1. BtB - Computerised CBT

2. GPs MOODJUICE BEATING THE BLUES BRIEF THERAPY PSYCHOLOGY STEP 1 STEP 2 STEP 3 STEP 4 The Matched Care Model

3. 0.00 0.50 1.00 1.50 2.00 2.50 Well BeingProblemsFunctioningRiskMeanMean - Risk Before After Clinical Cut-Off (CORE-OM Manual, 1998) Core OM scores taken at beginning of 1 st and end of 8 th sessions. Average score taken from 77 patients. Measured Core Score BtB – Clinical Outcomes

4. Systems Success NUMBERS OF REFERRALS Average waiting time for treatment = 31 days Number of Primary Care Doctors (GPs) = 220 Percentage of Psychology Referrals = 46% The percentage DNA for 1st sessions = 28.7%. The percentage DNA overall = 11.7%.

5. The Cost System becomes more efficient with increased use 2009 2010 2006 2007 2008 2009 2011 COST PER PATIENT

6. Where to Start

7. Phases of Implementation 4)DESIGN OF SERVICE MODEL 5)DEVELOP IMPLEMENTATION STRATEGY 6)IMPLEMENTATION OF MODEL 7)MARKETING 1)DEVELOPMENT OF OBJECTIVES 2)IDENTIFY RESTRICTIONS 3)CONSIDER WIDER IMPACT OUTCOME: SUSTAINABLE SERVICE WHICH ACHIEVES OBJECTIVES Objectives impact on all phases of implementation

8. Impact of Objectives and Restrictions Maximum numbers of patients seen Accessible across the region Efficiency of patient access Minimise DNA's OBJECTIVES; EFFICIENCY, MAXIMUM CAPACITY, ACCESSIBLE, MINIMAL WASTAGE Changes administration of services May limit accessibility to service across region, will impact on referrals Limits growth and may lead to restricted development of service Limited access to clinical input RESTRICTIONS; FUNDING, ACCESS TO CLINICAL STAFF Combination of Objectives and Restrictions provides foundation of service design and implementation

9. Example Models Forth Valley and Tayside – Aims; efficiency, maximum capacity, accessible Locations distributed across region Clinical responsibility remaining with referrer Different clinical models applied in psychology and GP’s Phased developments with capacity expanding due to needs and readiness of service Target time for referral to appointment System working to maximum levels of patient throughput allowed by targets Service part of matched/stepped care systems for added patient support Additional Aim in Tayside – minimal wastage of treatments Assign further appointment to patients that DNA

10. A Working Service

11. Access Across a Region Location vary greatly in style but not quality of service through combination of right location, good training and consistency of treatment. Service proves accessible by spreading machines across entire region including rural and deprived areas supported by onsite administrators

12. Referral Routes Systems run in parallel Direct GP Access Psychology and Other Mental Health Services Point of Referral to Beating the Blues Patients attend treatment, referrers kept informed of progress with Progress Reports GPs have option of referring to psychology to gain access Patients assessed for suitability Patients are given exit interview to determine success of program Upon patients are either discharged or offered further treatment Multiple streams of referral can be developed with minimal variation in process

13. Central Processing KEY ADVANTAGES Monitoring flow of referral Diverting patients to prevent waiting times Increased support of locations and patients Connection to psychology Addressing Suicide Alerts REFERS All refers use single point of access and standardised referral form Central Coordination of all initial appointments, across all locations MACHINE LOCATIONS Patient contacted and asked to attend appropriate location Location contacted, appointment arranged

14. Key Aspects for Success

15. The Right Workforce Clinical vs. Customer Services Experience Costs of clinical staff is high Clinical support is only required on few occasions Assess support network and position of service Non-clinical equals less threatening Availability to staff is essential Key Requirements Point of contact in relation to referral and enquiry Ability to address clinical issues and make informed decisions Co-ordinate and develop service Address IT issues as they arise Motivate and maintain high levels of communication Be available Development of the correct intra-structure and systems will enable the minimisation of staffing needs and therefore costs Forth Valley employs a single co- ordinator to run service with customer services and IT background

16. Communication With Referrers and Users Good communication with referrers = flexibility in service and the ability to manage referral patterns, clinical issues and support for future work Development of a clear understanding between referrers and service Efficiency when dealing with referrer requests either on a service or patient basis Recognition of referrer skills and abilities to determine best course of action for patient? Maintenance of links through updates and continued contact Good communication with patients = greater motivation, increased patience with program, better outcomes for patient Development of a clear understanding of program, its benefits and the need to complete course (this particularly on getting them past first two sessions) Support and assist users to overcome any barriers that prevent the completion of course Be accessible at all times and have the required information and understanding at finger tips Friendly, approachable and non-threatening

17. Marketing/Education Marketing to referrer groups = increase in referrals RequirementsOutcomes/Actions Marketing StrategyDevelopment of clearer defined targets, messages and requirements based on original service aims Delivery of Key MessagesCreates clear understanding of what BtB does, who it is for and how to access service. Delivery of messages is dependant on scale ScaleTargets generated from objectives, will focus on the numbers of referrals to be generated and desired impact of service TimingMarketing to different groups and levels needs to be timed around service development to ensure controlled increase of referral and use Key outcome of marketing would be integration into clinical structures and practice

18. Our Advice Genuine commitment to development and running service Dedicated team with right individuals to implement and then run service Allow focus to remain on patient by ensuring efficiency of process and administration Do not over complicate the service and administration systems Clearly defined responsibilities Develop clear lines of communication with referrers and patients Look to integrate service into exists structures Get the right clinical and managerial support structures in place before you start Do not underestimate complexity and subtly of task, having the right understanding and drive to develop the service within those involved is essential Approaching the service with the right mind set is essential Clearly define objectives and requirements before thinking about logistics of service

19. The Local Impact It has doubled the number of people receiving psychological therapy – 1100 new referrals a year to BtB The waiting time for individual therapy has decreased. Before the start of the system, it was up to 2.5 years, now it is no more than 6 months The waiting time for other forms of psychological therapy (non-individual) is lower than this, meaning that a far higher proportion of people are meeting the 18 week waiting time target for psychological treatment Audit of BtB has revealed that referrals are appropriate and treatment is effective The mild to moderate system is now having a significant impact on the population of Forth Valley. There are about 12000 new case of depression and anxiety in per year about 2000 (or 1 in 6) are receiving specialist psychological treatment, in addition to the people accessing Moodjuice (a total of 110,000 self- help resources are delivered through Moodjuice a year) Preliminary data suggests that BtB is helping reduce the increase in antidepressant prescribing by GPs Features of the Forth Valley Matched Care Model comments from Head of Primary Care Psychology Greatest impact was achieved by integrating mild to moderate stepped care into existing service models and local structures such as GP Enhance Service.