Improving Access to Psychological Therapies (IAPT) - The Need for Radical Reform

Scott, Michael J.

doi:10.1177/1359105318755264

Cited by 35 publications

(70 citation statements)

References 17 publications

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“…As a result of the high level of control that RCTs are able to employ, with optimal conditions of patient selection and timings of interventions made possible, RCTs can be criticised for being limited in their generalisability to settings where conditions naturally differ from that trial (Treweek and Zwarenstein, 2009). Therefore, this study meets the call for routine-based efficacy studies in the field on gCBT (van Ingen and Novicki, 2009) which are needed in order for IAPT services to benefit from the increased access to psychological interventions that gCBT facilitates (Scott, 2018). This study expands the evidence-base for group therapy, which may help to address any misconceptions professionals and patients have about its efficacy (Piper, 2008) and supports findings from other research designs in the field, such as RCTs.…”

Section: Discussionmentioning

confidence: 99%

“…The need to increase availability of CBT and demands for a cost-effective treatment further provides a strong rationale for gCBT, which may explain why more IAPT services are deploying group treatments for anxiety (Wykes, 2013). However, the lack of evidence and the gap between research trials and implementation between clinical practice is large (Scott, 2018); thus gaps need to be addressed to facilitate adaptations from research to routine practice (Shafran et al, 2009). Whilst randomised control trials (RCTs) are viewed as the gold standard of intervention research, they prioritise internal over ecological validity, causing difficulties with generalisation to clinical settings (Kodal et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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What are the recovery and attrition outcomes for group CBT and individual CBT for generalised anxiety disorder in an IAPT service? An exploratory study

Fanous

Daniels

2020

tCBT

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Group cognitive behavioural therapy (gCBT) is commonly used in Increasing Access to Psychological Therapies (IAPT) services. However, there is limited knowledge of the efficacy of gCBT as a delivery format for generalised anxiety disorder (GAD). To address gaps in literature, this study aims to explore the efficacy and attrition of individual and group CBT interventions, respectively, at Step 3 for GAD using data from a routine IAPT service over a 24-month period. Data were retrospectively derived from a routine serviceʼs IAPTus database, separating those eligible for comparison into group (n = 44) and individual (n = 55) CBT for GAD. Outcomes were differences in pre–post self-reported anxiety (GAD-7) and depression (PHQ-9) scores, clinical recovery and attrition for gCBT and individual CBT. Both gCBT and individual CBT yielded significant reductions in self-reported anxiety and depression scores over time. Results indicate that 53% of patients attending individual CBT achieved clinical recovery, with similar but less competitive rates of 41% in gCBT. Attrition rates were similar between gCBT (29.5%) and individual CBT (27.3%), respectively. Preliminary results suggest that both individual and gCBT are effective interventions for GAD patients in IAPT, offering symptom alleviation and comparable recovery and attrition rates post-intervention. This observational design offers credibility and insight into a pragmatic evaluative and explorative comparison. gCBT may offer an acceptable and potentially economical alternative. Key learning aims (1) To explore whether gCBT and individual CBT yield significant symptom reduction in self-reported anxiety and depression in GAD patients from a routine IAPT service. (2) To explore gCBT and individual CBT clinical recovery rates in non-optimum routine conditions. (3) To explore whether gCBT for GAD produces unacceptable attrition rates and if this differs from attrition rates in individual CBT for GAD in a routine IAPT service.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

What are the recovery and attrition outcomes for group CBT and individual CBT for generalised anxiety disorder in an IAPT service? An exploratory study

Fanous

Daniels

2020

tCBT

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“…Staff burnout results in decreased motivation and poorer interactions with patients and constitutes a further threat to healthcare quality and patient safety (Salyers et al, ; Westwood, Morison, Allt, & Holmes, ). Interventions that are delegated to less experienced practitioners may also compromise comprehensive assessment, patient engagement, and intervention effectiveness (Scott, ). These could all be reasons why the LV intervention, as it is currently delivered, may not be culminating in universal access to perinatal mental healthcare and measurable improvements in mental health outcomes.…”

Section: Discussionmentioning

confidence: 99%

Using the TIDieR checklist to describe health visitor support for mothers with mental health problems: Analysis of a cross‐sectional survey

