ProjectTitle:Healios–WorkingtoempowerpatientsandfamiliesaffectedbymentalillnessBackgroundTheNHSFiveYearForwardViewstressestheneedtoreshapehowcareisdelivered,increaseaccesstotherightcareattherighttime,drivedownvariationsinthequalityofcareonoffer,andimproveoutcomes.Theyacknowledgepeoplewantcareintheleastrestrictivesettingthatisappropriatetomeettheirindividualneeds,atanyage,andisclosetohome.Onewayinwhichtheyproposetomeetthischallengeisbyexpandingaccesstodigitalservicesensuringmorepeoplehaveincreasedaccessandchoicetohighqualitycarewhentheyneedit.Theystate“Weseeapivotalrolefordigitaltechnologyindrivingmajorchangestomentalhealthservicesoverthenextfiveyears.”TheNationalInstituteforHealthandCareExcellence(NICE)havepublishedclinicalguidelineforpsychosisandschizophreniainadults(CG178;NationalInstituteforClinicalExcellence.ClinicalGuidance178,2014),supportedbyNICEqualitystandard(QS80;NationalInstituteforClinicalExcellence.QualityStandards80,2015).Thebenefitsoffamilyinterventionareoutlinedwithintheguidelinesandarerecommendedforallfamiliesofpeoplewithpsychosisorschizophreniawholivewithorareinclosecontactwiththeserviceuser,notonlythosewithfirstepisodepsychosis.NICEalsooutlinethreekeyaspectsforfamilyintervention,theseare:

• Howtodeliverpsychologicalinterventions,section1.3.7• Monitoringandreviewingpsychologicalintervention,section1.3.8• Competenciesfordeliveringpsychologicalintervention,section1.3.9

ThefirstsetofmentalhealthtargetswhichhavebeenintroducedarethenewAccess&WaitingtimeStandardswhichcameintoeffecton1stApril2016(Guidancetosupporttheintroductionoftheaccessandwaitingtimestandardsformentalhealthservices2015/2016,2015).ThesetargetswillinitiallyfocusonpeopleexperiencingtheirFirstEpisodeofPsychosis(FEP).Theexpectationisthat,withinamaximumoftwoweeksfromreferral,morethan50%ofpeoplewithsuspectedFEP:

• havebeenassessedbytheEIPserviceand,whereappropriate:• havebeenacceptedontotheEIPservicecaseload• havebeenallocatedanEIPcarecoordinatorwhohasactivelyengagedwiththepersonto

developaplanofcareandcommencetreatmentinlinewithNICErecommendations.

Importantlytherewillbeanaccreditationprocessforproviderswheretheywillhavetodemonstratetheirabilitytonotonlyoffer,butactuallyhavethemeansandcapacitytodeliveralltheaspectsoftheNICEconcordantcarepackage.Thisislikelytobeasignificantchallengeforproviders.

