The featured paper is a 2007 Department of Health document – ‘Commissioning a brighter future: improving access to psychological therapies – positive practice guide’ and freely available here.
There is an introduction from Patricia Hewitt, former Secretary of State for Health in which she emphasises that successful psychological therapies are about delivering these services effectively for anxiety and depression – at the right time and with the right results. In the next section entitled ‘Purpose and Vision’ there is an outline of the big picture. The stated purpose is to focus on Pathfinder sites, sites where ‘Improving Access to Psychological Therapies’ has been introduced and how the services in these sites can be improved and the findings disseminated. In the Vision statement, it is stated that standards for recognising and treating depression will be raised and the needs of local communities will be met. The needs of different populations are discussed in different populations including for example adults of working age, children and young people and older people. The section ends by giving examples of positive practice which includes the Chinese Mental Health Association and the Changing Minds Centre for Education and Service Development.
The next section is titled ‘Our challenges – the case for change’ and covers some of the relevant statistics. There is then a section on the principles of modern psychological therapy services. There are four key principles. Firstly the services should be tailored to the needs of the community ensuring that the ‘right numbers’ of patients are treated. Secondly the right services should be provided within a stepped care paradigm. The quote used in the document is
‘The idea is simple: to provide patients with the most cost effective and appropriate treatment, in the least invasive manner, as close to home as possible’
Thirdly the timing should be right, specifically in terms of waiting times. Finally the right results should be obtained using relevant outcome data. The section looks at examples of good practice from different regions which incorporate various approaches including bibliotherapy, the use of the CORE outcome measure and the Trailblazers approach.
The next section is titled ‘Achieving the vision – promoting a commissioner-led approach’. The principles for planning Pathfinder Sites are described as assessment, care pathway development and service redesign and examples of good practice are given. There is a brief section on achieving the vision which mentions demonstration sites and further Pathfinder sites. The penultimate section looks at the demonstration sites in 2006/7 in Newham and Doncaster and case examples are included. There is a final brief section on plans for 2007 and 2008. This is an interesting document which although aimed at commissioners provides a useful overview for how psychological treatments for anxiety and depression are being integrated into the National Health Service.
Steps to Treatment = 1 (Policy)
Steps To Treatment (STT)
STT = Steps To Treatment. An estimate of the number of steps between the results and translation into practice i.e. treatment. This is an opinion. A policy statement would have a value of 1 as this a guide for practice whereas a speculative model would get a much higher score as there are more steps between statement of the model and treatment (which would involve testing the model, informing treatment approaches and trialling these approaches for instance).
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