Lowenhoff

Davison-Fischer

Pike

et al. 2019

Health Soc Care Community

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At least half of the 20% of mothers who experience mental health problems (MHPs) during pregnancy or after birth are not receiving the help they need that will lead to recovery. In order to identify where improvements need to be made, it is necessary to describe exactly what is being done and the barriers and facilitators that compromise or enhance optimal care. The majority of mothers experience mild to moderate anxiety or depression. The expectation is that primary care professionals, such as health visitors (HVs), can provide the support they need that will lead to recovery. The aim of this study was to explore the views of HVs regarding the content and purpose of an intervention to support mothers with MHPs, described as ‘listening visits’ (LVs). A link to an online survey was offered to the members and champions of the Institute of Health Visiting (n = 9,474) March–May 2016. The survey was completed by 1,599 (17%) of the target population, of whom 85% were offering LVs. The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a framework to describe commonalities and variations in practice. There appeared to be a shared understanding of the rationale for LVs but a lack of agreement about what the intervention should be called, the techniques that should be used and the duration, frequency and expected outcomes of the intervention. Contextual factors such as staff shortages; conflicting priorities; the needs and circumstances of mothers; the capability and motivation of HVs; inadequate training and supervision; and the absence of clear guidance contributed to variations in perceptions and practice. There are many ways in which the HV contribution to the assessment and management of mothers with MHPs could be improved. The intervention delivered by HVs needs to be more clearly articulated. The contextual factors influencing competent and consistent practice also need to be addressed.

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“…55 Furthermore, there is growing awareness that the adult version of the IAPT program has shortcomings. Cited problems in the adult program include low recovery rates, 56 treatment models failing to take contextual factors into account, 57 and high therapist burnout. 58 Because CYP IAPT is being expanded, there needs to be greater scrutiny of the CYP IAPT model to make sure mistakes made in the adult program are not repeated in the child and adolescent sector.…”

Section: Future Challengesmentioning

confidence: 99%

<p>A Current Review of the Children and Young People’s Improving Access to Psychological Therapies (CYP IAPT) Program: Perspectives on Developing an Accessible Workforce</p>

Ludlow¹,

Hurn²,

Lansdell³

2020

AHMT

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The CYP IAPT program has played a leading role in workforce development in the Child and Adolescent Mental Health Service (CAMHS) in England since its inception in 2011. Despite promising evidence of CYP IAPT's benefits, significant wait times for CAHMS have convinced policy makers that a new direction for CYP IAPT is required. Since 2017, the CYP IAPT program has changed its aim from workforce development to workforce expansion, with the project aiming to train 1700 new psychological practitioners by 2021. The CYP IAPT program now consists of three training streams (a) a low-intensity workforce, (b) a schoolsbased workforce, and (c) a high-intensity workforce based on the original CYP IAPT curriculum. The purpose of this paper is to outline the three CYP IAPT workforce streams. As will be reviewed, changes to CYP IAPT have occurred within the context of emerging ideas from dissemination science and government reviews that outline the shortcomings of traditional service models. Consequently, CYP IAPT practitioners are now increasingly being trained in the delivery of novel psychological interventions to address some of these shortcomings. A range of low-intensity interventions are being deployed by CYP IAPT practitioners to target mild-tomoderate anxiety, depression, and conduct. A recent meta-analysis indicates that low-intensity psychological interventions show promise for children and adolescents in efficacy trials. Nevertheless, further research is required to understand its effectiveness in real-world settings and to see if treatment effects are sustained over time. As such, this paper recommends that CYP IAPT services evaluate the long-term effectiveness of low-intensity work and subject their methods and findings to peer review.

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Improving Access to Psychological Therapies (IAPT) - The Need for Radical Reform

Cited by 35 publications

References 17 publications

What are the recovery and attrition outcomes for group CBT and individual CBT for generalised anxiety disorder in an IAPT service? An exploratory study

What are the recovery and attrition outcomes for group CBT and individual CBT for generalised anxiety disorder in an IAPT service? An exploratory study

Using the TIDieR checklist to describe health visitor support for mothers with mental health problems: Analysis of a cross‐sectional survey

<p>A Current Review of the Children and Young People’s Improving Access to Psychological Therapies (CYP IAPT) Program: Perspectives on Developing an Accessible Workforce</p>

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