The concept of Service Model Fidelity is considered as a parallel process to Treatment Fidelity in evidence-based psychological therapies. NHS Talking Therapies (formerly IAPT) aimed to increase access to an expanded, upskilled workforce on a national scale. This included systematic training, supervision and front-line service delivery, emphasising treatment fidelity to evidence-based interventions. A further feature of NHS Talking Therapies was modernising and restructuring of the health system that housed these trained practitioners. The term ‘service model fidelity’ (Cromarty, 2016) was coined to emphasise service modernisation aspects as a distinct entity. A definition of the latter is included. Examples of service model fidelity and of service model drift, are outlined to distinguish these from therapist drift. This links to past literature recommending changes in traditional mental health service design and emergent evidence from NHS Talking Therapies. The latter examines publicly available data identifying characteristics of service design, which appear to be predictors of enhanced clinical outcome. Challenges in modernising health systems are discussed and conclusions are made highlighting the crucial role of service model when delivering evidence-based therapies. Suggestions for further research into service configuration to improve experiences of service users are considered. This includes ongoing exploration of service design being more than a qualitative feature, and increasingly appearing as a key factor in enhanced clinical outcome.

1. (1) To identify service model fidelity as separate entity to treatment fidelity.

2. (2) To provide a clear definition of service model fidelity.

3. (3) To delineate therapist drift from service drift.

4. (4) To further examine the role of service model in delivering evidence-based interventions.

Older adults are under-represented in Talking Therapies (previously named IAPT) services in the UK, a national priority for improvement in the NHS. A Talking Therapies service in the south of England identified that many older adults who were referred did not opt-in to assessment. We aimed to explore the characteristics of these older adults and understand their experiences, to inform recommendations to support them to opt-in to the service in future. First, demographic and referral characteristics were compared for older adults who did and did not opt-in, to explore any that increased odds of not opting-in. Next, surveys and semi-structured interviews were used to investigate older adults’ reasons for not opting-in. Responses were thematically analysed, and themes were categorised using the COM-B model to inform theory-based recommendations. Older age, being from an ethnic minority group, having a previous referral, not being able to receive text messages, and not self-referring (e.g. being referred by GP) all significantly increased the chances of older adults not opting-in. Thematic analysis found that impersonal and confusing processes, as well as older adults’ limited knowledge of Talking Therapies, beliefs about therapy, and physical, cognitive and life changes with age were barriers to opting-in. Several recommendations are made, including ideas to increase accessibility of information, change procedures to improve personal connection, and explore and overcome practical barriers. Improving routine data and feedback collection from people who do not opt-in will be important to inform and evaluate improvements.

1. (1) To recognise that the ongoing issue of under-representation of older adults within Talking Therapies extends beyond barriers to referral.

2. (2) To understand demographic and referral characteristics that may increase the likelihood of older adults not opting-in to a Talking Therapies service following referral.

3. (3) To understand the experiences of older adults who do not opt-in and the barriers they cite, exploring factors that impacted their capability, opportunity and motivation to opt-in.

4. (4) To consider how services could change their procedures, information sharing, and community outreach to better serve older adults.

Memory complaint in the absence of organic pathology is a common phenomenon accounting for up to one third of patients presenting to memory clinics. Health anxiety has been specifically linked to dementia worry and repeated presentations to the National Health Service (NHS). Providing reassurance that an individual does not have dementia appears ineffective in reducing presentations to primary and secondary care services.

This study sought to evaluate and establish the effectiveness of a 1-hour pilot training workshop to enhance healthcare professionals’ knowledge and confidence to those with health anxiety around cognitive decline.

The one-session pilot training workshop was developed and informed by previous work and consultation with the 2Gether NHS Foundation Trust Memory Assessment Service staff. The training workshop was then evaluated by employing an idiosyncratic self-report questionnaire. Participants completed the questionnaire prior to and after the training workshop.

Pre- and post-training questionnaires revealed that the pilot training workshop was effective in increasing perceived knowledge and confidence in staff responding to patients presenting with health anxiety and co-occurring subjective memory complaints.

The findings suggest that healthcare professionals may benefit from training in identifying and addressing health-anxious individuals with subjective memory complaints. This may have implications in the provision of psychologically informed care offered in a memory assessment service. Recommendations are made for further enhancing the effectiveness of staff training and promoting alternative service treatment pathways.

Cognitive Behavioural Analysis System of Psychotherapy (CBASP) is an evidenced based treatment model for chronically depressed patients.

The main aim of this service evaluation was to assess the acceptability and clinical impact of CBASP for chronic depression within an Improving Access to Psychological Therapies (IAPT) service.

Routinely collected data were analysed for all patients that received CBASP treatment focussing on the recovery rates of these patients in terms of depression, anxiety and social functioning. Interviews were conducted with patients who had recently been discharged from CBASP therapist within one month of the follow-up date, explore their experiences of therapy.

