LGBQ+ adults’ experiences of Improving Access to Psychological Therapies and primary care counselling services: informing clinical practice and service delivery

AbstractLesbian, gay, bisexual, queer and other sexual minority (LGBQ+) people experience higher levels of psychological difficulties than heterosexual people. Evidence suggests that LGBQ+ treatment outcomes within England’s Improving Access to Psychological Therapies (IAPT) services are worse than the outcomes for heterosexuals, especially for bisexual people and sexual minority women. IAPT services provide evidence-based treatments like cognitive behavioural therapy (CBT), typically for anxiety or depression. This study explored LGBQ+ adults’ experiences with IAPT services and/or primary care counselling. LGBQ+ adults (n = 136) answered an online questionnaire (fixed-response and optional open-ended questions) about their access and treatment experiences. Descriptive statistics summarized multiple-choice responses. Qualitative data were analysed through thematic analysis. Before access, 41.9% of participants were concerned about experiencing LGBQ+ stigma/discrimination within psychological services. Only 13.2% of participants thought their sexuality negatively impacted their treatment, although prejudice/discrimination may be underestimated as 33.6% participants did not disclose their sexuality to practitioners and sexuality was not discussed in treatment for 44.0% of participants. Bisexual clients were significantly less likely to disclose their sexuality. The barriers LGBQ+ people described within IAPT or primary care services included: feared or experienced stigma in the services; reluctance to disclose sexuality; inconsistent discussion of sexuality in treatment; a lack of awareness and understanding towards LGBQ+ identities and community-specific challenges; and distrust, disillusionment and exclusion resultantly. Overall, 52.2% thought services could be improved for LGBQ+ individuals. This study identified multiple issues to be addressed in therapist training and service development.Key learning aims (1)The unique needs/experiences that LGBQ+ people bring to therapy, such as the need to disclose their sexuality and past experiences of stigma/discrimination, including how this differs within the community (e.g. bisexual people or LGBQ+ Black and minority ethnic people).(2)How these needs/experiences can result in barriers that make their treatment experience distinct from heterosexuals and influence their treatment outcomes.(3)What steps should be taken in future research and clinical practice to ensure improvements in the psychological treatment experiences of LGBQ+ people, including in relation to therapist understanding and training in LGBQ+-related issues.

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Improvement in IAPT outcomes over time: are they driven by changes in clinical practice?

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x20000173 ◽

2020 ◽

Vol 13 ◽

Author(s):

Rob Saunders ◽

John Cape ◽

Judy Leibowitz ◽

Elisa Aguirre ◽

Renuka Jena ◽

...

Keyword(s):

Clinical Practice ◽

Treatment Outcomes ◽

Patient Outcomes ◽

Research Network ◽

Service Improvement ◽

List Type ◽

Treatment Delivery ◽

Positive Effects ◽

Psychological Therapies ◽

Routinely Collected Data

Abstract Treatment outcomes across Improving Access to Psychological Therapies (IAPT) services in England have improved year-on-year, with the national average proportion of patients in recovery at the end of treatment now exceeding the 50% target. This is despite the number of referrals and numbers of treated patients also increasing year-on-year, suggesting that services have evolved local practices and treatment delivery to meet needs whilst improving performance. This study explores whether there have been changes in clinical practice with regard to: (1) the number of sessions and length of treatments; (2) the number of cancellations and non-attendance; and (3) the recording of problem descriptor information, and the association with treatment outcomes in IAPT. Routinely collected data from seven IAPT services involved in the North and Central East London (NCEL) IAPT Service Improvement and Research Network (SIRN) were brought together to form a dataset of nearly 88,000 patients who completed a course of IAPT treatment. Results showed that there was a slight increase in the average number of sessions, and decreases in the length of time in treatment, as well as decreases in both the number of non-attended appointments and the use of inappropriate problem descriptors. These findings highlight a number of areas where potentially small changes to clinical practice may have had positive effects on patient outcomes. The value of using IAPT data to inform service improvement evaluations is discussed. Key learning aims (1) How changes to treatment-delivery factors are associated with IAPT patient outcomes. (2) The link between clinical practice and potential service performance. (3) How analysing routinely collected data can be used to inform service improvement.

