content of each one before deciding either yourself or with the patient, which would be most suitable. I will go through two programmes – one for depression, and one more specifically for OCD.

Common Themes

Common Themes

Space from Depression Each section includes quizzes, stories from other patients and suggested skills. Patient view – modules to continue, messages etc.

Space from Depression Each section starts with a brief video to explain it

Space from Depression Goes through a quiz to explore patients’ existing knowledge and corrects them if incorrect

Space from Depression Specific tools – encourages patients to think about what could help them. Also includes other users’ suggestions.

Space from Depression Specific tools – ‘Activity Scheduling’ aka behavioural activation.

Space from Depression Specific techniques – thought challenging/cognitive restructuring

Space from Depression Each programme also includes ‘Bringing it all Together’ – relapse prevention. Example from anxiety programme.

Measures and Risk Also asks patients to complete questionnaires once per review cycle and to complete questions about risk. If risk is flagged, automatically emails PWP to alert them However is worth considering whether a patient likely to show risk should be on this programme? Considerations e.g. what if the PWP is away?

Why Does DPT Offer Silvercloud? Managing volume at step two is an on-going challenge Five Year Forward View Offering choice and flexibility to patients Affordability Therapist workload

Challenges for Patients Patient expectations Recovery/Drop-out (29% cf 16%) Can facilitate avoidance Change! Unsuitable for certain patient groups (e.g. risk)

Challenges for Service Therapist resistance Therapeutic alliance Can take longer than predicted Patients can stay on caseloads longer Unclear protocols for managing DNAs/poor engagement

Benefits for Patients Content is interactive, thorough and user-friendly Emphasis on skill development Breadth - less constrained than standard LI protocols 24/7 access – flexible Suits dispersed population Can be offered as pure self-help, e.g. if below caseness or waiting for step three Normalising/Non-stigmatising Recovery rates are good for those who engage

Benefits for Service Affordability Links directly to Iaptus via the ‘prism’ Less stressful for PWPs – managing volume Therapists can consider their responses Less susceptible to therapist drift

What the Patients Say “I have found the silvercloud work useful. It's definitely calmed me down a bit and helped me get a bit of grip on things” “I am still worrying but what I'm able to do now is use the tools to help me worry less and really put things into perspective.”

What the Patients Say “ I am starting to feel that I can have some quiet time to reflect on my thoughts and feelings.” “I have found this course really useful and am certainly feeling better. It good to read that even in the recovery stage you can still feel anxious but that is normal. ”

A Patient’s Story Linda, 41 yrs, living in Princetown with two young children Symptoms of both depression and anxiety Nearest clinic – Tavistock (8 miles), no car! Works shifts including some nights Difficulty attending phone appointments due to childcare commitments Signed up to ‘Space from Depression & Anxiety’

A Patient’s Story Weekly online reviews with therapist Gradual reduction in symptoms over 2 month period After 7 reviews therapist and patient agreed to discharge to pure self-help “At first it felt like e-learning but after my therapist explained the importance of putting the skills and tools into practise everything started to change for me”

Implementing cCBT - Lessons Learnt Encourage patients to trial it for a week, include a telephone review at this point Have a ‘champion’ with responsibility to instruct other PWPs Incorporating a telephone review after one week can help to reduce drop-out Prepare patients for the amount of work involved

Implementing cCBT - Lessons Learnt Suggest that patients aim to complete one module per week in 10-20 min ‘chunks’ Clarify protocols around DNAs prior to implementation Give a brief demonstration in session if possible Arrange more thorough training, consider contracting an existing service to provide this cCBT should be one option of many and no patient should be offered only this option

Heading Copy