Outcome data for 27 patients suggested substantial reduction in scoring on measures of depression and anxiety following CBASP treatment. Across all interviews it was clear that patients developed an insight and understanding of how their behaviours affect the outcome of interpersonal situations.

Results from this service evaluation suggest that CBASP is acceptable to service users and has a positive clinical impact in terms of IAPT recovery targets for anxiety, depression and social functioning.

At Coombe Wood Mother and Baby unit (MBU) there are daily multi-disciplinary team (MDT) handover meetings and a weekly MDT ward round attended by 7-8 team members. There are concerns that the handover is too time consuming, utilising time which could be spent on other clinical duties, and concerns regarding the relevance of information that is handed over.

To perform a service evaluation to determine the efficiency and quality of MDT handover meetings in an MBU setting.

Data was collected from September to October 2020. A checklist was designed listing information felt to be relevant to handover and contained the following data points – ‘current situation’, ‘mental health’, ‘level of observations’, ‘risk’, ‘physical health’, ‘baby care’, ‘baby supervision levels’ and ‘tasks and responsibilities’. The start and stop times of each MDT handover meeting were noted and a record was made as to whether these topics were discussed.

Mean meeting duration was 32.2 minutes (range: 13 – 45 minutes) and amounted to 2.68 hours spent in MDT handover over a 5-day working week. This equates to 21.4 person-hours (based on 8 staff) a week. 928 data points were generated. 50.7% (468) data points were recorded and commonly omitted data points were – ‘tasks and responsibilities’, ‘risk’, ‘level of observations’ and ‘physical health’. On all occasions, ‘current situation’, ‘mental health’ and ‘baby care’ were handed over.

The results of this service evaluation provide compelling evidence for a wider improvement project. Involving MDT staff in designing interventions will make handover meetings more meaningful.

1. (1) To identify the unique experiences and particular mental health disparities that LGBQ people face in life and why a culturally adapted LGBQ CBT group offers both a necessary and unique therapeutic tool to support sexual minorities.

2. (2) To explore how a culturally adapted CBT group intervention for LGBQ people is experienced in practice, from the service user perspective. In particular, what aspects do LGBQ people find helpful, unhelpful and what might they suggest for future group improvement.

3. (3) To consider how such CBT groups may be culturally adapted to benefit sexual minorities, including: what actions should be taken in future clinical practice to ensure improvements in the psychological treatment experiences of LGBQ people. Specifically, including the need to incorporate more inclusive and intersectional examples that engage and support recovery from psychological distress.

1. (1) To enhance practitioners’ awareness of distress intolerance as a potential maintaining factor and therefore treatment target.

2. (2) To outline a transdiagnostic distress tolerance brief psychological intervention.

3. (3) To illustrate the potential of this distress tolerance brief psychological intervention to produce positive reliable change with real-world clients when delivered by non-psychologists.

Currently, no separate service exists for patients with young-onset dementia in Cambridgeshire. These patients are managed together with late-onset dementia patients within old age psychiatry services. To inform service design, we sought to characterise young-onset dementia patients in our population. We first analysed service-level data and supplemented this with a detailed case review of 90 patients.

Young-onset dementia remains a relatively rare condition. Only a small proportion of those referred for assessment receive a diagnosis of dementia. Data collected on presenting complaints, comorbidities, medication and Health of the Nation Outcome Scales scores associated young-onset dementia with a greater incidence of depression than late-onset dementia. Outcomes in the two groups did not appear to differ.

The data presented here do not suggest a need to create a separate service. Practitioners should be aware of the increased incidence of depression observed in this group.

1. (1) The use of unsupported digital cognitive behavioural therapy for insomnia (dCBTi) requires proper patient selection.

2. (2) There are many insomnia mimics and also previously unrecognized sleep and psychiatric disturbances that are under-diagnosed in the primary care setting that are contraindications for unsupported dCBTi.

3. (3) The use of a stepped care approach similar to the UK’s Improving Access to Psychological Therapies (IAPT) model using dCBTi could be feasible in the public health setting.

1. (1) To be familiar with common predictors of drop-out from psychological therapies, as indicated by the literature.

2. (2) To understand the theories underlying factors that impact drop-out and the associated consequences for mental health services.

3. (3) To understand the potential impact of staff assumptions of factors that affect drop-out on client retention.

4. (4) To have an understanding of initiatives and strategies that may improve client-retention and engagement in services.

As a result of reading this paper, the reader should:

1. (1) Learn about what psychotherapists report as occurring in routine care for individuals with anxiety and related disorders.

2. (2) Know the potential therapist traits that influence the use of CBT techniques.

3. (3) Gain knowledge to help explain to clients why previous therapy may not have been effective.

4. (4) Develop a richer understanding of what factors may influence their own therapeutic practice.