ProjectDescription:HealioscredentialsFoundedin2013,Healiosphilosophyistoimprovethelivesofthoseaffectedbydisablingillnesses.Healiosdoesthisbyprovidingevidencebasedservicesfocusedondeliveringclinicallymeaningfuloutcomesforclientandfamilies/carers.TheyrecognisethegreatworkandcarebeingdeliveredwithintheNHS,whilstappreciatingthestrainthehealthserviceisunder.HeliosstrivestosupportandoptimisethisgreatworkbycollaboratingwithNHStreatmentteamstoenhancethe‘triangleofcare’betweenclients,families/carersandtheNHSclinician.CoretoHealiosistheirsafeguarding,riskmanagement,informationgovernanceandsupervisionresponsibilities.HealiosvaluesandrespectthetrustNHSpartnerorganisationsplaceinusandthereforethesafetyofallclientsandfamily/carer/significantothersisourfirstpriority.AttheheartofHealiosisaveryexperiencedclinicalleadershipteammadeupofDr.LarsHansen,ConsultantPsychiatristwithover20years’experienceandcurrentEIPleadwithinSouthampton.Dr.KatieAshcroft,ConsultantClinicalPsychologistwithnearly20years’experienceandprevioustrainingandsupervisionleadforSouthernHealth.Dr.AngharadRudkin,ChildClinicalPsychologistwithnearly15years’experiencewithinCAMHS.AlisonJoyce,ClinicalTeamManagerwithover18years’experienceworkingwithinNHSmentalhealthteams.Since2013,HealioshavebeencommissionedacrosstheUKbyNHSTrusts,CCG’s,localauthoritiesandcharitiestodeliverpsychologicalinterventionstopeopleandtheirfamilies/carersaffectedbymentalillness.Healioshavedeliveredthousandsofpsychologicalsessionandhavedemonstrated,byusingvalidatedscales,improvedclinicaloutcomes.Theseoutcomesincludeimprovedpatientfunctionality,reducedsubstanceuse,reductioninoverallburdenanddistress,increasedtreatmentadherence,increasedserviceuserexperienceforbothpatients&families/carersandmore.Healiosfamilyinterventionserviceisbuiltuponcomponentsofbehaviouralfamilytherapy,briefsystemicfamilytherapy,systemicfamilytherapyandunderpinnedbyHealios’sproprietary5tierqualitysupervisionmodelandManualRatingScale.Healiosusesthebestofmoderntechnologyprovidingvideoaccesstoatrainedclinicianwhowillworkwiththeclientandfamily/carertodeliverstructuredinterventiontoaddresstheirspecificneeds.Healiosusesavarietyofmultimediatoolstosupportunderstandingandlearningwhichhelpsfacilitateaveryengagingandinteractivesession.Eachcoursewillbestructuredaroundtheneedsofthefamily,asisthepaceofdelivery.

Inaddition,HealiosfollowtherequirementssetoutbytheNationalInstituteforHealthandCareExcellence(NICE)forwhatfamilyinterventionshouldencompass,thisissetoutwithinCG178,sections1.3.7,1.3.8and1.3.9.NICEhaveendorsedthetrainingprovidedbyHealiosaspartoftheirfamilyinterventionservicestosupportfamiliesimpactedbypsychosis.NICEendorsementstatementforresourceproducerE0094-Healios

FamilyInterventionservicemanual

“ThisservicemanualsupportstherecommendationsonfamilyinterventionintheNICEguidelineonpsychosisandschizophrenia.TheservicemanualdescribesthecontenttobeusedbythoseprovidingtrainingforfamilyinterventioninlinewithNICEguidance.ItalsosupportsthestatementonfamilyinterventionintheNICEqualitystandardforpsychosisandschizophrenia.”NationalInstituteforHealthandCareExcellenceMay2016Healiosistransforminghowcareisdelivered,byprovidinginnovativesolutionstothecomplexchallengesfacedwithintheNHS.ThisisverymuchalignedwiththeNHSFiveYearForwardViewand

Healioshasestablishedanewgold-standardinclinicalsupervisiontodeliveraconsistentlyhighqualityFIservice

WeeklyQualityControl&Supervision

Model

StriveforContinuousImprovementContinuousprofessionaldevelopmentsupportedwithtrainingfromConsultant

Psychiatristandotherpsychologyspecialismsbasedoncurrentevidencebase

RecordingofAll Session

OverseenbyConsultantPsychologistProvidesregularhighquality1:1andgroupsupervision,

traininganddevelopmentcoaching

Ensuresconsistenthighquality&safety

Healios’ManualRatingScale(HMRS)

Cliniciansselfmarkagainstconsistentscale

SupervisionbyClinicalTeamLeaderRecordedsessionsselectedeachweekandscored

againsttheHMRS

akeycomponentofthis,isbeingabletofindwaysinwhichtoprovideservicesinamoresustainableway.Futureservicesneedtomeetboththeincreasingdemandbythepopulationintermsofwhen,whereandhowtheywishtoaccesscare,butalsothefinancialpressuresofbeingabletorealiseefficiencysavings.Healiosareabletodeliveruponboththesecriticalchallenges.Firstly,duetothemodeloftheirservicedeliverytheyareabletodeliverfamilyinterventionserviceatpaceandscale.Healiosdelivergreateraccess,choice,flexibilityandconvenienceforpeople.TheservicecanallowpartnerTrustsandCCG’storealiseimportantsavings,thesemayincludedirectcostofdeliverysavings,freeingupvaluablestafftimetoreprioritiseinotherareasofneedandsignificantdownstreamsavingsinhospitalisationcosts.

