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IAPT Outcomes Toolkit 2008/9
The IAPT programme is built on the foundation of evidence-based therapies, provided by the NHS close to people’s homes. The ability to demonstrate that these therapies have a positive impact on people’s health, wellbeing and social inclusion has been paramount to the programme’s success, not least in securing the CSR07 investment.
IAPT sites in 2008/9 will begin collecting outcomes data from their commencement in September 08. This data will support the business case for further expanding IAPT and provide Key Performance Indicators that PCTs will be expected to complete quarterly.
Outcome Measures in other languages , currently the IAPT Outcome Measures have not been validated for use in other languages.
The IAPT Outcomes Toolkit 2008 contains guidance on the following:
- Importance of collecting routine outcomes data
- What information should be collected – the IAPT Minimum Data Set and Data Dictionary
- How will information be collected
- How can the data be used
- Information governance and consent
The National IAPT Team is offering a free training session for IAPT sites on Implementing the IAPT Outcomes Toolkit on 28th August 2008 in central London - Download IAPT Outcomes Flyer Word 62Kb
A series of IAPT Outcomes 2008/9 Frequently Asked Questions (FAQ) have been provided below, to contribute further questions, please use the comment box or email iapt@dh.gsi.gov.uk
Imprortance of routine outcomes monitoring
1. Does the administration of questionnaires adversely affect the client relationship and reduce therapy time?
The evidence from qualitative studies of patient experiences is no, but it does slightly increase contact time; the data gained is worthwhile for the patient if integrated in care reviews between patients and workers and between workers and supervisors. Therapists may need to use specific skills to manage the use of measures within the therapeutic relationship. These skills are covered in the IAPT National Curricula for trainees.
2. When should a clinician abandon collecting data when the patient clearly is unhappy about it?
Experience from the Pathfinders indicates that if the purpose of data collection is explained to patients, collection is integrated into their care and outcomes are shared with them, they are usually positive about outcome monitoring. However, patients always have the right to opt-out and clinicians must accept this.
3. Is data collection part of the IAPT training programme?
Yes, the need to develop competency in routine outcome monitoring is part of the Low and High Intensity National Curricula and IAPT training courses will cover this.
4. It seems the questionnaires fit with CBT model not psychoanalytical model of therapy, is this true?
No, the PHQ and GAD are based on DSM IV diagnoses of anxiety and depression, not based on a particular therapy.
What information should be collected
5. Why does so much need to be collected every session?
Services should use clinical outcome measures at each session to obtain at least 90% pre-/post- treatment outcomes data. Patients sometimes drop out of therapy or terminate at a different time to that which was originally planned. Session by session monitoring ensures that a clinical endpoint (the last session) is always available. This is particularly important because patients who fail to return measures tend to have a less good outcome.
6. Why is data on employment collected?
This data demonstrates how psychological therapy services might help service users to maintain employment, assist them in moving off statutory sick pay and benefits to return to work, or help them engage with local communities and activities of daily living. For many service users, this is a meaningful measure of their wellbeing, in addition to measures of health gain.
7. When should disorder-specific measures be used?
Disorder specific measures should be used where necessary, in addition to the PHQ9 and GAD7, to confirm identification and severity of the disorder, and to monitor improvement. The recommended disorder-specific measures are listed on page 21 of the IAPT Outcomes Toolkit 08/09.
8. Does the data set monitor co-morbid physical health conditions?
No, but local sites may wish to include measures of physical health conditions. Some Pathfinder sites used lists of Long Term Conditions.
9. Will service users be able to answer all the medication questions in the full data set?
The IAPT minimum data set only requires the therapist to note whether or not the service user is currently taking medication. Pathfinder sites have requested that GPs provide records of current medication since it can be difficult for individuals to provide detail on the dosage of medication as described in the full IAPT data set. Sites may wish to provide guidance for staff on discussing medication.
10. What are the benefits of collecting follow-up data?
Depression in particular is a recurring problem, therefore, services are recommended to conduct routine 3-6 month follow-ups on all patients using the IAPT minimum data set sessional measures. For individuals who show a partial return of symptoms, services should consider offering a small number of booster/top-up sessions to prevent full relapse and the associated additional costs for both the individual and the service.
How can the information be collected
11. Is there a national specification for a computerised data collection system?
No, but there are guidelines at page 27 of the IAPT Outcomes Toolkit 08/09. Broadly, a data collection system should:
- Allow capture and storage of all routine data items specified in the IAPT Data Set
- Be clear, functional and simple and easy to use
- Enable all data to be downloaded to an Excel spreadsheet for analysis and reporting
- Allow all providers (including voluntary and non-NHS providers) to enter data locally and PCTs to view progression regionally
- Provide a high level of security to protect patient data
- Be interoperable with a local/national Electronic Patient Record (EPR) systems (where possible) to avoid duplication of entry
12. What’s the best data collection model?
The IAPT Pathfinders showed that there is no right or wrong way to collect data. Choice of data collection method depends on service structure (including geographical spread, number of referrals, workforce, and use of third sector providers), IT equipment availability and IT systems. Regardless of the method(s) chosen, it is essential that clinicians have access to up-to-date clinical progress data at each of their patients’ sessions.
13. How can new data collection systems be integrated with existing ones?
If sites have not adapted their local service provider to collect the IAPT data set, their data collection system is unlikely to be connected to the National Spine. In this case, there will be some duplication of data entry at a local level. Sites should evaluate existing systems to minimise duplication where possible.
14. Data pathway - is paper or electronic better through a period of transition?
This depends on existing IT infrastructure, types of workforce and local working styles. Pathfinder sites were able to move from a paper based approach to electronic over time, sometimes using a ‘data hub’ in which therapists use a paper based approach and submit forms centrally for input onto the computer system.
15. Our staff are reluctant to ask clients to fill in forms in waiting rooms prior to sessions, are there any other ways?
It is always better if outcome measures are integrated into the therapeutic process. Patients report liking the feedback given by therapists about the measures. An alternative is to give forms to the client at the end of one consultation, to bring with them, completed, before the start of the next session.
Information governance and consent
16. Do you need to get a service user’s consent before collecting the MDS?
IAPT use of outcome measuring tools is part of clinical practice, primarily for the benefit of the patient to inform treatment and appropriate care pathways. Therefore, the notion of implied consent applies. However, sites should adopt a ‘no secrets’ approach informing patients about routine outcome measurement so that the purpose and benefits to the patient are appropriately conveyed. The same issue applies to GPs entering data on their computer system, and the advice is that best practice suggests that there is a notice in the waiting room, saying that patient records are stored on a computer system – individual permission is not necessary.
17. Does putting names on forms compromise patient confidentiality?
No this is not a problem, the questionnaires are part of ordinary clinical care and are processed by the clinical team, (and therefore within the usual confidentiality framework) - results have to be united with the person’s clinical record so needs their name.
18. What are the confidentiality issues of using patient information for government data collection?
The data that is received by SHAs and DH in the IAPT Key Performance Indicators is aggregated, anonymised data so there are no confidentiality issues.
19. Is there a standard script used to explain to patients why their data is collected?
The IAPT Outcomes Toolkit 08/09 includes an example Patient Information Leaflet that may be helpful to sites at Appendix D.
Last Updated 29th July 2008