We aimed to evaluate a pilot service to facilitate discharge of patients with stable long-term mental health needs from secondary to primary care.

Patients with stable long-term mental health conditions are often not discharged from secondary mental health services when no longer needed due to insufficient systems and processes to enable safe, effective, recovery-focussed treatment and support. The Primary Care Mental Health Specialist (PCMHS) Service was developed to address this gap; new PCMHS posts were introduced to act as a conduit for patients being discharged from secondary care and a single point of referral back into secondary care, should it be required. The two-year pilot, across six Clinical Commissioning Groups in South East England, began in March 2013.

Interviews were conducted with all PCMHS employed in the pilot service (n=13) and a sample of service users (n=12). The views of professionals working alongside the service, including GPs, Psychiatrists and Mental Health Nurses, were captured using a brief online questionnaire (n=50). Time and Activity Recording Sheets were used to capture data required for economic analysis.

Our findings indicate that the service is working well from the perspective of patients; staff employed within the service and professionals working alongside the service. Patients described the service as a ‘safety net’ they could fall back on in case of difficulties, whereas staff used the analogy of a ‘bridge’ to describe the way the service improved communication and collaboration between the various professionals and organisations involved in the patient’s care. Improvements in well-being were seen to result from increased support for those transitioning from secondary to primary care, a more pro-active approach to relapse prevention and increased engagement in daily activities. Each PCMHS covered 36 patients in a one-month period, with a unit cost of £73.01 per patient.

Older people with mental health problems who meet needs based criteria for National Health Service (NHS) continuing care funding may be cared for in a variety of settings. These services have evolved due to socio-economic and political pressure, with the extent of movement of care from traditional NHS run long stay units into the private sector being unclear. Little attention has been paid to the best model of service provision for this group in terms of quality of care, patient outcomes, and cost effectiveness.

A literature review was conducted in order to explore what is known about service models for long-term psychiatric care for older people and their cost effectiveness. Following this review, an online survey was conducted in order to establish current specialist continuing care service provision by provider organizations, as well as any planned developments in services.

The way specialist mental health continuing care services are provided in the United Kingdom (UK) varies, with just 45% (33) of NHS providers still operating their own services. Specialist mental health continuing care is an area of current service review for a number of organizations.

Specialist care services for older adults with mental health problems in the UK are changing, but there is a lack of research on models of service delivery for this group of vulnerable individuals with complex needs. In the context of financial pressures within the NHS, and an increasing awareness of the need to develop and improve quality of services both for those with dementia and other mental illnesses, an urgent need for further research in this area is identified.

The Family Group Conference (FGC) is an approach to partnership working which brings together service users, their support network and care professionals in a family-led decision making forum. Evidence, though limited, indicates that that FGC can enhance outcomes for service providers and their users. This study aimed to evaluate the impact of the pilot FGC service, delivered to people with dementia and their families, in terms of the experience of care provision by families and care professionals involved in the project.

Focus group interviews were conducted with families and professionals participating in the pilot intervention.

FGC was perceived as having the potential to positively impact service users, their families, service providers and the wider culture of care. However, despite an overall positive evaluation the participants identified a number of challenges related to service implementation. Both the opportunities and challenges identified in this study are discussed in the context of the existing international evidence base.

This study contributes to a better understanding of the applicability of FGC as a strategy to support people with dementia and their families. Although promising in terms of potential outcomes for service users and providers, FGC presents challenges which need to be carefully managed in order to secure maximum benefit to all parties.

To describe and evaluate a community-based musculoskeletal service, commissioned by National Health Services North East Essex Primary Care Trust (PCT), in terms of patient-reported outcomes and satisfaction.

Persistent musculoskeletal conditions, including back and neck pain, are costly in terms of primary and secondary healthcare resources. Most patients are assessed and managed by general practitioners (GPs), with referral when necessary to secondary care services.

Patients consulting for at least four weeks for back or neck pain were referred by their GP according to patient preference to either a chiropractor or osteopath or physiotherapist working in the independent sector. Patients completed questionnaires at baseline and at discharge from the service.

Questionnaire data were obtained from 696 patients, 97% of whom were seen within two weeks. About half (51%) had had their pain for less than three months, and of the remainder 49% for more than 12 months. Patients received on average six treatments. Using the Bournemouth Questionnaire, the Bothersomeness scale and the Global Improvement Scale, approximately two-thirds (64.6%, 67.8% and 69.9%, respectively) reported improvement at discharge, and approximately 65% a significant reduction in medication. Almost all (99.5%) patients were satisfied with the service. Similarly, almost all (97%) patients were discharged from the service with advice on self-management; the remainder were recommended for secondary care referral.

This service improved patient access and choice resulting in shorter waiting times and effective outcomes. An impact analysis of the first 12 months of the service by the PCT showed a reduction in primary care consultations and in inappropriate referrals to secondary care.