ServiceuserexperienceiskeytoHealiosandtodatehavedemonstratedsomeexceptionalresultswith98%ofusersbeingverysatisfiedorsatisfiedand95%whowoulddefinitelyrecommendtheservice.Astheserviceisdeliveredonline,itmeansaslongasthepersonorfamilymemberhasasmartdevice,tabletorcomputerwithaccesstotheinternetor3Gconnection,theyareabletoaccesssupportfromHealios.RecentindependentdatapublishedbyOfcomsuggests80%ofadultshavebroadbandwithafurther66%havingasmartphone.Thisincreasesto90%forpersonsaged16-24years.Ofcomalsofoundthatpersonsagedbetween7-16yearsspendonaverage3hoursperdayonline,increasingto4.8hourswhenlookingatpersonsagedbetween15-16years.Theyreportedasharpincreaseinownershipoftabletcomputersbychildren,up50%comparedwiththepreviousyear.

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FamilyInterventionshouldbeprioritisedwithintheNICEconcordantcarepackageforpsychosis

0%

5%

10%

15%

20%

25%

30%

35%

StandardCare FIGroup

FIimpact onreducing relapseandhospitalisation

0

5

10

15

20

25

30

35

40

45

50

Standardcare FIgroup

FIreducesaveragelength ofstay(days)inhospital

%re

lapse&hospitalisation

Bedda

ysThrough38randomisedclinicaltrials,FIhasconsistentlyprovento:

• Reduceoverallcostofcare

• Reducerelapse

• Reducehospitalisation

• Reduceburden

• Improvetreatmentadherence

• Increasefunctionality

• Manyotherparameters

50%reduction

61%reduction

HealiosserviceisavailableMondaytoFriday8am-8pm.Clients/family/carersscheduletheirownappointmentswiththesameclinicianatatimewhichisconvenientforthem.It’simportanttonotethatmultipleuserscanaccessthesameonlinesessionatthesametime,meaningiffamilymembersarenotinthesamegeographicallocation,theyarestillabletoconnectandsupporteachotherinthesamesession.ThispartnershipbetweenapproachisalignedtonationalguidelinesandtheNHSdirectionoftravel.AtthesametimethispartnershipwillensureTrustsandCCG’sareabletocontinuetodeliverhighqualitycare,greateraccess,choice,convenience,flexibilityfor'whenandhow'peopleandtheirfamiliesaffectedbypsychosiswishtoaccesssupport.MoreaboutHealiosHealiosprovidepsychologicalandbehaviourchangetherapiesacrossawiderangeofmentalandphysicalhealthconditionsuchaspsychosis,schizophrenia,CAHMS,dementia,bipolar,PTSD,anxietyanddepression,eatingdisorder,diabetesandcardiovascular.HealiosalsohaveAppbasedtechnologieswhichproviderealtimefeedbackonthepatients’statustotreatmentsteamssupportingclinicaldecisionmakingandresourceprioritisation.

4

Healiosprovidesinnovativesolutionsacrossmultipleconditionswithnewtherapyofferingsindevelopment

Psychosis,Schizophrenia

Child&Adolescent

Bipolar

Anxiety

Depression (incl.perinatal*)

PTSD

Adjustmentdisorder

Dementia

Obesity*

COPD/Asthma*

EatingDisordersSubstancemisuse* HIV/AIDS*

Mentalillnesses/Neurologicalconditions Physicalconditions

Diabetes&CV

Underpinned byrelevantnationalclinicalguidelinesonbehaviouralchange

Builtoncomponentsofbehavioural familytherapy,briefsystemicfamilytherapy&

functionalfamilytherapy

*Indevelopment

LogoofOrganisation:

ChangingthelivesoffamiliesaffectedbymentalillnessAnyotherimages,documentsorvideosrelevanttotheproject:

1. outcomes&measures

Theaimoftheserviceistodeliveranumberofoutcomeswhichcanbecategorisedintofourmaingroups:Clinicalrelatedoutcomesforclients&family/carer:

• Improvedpatientandfamilyfunctioning• Reductioninsubstancemisuse• Improvedtreatmentadherence• Reductioninoverallfamilyburden• Reductioninoverallfamilydistress

