Exploring access and engagement with Improving Access to Psychological Therapies (IAPT) services, before, during, and after the COVID-19 lockdown: A service evaluation in the Northwest of England.

The purpose of this study was to compare clients' prevalence and explore the characteristics that predicted access and engagement with IAPT treatment before, during, and after Lockdown.We conducted a retrospective observational service evaluation, using routinely collected IAPT data from n = 13,019 clients who entered treatment between March and September in 2019, 2020, and 2021. Chi-square and multiple logistic regression were used to explore associations and potential predictors of access and engagement with IAPT treatment.The number of people accessing and engaging with IAPT treatment was significantly higher after lockdown compared to before. Unemployed clients were less likely to access treatment during and after lockdown. Yet, perinatal clients and people from a black ethnic background were more likely to access treatment during lockdown. Being young and being unemployed were predictors of treatment disengagement across all three time points, whereas perinatal clients were less likely to engage only before and during lockdown. Clients who were not prescribed medication and clients with a long-term condition were more likely to engage during lockdown.The demonstrated changes in access and engagement with IAPT treatment after the introduction of remote therapy urges the services to further consider the individual needs of specific client groups.

Improving access to psychological therapies: Analysis of effects associated with remote provision during COVID-19.

BACKGROUND: COVID-19 had an immediate impact on the way Improving Access to Psychological Therapy (IAPT) services in the United Kingdom were delivered, requiring services to move to remote therapy. While remote therapy has been shown to be effective, little is known about the effects associated with moving to remote therapy delivered during COVID-19 within IAPT services. OBJECTIVE: The objective of the study was to assess the characteristics of those undergoing remote therapy and test the effects associated with the effect of remote delivery on anxiety and depression symptoms compared with in-person therapy before lockdown. METHODS: We conducted a retrospective, cross-sectional benchmark comparison of remote therapy across four IAPT services in Greater Manchester. Routinely collected measures of anxiety (GAD-7) and depression (PHQ-9) were used to compare effects across the two time periods. A mixed-effects model was conducted to assess within and between group changes in anxiety and depression, while controlling for pre-specified confounders. FINDINGS: Remote therapy did not appear to impact on service provision, with the number of sessions offered and attended being similar to those prior to COVID-19. Both face-to-face (pre-COVID-19) and remote therapy (during COVID-19) were associated with variable improvements in anxiety and depression with no significant difference between them. However, remote therapy was associated with a more rapid decrease in symptoms in comparison with face-to-face treatment. Mean improvement in symptoms was small and increased as number of sessions/time increased and analysis of rates of improvement indicated that both face-to-face and remote therapy might need more time to reach target cut-off points on measures. CONCLUSIONS: Both face-to-face and remote therapies delivered under IAPT were associated with improvements in symptoms with no apparent difference apart from the finding that remote therapy was associated with more rapid change. CLINICAL IMPLICATIONS: Remote therapy delivery in IAPT does not appear to confer a disadvantage over face-to-face contact, but at a group mean level the magnitude of improvement associated with both treatments was small. Remote therapy provision may widen patient access to and engagement with psychological services.

Frequency and impact of childhood sexual and physical abuse on people using IAPT services.

OBJECTIVES: This study explored the prevalence of childhood sexual/physical abuse (CSA/CPA) as identified by practitioners in Improving Access to Psychological Therapies (IAPT) services and clarified differences in clients' characteristics with and without a history of CSA/CPA. METHODS: A retrospective analysis of a large dataset comprised of IAPT routine data and data from a local service evaluation reporting on clients' presenting problems. RESULTS: 14% of IAPT clients (n = 1,315) were identified with a record of CSA/CPA. CSA/CPA history was associated with longer duration and earlier age of onset of condition(s), greater number of presenting problems and post-traumatic stress disorder co-occurrence, higher intensity treatment delivery, and lower recovery rates. CONCLUSIONS: CSA/CPA history appears as an important feature in a sizable minority of IAPT clients; further work is required to meet clients' trauma-related needs. PRACTITIONER POINTS: A sizable minority of IAPT clients (14%) present with a history of CSA/CPA as recorded in clinical notes. CSA/CPA history is associated with more complex and enduring presentations in IAPT clients. The reported CSA/CPA frequency is likely to be underestimates of the actual prevalence and impact of adverse childhood experiences in IAPT clients. Trauma-informed inquiry and trauma-specific screening tools would help practitioners to meet clients' trauma-related needs.