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LGBQ adults’ experiences of a CBT wellbeing group for anxiety and depression in an Improving Access to Psychological Therapies Service: a qualitative service evaluation

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x20000598 ◽

2021 ◽

Vol 13 ◽

Author(s):

Christopher E. M. Lloyd ◽

Katharine A. Rimes ◽

David G. Hambrook

Keyword(s):

Mental Health ◽

Sexual Minority ◽

Group Intervention ◽

Sexual Minorities ◽

Mental Health Problems ◽

Psychological Treatment ◽

Qualitative Content Analysis ◽

List Type ◽

Psychological Therapies ◽

Culturally Adapted

Abstract Sexual minorities, including those identifying as lesbian, gay, bisexual or queer (LGBQ) are at heightened risk of experiencing mental health problems. Nationally, treatment outcomes within England’s Improving Access to Psychological Therapies (IAPT) services are worse for sexual minority patients than for heterosexuals. An IAPT service in London developed a cognitive behavioural therapy (CBT) group specifically for sexual minority patients to provide a safe, affirmative intervention to learn skills for overcoming depression, anxiety and stress. A qualitative online survey was emailed to all 59 service users who had completed the eight-session intervention, to explore their experiences inductively. Survey data were analysed using qualitative content analysis. Themes were identified in participants’ responses in order to establish which aspects of the group intervention were deemed to be helpful and unhelpful, and to explore suggestions for group improvement. Eighteen people completed the survey (response rate 30.5%). Respondents reported that they found the CBT frame of the group useful, with the LGBQ focus experienced as particularly beneficial, often enhancing engagement with CBT concepts and tools. In addition to generic elements of group therapy that some found difficult, others reported that intragroup diversity, such as generational differences, could lead to a reduced sense of connection. Several suggestions for group improvement were made, including incorporating more diverse perspectives and examples in session content and focusing more on issues relating to intersectionality. These results provide preliminary evidence that a culturally adapted CBT group intervention developed specifically for sexual minorities is acceptable and perceived as offering something unique and helpful. Key learning aims (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) 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) 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.

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Understanding the psychological therapy treatment outcomes for young adults who are not in education, employment, or training (NEET), moderators of outcomes, and what might be done to improve them

Psychological Medicine ◽

10.1017/s0033291721004773 ◽

2021 ◽

pp. 1-12

Author(s):

Joshua E. J. Buckman ◽

Joshua Stott ◽

Nicole Main ◽

Daniela M. Antonie ◽

Satwant Singh ◽

...

Keyword(s):

Young Adults ◽

Treatment Outcomes ◽

Psychological Treatment ◽

Service Level ◽

Psychological Therapies ◽

Differential Outcomes ◽

Pre Treatment ◽

Additional Support ◽

Minority Participants ◽

Deprived Areas

Abstract Background To determine: whether young adults (aged 18–24) not in education, employment or training (NEET) have different psychological treatment outcomes to other young adults; any socio-demographic or treatment-related moderators of differential outcomes; and whether service-level changes are associated with better outcomes for those who are NEET. Methods A cohort was formed of 20 293 young adults treated with psychological therapies in eight Improving Access to Psychological Therapies services. Pre-treatment characteristics, outcomes, and moderators of differential outcomes were compared for those who were and were not NEET. Associations between outcomes and the following were assessed for those that were NEET: missing fewer sessions, attending more sessions, having a recorded diagnosis, and waiting fewer days between referral and starting treatment. Results Those who were NEET had worse outcomes: odds ratio (OR) [95% confidence interval (CI)] for reliable recovery = 0.68 (0.63–0.74), for deterioration = 1.41 (1.25–1.60), and for attrition = 1.31 (1.19–1.43). Ethnic minority participants that were NEET had better outcomes than those that were White and NEET. Living in deprived areas was associated with worse outcomes. The intensity of treatment (high or low) did not moderate outcomes, but having more sessions was associated with improved outcomes for those that were NEET: odds (per one-session increase) of reliable recovery = 1.10 (1.08–1.12), deterioration = 0.94 (0.91–0.98), and attrition = 0.68 (0.66–0.71). Conclusions Earlier treatment, supporting those that are NEET to attend sessions, and in particular, offering them more sessions before ending treatment might be effective in improving clinical outcomes. Additional support when working with White young adults that are NEET and those in more deprived areas may also be important.