Serviceuserexperienceoutcomes:• Clientandfamily/carerexperience,choice,serviceengagementandsatisfaction• Clientandfamilypreferencedata

NHSEfficiencyrelatedoutcomes:• Numberofworkingdaysfreedupforstaff

NHSFinancialoutcomes:• Reducedcostofdelivery• Reductioninhospitalisationcosts

SavingscanbemodelledonthebasisofdatasuppliedbyTrusts/Commissionerstosupportthedevelopmentofadetailedbusinesscase.Anexampleofdirectcostsavingsbasedon100familiesreceiving12sessionsishighlightedinthetablebelow.Thisdoesnotincludethesignificantsavingthatcanbeobtainedthroughreductionofrelapseratesandreductioninhospitallengthofstay

,througheffectiveearlydeliveryofFamiliyIntervention.Studieshavealsoshownsignificantimpactonmortalitywherefamilyinterventionshavebeenprovided.

10

Familyinvolvementfromthestartsignificantlyreducesmortalityrates

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

AllCauses NaturalCauses UnnaturalCauses

NoInvolvementoffamilyatfirstcontact LimitedInvolvementoffamilyatfirstcontactFullInvolvementoffamilyatfirstcontact

MortalityHa

zardRatio

MortalitybyCause

Reininghausetal2014:10yearfollow-updataofearlyinterventionservicesinpsychosis

50%

30%

90%

90% reductioninunnaturalcauses

whenfamilyinvolvedfromthe

start

Measures:

• Substanceuse-(SubstanceUseandfrequency)• Treatmentadherence-(TherapyandMedicationCompliance)• Distress–(HospitalAnxietyandDepressionScale–HADS)• Burden–(InvolvementEvaluationQuestionnaire–IEQ)• Serviceusersatisfaction–(ClientSatisfactionQuestionnaire–CSQ8)• Workandsocialfunctioning–(WorkandSocialAdjustmentScale)• Lifesatisfaction-(BriefMultidimensionalStudent’sLifeSatisfactionScale;BMSLSS)• Reducedcostofdelivery–Trustdata• Relapse,hospitalisation&lengthofstay–Trustdata• Numberofdaysfreedupforstaff–Trustdata

17

CommissioningHealios helpsyousaveTimeandMoneytore-prioritise inotherareasofneed(basedon100patients/families receiving12sessionsofFI)

-

50,000

100,000

150,000

200,000

250,000

300,000

350,000

CurrentServices Healios

££144,000

68

75

Working daysrequiredbyNHStreatmentteamtodeliver240sessions

DaysofFIsessions

Daysofround-triptraveltime

293 totaldays

DaysofFIadmin

150

WorkingDaysCostofDelivery

CurrentServices

AHealiosClinicalResearcherwillleadtheassessmentapproachwiththeclientandfamily/careratbaseline,after8and12weeks.Amajorityoftheseassessmentswillbeconductedonlinetoallowflexibilityandconvenienceforclientsandfamilies.Forthosewhoareunabletocompletetheonlineassessmentsforwhateverreason,theHealiosClinicalResearcherwillconductrecordedtelephoneassessments.Allpatientdatawillbeanonymisedandanalysedusingaspecialiststatisticalsoftwarepackage.ScalesusedtomeasureoutcomescanbevariedtomatchTrustrequirements.DetailsofresultsfromHealiosprojectsareattachedasPowerpointpresentation.

1.1 Risksidentificationandmitigation

Risk MitigationSafeguardingandriskmanagementincidencemaybemissed

HealioshasaproventrackrecordofdeliveringfamilyinterventionforotherTrusts.Theyalsohaveestablishedprocessesinplaceoverseenbyaclinicalgovernanceteamofqualified

14

Healios improvesthelivesofpeoplewithmentalillnessandtheirfamilymembers

Healiosdatafromover3,000sessions inpsychosisbetweenJun2013–Mar2015basedonusershaving8sessionswithaHealiosclinician

Familycriticalcomments

Substanceuse

13%reduction

22%reduction

Patient-relatedoutcomes

Treatmentadherence

8%increase

OverallFamilyburden

Familyoveralldistress

28%reduction

23%reduction

Family-relatedoutcomes

healthcareprofessionals(ledbyaConsultantPsychiatrist,Dr.LarsHansen)whohaveallpreviouslyworkedwithintheNHS.ThisisfurtherenhancedbyHealiosincorporatingthecommissioningTrust’sspecificrequirementsintotheirsafeguardingandriskmanagementproceduresfortheproject.AllHealiosstaffincontactwithclientsandfamilieshavecompletedlevels1,2,3safeguardingtrainingforadultsandchildren

