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The Improving Access to
Psychological Therapies (IAPT)
Program in United Kingdom (UK)
Dr. Cheryl So, Clinical Psychologist, Kwai Chung Hospital
Dr. Martina Cheung, Clinical Psychologist, Castle Peak Hospital
Dr. Amy Kwok, Clinical Psychologist, Prince of Wales Hospital
Ms. Carole Li, Clinical Psychologist, Oasis, HAHO
Dr. Wilson Tsui, Clinical Psychologist, Kowloon Hospital
Acknowledgement
• The training program and schedule was
organized by Mood Disorders Center,
University of Exeter, UK
– Professor David Richards
– Professor Eugene Mullan
• Working Group on Primary & Community Care,
COC(CP)
• Hospital Authority
Attachment in UKA. University of
Exeter
B. Devon (NHS IAPT Service)
C. University of Reading (Child IAPT)
D. Colchester (NGO IAPT Service)
E. London (Rethink)
Background
• The Improving Access to Psychological
Therapies (IAPT) Program
– Large scale initiative from the UK government in
May 2005 & funded in 2007
• ₤309 m (2008-2010); 3660 new therapists
• ₤400 m (2011-2015); 2400 new therapists
– New standalone psychological service in
community settings
– Depression & Anxiety Disorders
Clinical & Policy Development
1. National Institute for Health and Clinical
Excellence (NICE)
– Clinical guidelines (evidence-based psychological
therapies)
– Cognitive Behavior Therapy (CBT)
– Aims to greatly increase the availability of these
therapies in the National Health Service (NHS)
Clinical & Policy Development
2. Economists and clinical researchers
– An increase in access to psychological therapies
would largely pay for itself
– ↓ other depression- and anxiety-related public
costs (welfare benefits and medical costs)
– ↑ increasing revenues (taxes from return to
work, increased productivity etc)
IAPT Program Governance
1. Well-trained Workforce (Accreditation &
Qualification)
– The Department of Health (UK) commissioned and
developed two national curricular for the training of the
new workforce for IAPT service, based on competence
frameworks derived from the NICE guidelines and
evidence from large clinical trials.
– Postgraduate Certificate (1-year; Low Intensity CBT –
behavioral activation, problem-solving)
– Postgraduate Diploma (1-year; High Intensity CBT)
IAPT Program Governance
1. Well-trained Workforce (Accreditation &
Qualification)
– All IAPT training courses are accredited by
• The British Psychological Society (BPS) / The British
Association for Counseling & Psychotherapy (BACP) /
The British Association for Behavioral & Cognitive
Psychotherapies (BABCP)
• NHS’s IAPT program
• Professional qualification (knowledge & skills)
• Individual registration
IAPT Program Governance
1. Well-trained Workforce (Accreditation &
Qualification)
2. Management / Clinical Guidelines• IAPT Guidance for Commissioning IAPT Training
• Guidance for Commissioning Supervisor IAPT Training
• Good practice guidance on the use of self-help materials within IAPT
services
• IAPT Positive Practice Guides (for Black and Minority Ethnic
Communities, Older People, Perinatal Care, Offenders, etc.)
• IAPT Supervision Guidance
• IAPT Key Performance Indicator (KPI) Technical Guidance for 2011/12
IAPT Program Governance
1. Well-trained Workforce (Accreditation &
Qualification)
2. Management / Clinical Guidelines
3. Treatment Protocols
– Evidence-based treatments recommended by
NICE Guidelines
– Specific treatment protocols
Process of Service Delivery
Step 3 High Intensity
Step 2 Low Intensity
Step 4 Specialist Mental Health Service
Step 1 Self-help, active monitoring
The Stepped Care &
Collaborative Service
Model
IAPT – Step 1-3
Referral
“Least Burden” principle “Self-Correction” principle
Successful Implementation of IAPT
1. Written clinical protocols covering assessment &
treatment of each condition
– Based on the National Institute for Health & Clinical
Excellence (NICE) Guidelines
2. Core of experienced staff (e.g., clinical
psychologist) who are competent in relevant
psychological therapies
3. All IAPT therapists are required to attend
– Weekly 1-hour Case Management Supervision
– Bi-weekly 1.5 hour Clinical Skills Supervision
Successful Implementation of IAPT
Supervision structure in IAPT program
Successful Implementation of IAPT
4. Smart IT system for
outcome measures
and supervision
• Instant profile analysis
• Supervisor Alert
Effectiveness
• More than 40 Key Performance Indicators
(KPIs)
– Patient Health Questionnaire Depression Scale
(PHQ-9; Kroenke et al., 2001)
– Patient Health Questionnaire Generalized Anxiety
Disorder Scale (GAD-7; Kroenke at el., 2007)
– Sick pay / illness-related benefit
• Recovery rate: 42.8% (over 120, 000 people)
• Over 23, 000 people came off sick
pay/benefits
Recommendations
1. Quality Standards & Supervision
– Treatment protocols
– Continuous supervision
Recommendations
2. Training Program
– Structured training program (low intensity CBT)
– Close liaison between COC(CP), Institute of
Advanced Allied Health Studies (IAAHS),
academic psychologists, & relevant professional
bodies (The Hong Kong Psychological Society)
Recommendations
3. Service Development
– Long Term Medical Conditions
• Diabetes, hypertension, coronary artery disease or
chronic obstructive pulmonary disease (COPD)
• 3 or 4 times more: depression & anxiety disorders
• Savings in other costs to the NHS and to society
• COC(CP) – COC(FM)
• COC(CP) – COC(MED)
Recommendations
3. Service Development
– Improve Access to Psychological Therapies for
Children & Young People
• Depression, eating disorders, self-harm, conduct
problems, Attention-Deficit/Hyperactivity Disorder
(ADHD)
• Early intervention – treatment; prevent 2nd
psychological problems
Recommendations
4. Quality Improvement
– Care Delivery Model
• Integrated Mental Health Problem (IMHP) in general
out-patient clinics; Common Mental Disorder Clinic
(CMDC) in psychiatric settings
• Close collaboration between the psychiatric specialist &
primary care services to provide “seamless”,
coordinated mental health service
• COC (CP) / COC (Psy) / COC (FM)
The Stepped Care &
Collaborative Service Model
Step 3 Specialist Psychological Intervention
Step 2 Early Intervention
Beh activation; problem-solving
Step 4
Psychiatric Care
Step 1 Early detection; Initial Assessment; Psychoed
Step 1-3:Non-psychiatric settings
Care pathway
•Who should be seen•By which service
•At which point in theircare
Experienced clinicians – therapy; supervision; collaboration
Conclusion
Concerted effort from different COCs
• Program plan
• Clinical governance
• Management / clinical guidelines
• Structured training curriculum
• Written protocols (assessment and treatment)
Questions & Answers
Thank you!
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