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Real-world research and its importance in respiratory medicine

Breathe ◽

10.1183/20734735.015414 ◽

2015 ◽

Vol 11 (1) ◽

pp. 26-38 ◽

Cited By ~ 42

Author(s):

David Price ◽

Guy Brusselle ◽

Nicolas Roche ◽

Daryl Freeman ◽

Alison Chisholm

Keyword(s):

Clinical Practice ◽

Treatment Outcomes ◽

Real World ◽

Randomised Controlled Trials ◽

Real Life ◽

Controlled Trials ◽

List Type ◽

Pragmatic Clinical Trials ◽

Randomised Controlled ◽

Meta Analyses

Educational AimsTo improve understanding of: The relative benefits and limitations of evidence derived from different study designs and the role that real-life asthma studies can play in addressing limitations in the classical randomised controlled trial (cRCT) evidence base.The importance of guideline recommendations being modified to fit the populations studied and the model of care provided in their reference studies.Key pointsClassical randomised controlled trials (cRCTs) show results from a narrow patient group with a constrained ecology of care.Patients with “real-life” co-morbidities and lifestyle factors receiving usual care often have different responses to medication which will not be captured by cRCTs if they are excluded by strict selection criteria.Meta-analyses, used to direct guidelines, contain an inherent meta-bias based on patient selection and artificial patient care.Guideline recommendations should clarify where they related to cRCT ideals (in terms of patient populations, medical resources and care received) and could be enhanced through inclusion of evidence from studies designed to better model the populations and care approaches present in routine care.SummaryClinical practice requires a complex interplay between experience and training, research, guidelines and judgement, and must not only draw on data from traditional or classical randomised controlled trials (cRCTs), but also from pragmatically designed studies that better reflect real-life clinical practice. To minimise extraneous variables and to optimise their internal validity, cRCTs exclude patients, clinical characteristics and variations in care that could potentially confound outcomes. The result is that respiratory cRCTs often enrol a small, non-representative subset of patients and overlook the important interplay and interactions between patients and the real world, which can effect treatment outcomes.Evidence from real-life studies (e.g. naturalistic or pragmatic clinical trials and observational studies encompassing healthcare database studies and cohort studies) can be combined with cRCT evidence to provide a fuller picture of intervention effectiveness and realistic treatment outcomes, and can provide useful insights into alternative management approaches in more challenging asthma patients. The Respiratory Effectiveness Group (REG), in collaboration with the European Academy of Allergy and Clinical Immunology (EAACI) and the European Respiratory Society (ERS), is developing quality appraisal tools and methods for integrating different sources of evidence. A REG/EAACI taskforce aims to help support future guideline developers to avoid a one-size-fits-all approach to recommendations and to tailor the conclusions of their meta-analyses to the populations under consideration.

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Psychological Treatment of Depression in Primary Care: Recent Developments

Current Psychiatry Reports ◽

10.1007/s11920-019-1117-x ◽

2019 ◽

Vol 21 (12) ◽

Cited By ~ 6

Author(s):

Pim Cuijpers ◽

Soledad Quero ◽

Christopher Dowrick ◽

Bruce Arroll

Keyword(s):

Primary Care ◽

Behavioral Activation ◽

Psychological Treatment ◽

Target Groups ◽

Middle Income ◽

Middle Income Countries ◽

Psychological Therapies ◽

Medical Disorders ◽

Treatment Of Depression ◽

Recent Developments

Abstract Purpose of Review We give an overview of recent developments on psychological treatments of depression in primary care. Recent Findings In recent years, it has become clear that psychotherapies can effectively be delivered through e-health applications. Furthermore, several studies in low and middle income countries have shown that lay health counselors can effectively deliver psychological therapies. Behavioral activation, a relatively simple form of therapy, has been found to be as effective as cognitive behavior therapy. Treatment of subthreshold depression has been found to not only reduce depressive symptoms but also prevent the onset of major depression. In addition, therapies are effective in older adults, patients with general medical disorders and in perinatal depression. Summary Psychological therapies are effective in the treatment of depression in primary care, have longer lasting effects than drugs, are preferred by the majority of patients, and can be applied flexibly with different formats and across different target groups.