Case complexity as a guide for psychological treatment selection.

OBJECTIVE: Some cases are thought to be more complex and difficult to treat, although there is little consensus on how to define complexity in psychological care. This study proposes an actuarial, data-driven method of identifying complex cases based on their individual characteristics. METHOD: Clinical records for 1,512 patients accessing low- and high-intensity psychological treatments were partitioned in 2 random subsamples. Prognostic indices predicting post-treatment reliable and clinically significant improvement (RCSI) in depression (Patient Health Questionnaire-9; Kroenke, Spitzer, & Williams, 2001) and anxiety (Generalized Anxiety Disorder-7; Spitzer, Kroenke, Williams, & Löwe, 2006) symptoms were estimated in 1 subsample using penalized (Lasso) regressions with optimal scaling. A PI-based algorithm was used to classify patients as standard (St) or complex (Cx) cases in the second (cross-validation) subsample. RCSI rates were compared between Cx cases that accessed treatments of different intensities using logistic regression. RESULTS: St cases had significantly higher RCSI rates compared to Cx cases (OR = 1.81 to 2.81). Cx cases tended to attain better depression outcomes if they were initially assigned to high-intensity (vs. low intensity) interventions (OR = 2.23); a similar pattern was observed for anxiety but the odds ratio (1.74) was not statistically significant. CONCLUSIONS: Complex cases could be detected early and matched to high-intensity interventions to improve outcomes. (PsycINFO Database Record

Self-management and well-being in adolescents with diabetes mellitus: do illness representations play a regulatory role?

This investigation examined the applicability of the self-regulatory model to adolescents with type 1 diabetes. Relationships among illness beliefs, diabetes self-management behaviors, psychological well-being, and blood glucose control were explored in 30 adolescents attending outpatient clinics in the United Kingdom. Correlation and regression analyses indicated that illness beliefs were not related to self-management behaviors, but both were important contributors to psychological well-being.

The Reasons for Depression Questionnaire (RFD): UK Standardization for clinical and non-clinical populations.

Recent research into reason giving for depression has illustrated the importance of client beliefs about the cause of their depression. Reasons given have been found to be associated with level of depression, perceived credibility of treatments and therapy outcome. It has been suggested that giving reasons for depression is a form of rule-governed behaviour and as such can cause the depression to be harder to treat (i.e. the reasons become functionally true for the individual). This study investigates the reliability and validity of the Reasons for Depression Questionnaire (RFD; Addis, Truax, & Jacobson, 1995), a 48-item self-report measure developed to measure explanations for the causes of depression. The study provides preliminary normative data for both clinical (n = 123) and non-clinical (n = 105) UK samples. The data indicate high reliability for all subscales including a further subscale (biological) added since the measure was initially developed. Certain subscales correlate significantly with level of depression and specific aspects of self-esteem. This supports the validity of the measure and suggests that it is measuring a distinct concept rather than significantly overlapping with individuals' general beliefs about themselves.

A portrait of clinical psychology.

The purpose of this paper is to provide an introduction to the profession of clinical psychology. We provide a definition and overview of the core features of the profession, followed by a description of entry requirements and education. We go on to describe the dominant models which have driven the training and practice of clinical psychologists through the latter half of the 20th century to the present day. We conclude with a look to the future of the profession and a brief consideration of opportunities and threats. Throughout we have attempted to pick out aspects of the profession that are relevant or of interest, irrespective of national differences in professional training and practice, or variations in the development of clinical psychology in particular nation states. When generalisations would be too broad to be useful or are otherwise difficult, we have provided specific information about the profession as it has developed in the UK or USA. The references should provide a rich source of further information for the interested reader.