Dr. Kate Chatters, Clinical Psychologist

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Learning Disabilities and IAPT- The Oxleas Model
Dr. Kate Chatters, Clinical Psychologist Dr.
Rachel Blundell, Clinical Psychologist Aysem
Mehmet, Psychological Well-Being
Practitioner Wendy ONeill, Assistant
Psychologist 19th November 2014
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Despite their widespread experiences of
disadvantage and social exclusion, and high risk
of poor physical and mental health, people with
learning disabilities as a group are not well
served by the NHS (Michael, 2008) and are at risk
of missing out on centrally funded initiatives
such as the Improving Access to Psychological
Therapies (IAPT) programme. (Chinn, Abraham,
Burke and Davies, 2014)
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To date the evidence base regarding the
effectiveness of CBT for people with learning
disabilities and common mental health problems is
still quite limited (Willner, 2005 Sturmey,
2006). There are a number of published case
reports (Brown and Marshall, 2006 Willner,
2004), but few RCTs. (Chinn et al. 2014)
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Outline for today

• What is IAPT
• TLC Introduction
• Who we see
• Outcomes
• Case discussion
• Q As

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IAPT
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Improving Access to Psychological Therapies (IAPT)

• Government led programme to train people to
  deliver step 2 and 3 CBT interventions in
  accordance with NICE recommendations.
• Mild to moderate presentations try step 2
  and/or step 3 psychological interventions in
  preference to medication
• Moderate to severe try step 3 interventions
  before/in conjunction with medication
• Severe and complex secondary care services

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Our Service - TLC

• New Project Official Launch July 2013
• Tries to replicate mainstream IAPT - stepped care
  model for People with Learning Disabilities
• Set up with short term funding from commissioners
• Recently became a permanent service
• Started as IAPT-LD now TLC
• Separate service from CLDT and IAPT Greenwich
  Time To Talk good links
• 
  
  

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TLC Team

• Aim of service
• To provide evidence based psychological
  interventions following the principles of the
  National IAPT programme to people with LD and
  their carers.
• To provide primary care level short term
  focused relatively low intensity interventions
• To raise awareness of the mental health needs of
  people with LD (e.g GTTT/ MIND training).
• To collect data on the effectiveness of these
  interventions.
• To develop resources to support mainstream IAPT
  teams work
• To path find!

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Reasonable Adjustments

• Easy to read docs
• Adapting interventions
• Flexibility in appointments same time/day/
  accommodate carers
• Longer sessions
• Engagement with CLDT- collaborative work
• Removing barriers to access

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Eligibility Inclusion

• Mild-moderate learning disability
• 18 years or older
• Lives in the Borough of Greenwich
• Mild to Moderate Mental Health Problems
• Can use psychological approach adapted CBT

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Inclusion

• Anxiety disorders
• GAD
• Obsessive compulsive disorder (OCD)
• Panic disorder
• Agoraphobia
• Social anxiety
• Social phobia
• Stress/work issues

• Depression
• Adjustment disorders (Coping with illness/chronic
  conditions)
• Self image/self esteem
• Sleep Management

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Exclusion

• Acute psychotic symptoms
• Bipolar disorder
• Complex disorders
• Eating disorders
• Major drug or alcohol problems
• Complex MDT interventions

• Mania
• Personality disorders
• Sexual dysfunction
• People with significant issues of risk to self or
  others.

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What we offer

• Individual therapy
• Group therapy
• Carers Workshops
• Joint work/ consultation GTTT and MIND
• Training

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How similar to GTTT

• We offer Step 2 Step 3 Interventions
• Group Interventions
• Use core outcome measure GAD/PHQ every session
• Time limited 8-20 sessions
• Self/GP referral

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Differences between CLDT IAPT-LD

• CLDT
• Assessments for eligibility autism
• Psychometric testing
• Challenging Behaviour
• Complex systemic work
• Step 3-4 interventions
• Wide range of MH difficulties

• IAPT-LD
• Step 2 3 interventions
• Anxiety and depression
• Short term time limited
• Clinic based model

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1 year on

• 53 referrals to TLC from July 2013 to present
• 50 of these referrals were from CLDT 50 other
  sources inc. GTTT
• Small sample but reliable improvement and
  reliable recovery rates broadly comparable to
  mainstream IAPT KPIs
• Number of people showing reliable improvement at
  6 sessions stage is positive

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Reflections

• Under Oxleas umbrella unlike other IAPT services
  that are not aligned
• Promising preliminary outcome data evidencing
  that PWLD with symptoms of depression and/or
  anxiety can demonstrate improved psychological
  wellbeing through a stepped care IAPT model.
• Adds to very limited current evidence base
• May help challenge current beliefs about
  candidacy (FPLD research)
• May help challenge beliefs that only long term
  work could improve mood in LD
• Staff all part-time but some members have a split
  post with CLDT LD clinicians
• Stand alone status allows for greater flexibility
  in terms of adaptations made may not be
  achievable in current IAPT climate

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Where next

• GTTT screening, joint projects, research
• Resources new interventions
• FPLD
• Research/Publications
• Trust Quality Showcase

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Break slide with title area here
Sub heading area or space for another presenters
name And job title
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Case Presentation

• Social Anxiety

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Demographics

• 21 year old male
• Lives at home with his parents and 2 younger
  brothers (18 years 15 years).
• Unemployed seeking employment.
• No risk reported

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LD Diagnosis

• This client has a statement of SEN
• He attended specialist unit within a mainstream
  school
• He has a global learning disability which
  includes problems with reading, writing and fine
  motor skills
• He was assessed by CLDT but was found not to be
  eligible for services due to FACS criteria

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Presenting problem

• He was referred to our service for help with
  social anxiety
• Trigger Incident with a security guard
• He now has the belief that he looks suspicious
• Previously assaulted This has left him feeling
  hyper-vigilant
• History of panic attacks

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Impact of problem

• He avoids going out alone
• When he is out he will usually return home sooner
  than he would like
• He will only go to places he is familiar with and
  not too far from home
• For large parts of his week he is at home without
  activity

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Treatment Plan

• Psychoeducation on social anxiety panic
• Graded exposure
• Relaxation techniques
• Activity scheduling
• Signposting to Remploy employment support

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Hierarchy
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Adapted Resources

• Visual anxiety thermometer
• Scrapbook for achieved goals
• Pictures of activities
• Use of computer for activity diary
• Stress ball for PMR techniques

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Other adaptations

• His mum attended all sessions
• Phased sessions Initially weekly sessions
  however after session 10 we moved to fortnightly
  sessions.

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Outcomes

• Client is no longer avoiding previously avoided
  places/situations
• He does not leave a situation when he feels
  anxious and instead using relaxation, breathing
  techniques and positive thinking
• He goes out every day and his routine is more
  varied
• He is spending more time with his family doing
  things like going to the cinema, taking his dogs
  for a walk, helping with household tasks, started
  going to the gym
• This client has regularly been invited to several
  interviews and is due to start a work trial soon.
  He now feels more confident in public places

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PHQ9 GAD7 Scores
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Thank you