InformationGovernanceandsharingidentifiabledata

ThelevelofinformationsharingwillbekepttoanabsoluteminimumrequiredinorderforHealiostofullycarryouttheinterventions.HealiosisregisteredasIGlevel2withintheNHSIGtoolkitandISOcertified.HealioshasrobustsystemsandprocessesinplacethatprovideassuranceandasmentionedhavesuccessfullyworkedwithotherNHSTrustsinthesamecapacity.

Failuretogainbuyinfromstaffimpactingthenumberofreferralsgenerated

HealioswillprovidecomprehensivetrainingforrelevantTruststaffontheservice.Staffwillbeprovidedwithhowtoguidesandaresourcepacktosupportengagementandclarity.HealioswillbeincludedwithinthemonthlyMDTmeetingsandamonthlyperformancereportproducedbythemtofacilitateandidentifyareasforimprovement.

Difficultyinrecruitingtherapiststosupportphase2oftheproject

Duetothemodelofdelivery,HealiosareabletorecruitfromtheentireUKandassuchareabletotoprovideservicesatpaceandscale.

Failuretoreducerelapseratesandhospitalisations

Theseoutcomeswilltakeatleast12-24monthstodemonstrateatalocallevel.Anumberofsurrogatemarkerscanbeagreedastheprimaryoutcomesforanypilot.Ifachieved,theycanbeusedtotriggerawiderrolloutoftheservices.

2. Healiosreference

3. SummaryInsummary,apartnershipwithHealioswill:

1) Providegreateraccess&choiceforwhere,whenandhowserviceusersandtheirfamilies/carerswishtoaccesssupport

2) Providegreaterconvenienceasserviceusersandfamilymembersareabletoaccesscarefromthecomfortoftheirhome,orindeedonthemoveprovidingtheyhaveasmartdeviceand3Gconnection

3) Providegreaterflexibilitywithserviceusersschedulingsessionsaroundtheirexistingcommitments,anytimebetweenthehoursof8am-8pmMondaytoFriday

4) Supportfamiliestostayconnectedandfeelsupportedaspeoplecandialintothesamesessionfromdifferentgeographicallocations

5) Supportingclients&carerstostayinemploymentastheycanmoreeasilysupportthemselvesandtheirlovedones

6) Reducerelapseandhospitalisationratesbyanestimated50%andshortenthelengthofhospitalstaybyanestimated61%.

7) DeliverthehigheststandardsandqualityofcarethroughtheHealiosfive-tierqualitycontrolandsupervisionmodel

8) Providedocumentedevidencefortheclinicalinterventionthathavebeendeliveredandtheoutcomesachieved.DataTrustscoulduseasevidencetosupportperformancereviewswithlocalCCG’s,nationalbodiessuchasMonitorandtomeetthenewAccessandWaitingTimeStandardsforEIPservices

9) DeliverexceptionalserviceuserexperienceratingswhichtheTrustcoulduseaspartoftheiroverallqualityratings

10) ProvidecareinaccordancewithclinicalguidelinessuchasNICE11) SupportTrustaccreditationrequirementsforEIPservices12) Transformhowcareisdeliveredbyembeddinginnovativesolutionstooptimiseexisting

servicein-linewiththeNHSFiveYearForwardView13) HelplocalTrustdemonstratetheimplementationofanumberofimportantpolicies:NHS

FiveYearForwardView,NHSandAdultSocialCareOutcomesFramework,PersonalisedHealthandCare2020,PersonalisationofCare,TheBetterCareFundandTheCareAct

14) Realiseimportantfinancialsavingsincostofdelivery,15) Deliverimportantefficiencysavingsinstafftime,16) Reducehospitalisationcosts

DoyouwishtomakeyourprojectprivateandonlyviewabletoyouandtheInnovationAgencyNO?Contacts: Name:SteveRoberts Website:www.healios.org.uk Email:Stephen.roberts@healios.org.uk Telephone:07971770584