Islington iCope

Background and aims

iCope is an Improving Access to Psychological Therapies (IAPT) service in London which is dedicated to the provision of high quality Cognitive Behavioural Therapy (CBT) and other psychological approaches as recommended by NICE guidelines.

The iCope service uses a stepped-care approach and is staffed by psychological wellbeing practitioners (step 2) which offer guided self-help, low intensity behavioural activation, psychoeducational groups and workshops, computerised CBT, and community linking. Additionally, step 3 practitioners offer more in-depth assessment and treatment for clients with more complex needs.

iCope serves a population of 206,100 people referral rates are ever increasing, from 2033 referrals in 2011, to 8194 in 2015. Subsequently, staff are working at their full capacity to meet the need of the high numbers of referrals from GP’s and self-referrals, so that patients have timely access to treatment. As a result, staff had limited capacity to reflect, learn and implement changes to improve service outcomes, including reducing recovery rates.

Solution

In the hope to improve patient recovery rates, iCope developed an approach called recovery consultations. This was to ensure that they could meet the national target of having 50% of patients recovered, both across the service but on an individual clinician basis.

Recovery consultations were put forward as an invitation to a support professional learning environment and to focus on the developing the quality of the therapy delivered by individual clinicians.

This enabled clinicians to have a reflective session. If recovery rates were low, recovery consultations enable clinicians to reflect on issues they faced, such as the impact of having a high caseload of complex patients or challenges in coding data on patient record systems. This approach emphasised the importance of providing support to clinicians, rather than associating service performance to a quality deficiency in clinical work.

The recovery consultations enabled the ability to monitor recovery rates, comparing on-going consultations to baseline measures. This encouraged clinicians to reflect on targets, record learning points and problem solve challenges that arose during their service user sessions.

Prior to the consultation, the following was gathered:

• A list of 5-10 non-recovered and 5-10 recovered clients that were recently discharged.
• Missed session rates.
• Number of treatment sessions completed for non-recovered and recovered cases.
• Drop-out rates.
• Whether follow-up appointments (before or after discharge) were offered.
• Recovery rates overall for different GP surgeries, and different levels of complexity.
• Using questionnaires to support tracking change throughout therapy.
• The number of review sessions offered for clients that did and did not recover.

During the consultations, this data was explored and compared to both recovered and non-recovered cases to identify:

• How treatment decisions were made.
• How to support a good match of client and clinician’s expectations.
• How to have a helpful use of the stepped-care model
• That the appropriate data was used.
• How to track recovery using goals and questionnaires.
• When the right time to discharging a client was, with recovery rates in mind.

Overall, the consultations gave clinicians an opportunity to reflect and develop tailored learning points which were used as a recovery focussed professional development goal.

Outcomes

The iCope recovery consultations have shown:

• An increase in recovery rates from 40.9% in 2015 to 51%, surpassing the 50% national target for IAPT services in 2016.
• Recovery rates three months prior to the consultation compared to three months after the consultation improved markedly for 9 out of 12 clinicians.

Additional information

You can find more about Islington iCope on the the NHS England webpage.