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The Impact of Alcohol Use on Drop-out and Psychological Treatment Outcomes in Improving Access to Psychological Therapies Services: an Audit

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465817000819 ◽

2018 ◽

Vol 46 (5) ◽

pp. 513-527 ◽

Cited By ~ 7

Author(s):

J.E.J. Buckman ◽

I. Naismith ◽

R. Saunders ◽

T. Morrison ◽

S. Linke ◽

...

Keyword(s):

Alcohol Use ◽

Treatment Outcomes ◽

Alcohol Misuse ◽

Common Mental Disorders ◽

Psychological Treatment ◽

Good Practice ◽

Drop Out ◽

Exclusion Criterion ◽

Psychological Therapies ◽

The Impact

Background: The impact of alcohol use disorders (AUD) on psychological treatments for depression or anxiety in primary care psychological treatment services is unknown. Aims: To establish levels of alcohol misuse in an Improving Access to Psychological Therapies (IAPT) service, examine the impact of higher risk drinking on IAPT treatment outcomes and drop-out, and to inform good practice in working with alcohol misuse in IAPT services. Method: 3643 patients completed a brief questionnaire on alcohol use pre-treatment in addition to measures of depression, anxiety and functioning. Symptom and functioning measures were re-administered at all treatment sessions. Results: Severity of alcohol misuse was not associated with treatment outcomes, although those scoring eight or more on the AUDIT-C were more likely to drop out from treatment. Conclusions: IAPT services may be well placed to offer psychological therapies to patients with common mental disorders and comorbid AUD. Patients with AUD can have equivalent treatment outcomes to those without AUD, but some higher risk drinkers may find accessing IAPT treatment more difficult as they are more likely to drop out. Alcohol misuse on its own should not be used as an exclusion criterion from IAPT services. Recommendations are given as to how clinicians can: adjust their assessments to consider the appropriateness of IAPT treatment for patients that misuse alcohol, consider the potential impact of alcohol misuse on treatment, and improve engagement in treatment for higher risk drinkers.

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Improving access to psychological therapies for all adults

Psychiatric Bulletin ◽

10.1192/pb.bp.108.021972 ◽

2009 ◽

Vol 33 (5) ◽

pp. 186-188 ◽

Cited By ~ 6

Author(s):

Pradip Ghosh

Keyword(s):

Psychological Treatment ◽

Waiting Times ◽

Clinical Excellence ◽

Psychological Services ◽

Service Development ◽

Government Investment ◽

Psychological Therapies ◽

Age Related ◽

Treatment Of Depression ◽

The Government

SummaryNew psychological services are about to roll out across England. the National Institute for Health and Clinical Excellence clinical guidelines have led to government investment in the Improving Access to Psychological Therapies (IAPT) programme. New IAPT services should cut waiting times for psychological treatment of depression and anxiety disorders from months to days. They are intended to be available for all adults on the basis of need rather than age. It is not currently illegal for patients to be discriminated against by the National Health Service (NHS) because of their age. the government intends to introduce new legislation against age discrimination in the provision of goods, facilities and services by the NHS. Further investment and service development will be needed to counter existing age-related inequalities in mental health services

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17. Boundaries or overlap: An examination of the community-oriented clinical practice of community medicine specialists and family/general practitioners

Clinical & Investigative Medicine ◽

10.25011/cim.v30i4.2777 ◽

2007 ◽

Vol 30 (4) ◽

pp. 36

Author(s):

M. L. Russell ◽

L. McIntyre

Keyword(s):

Public Health ◽

Primary Care ◽

Clinical Practice ◽

Community Health ◽

Royal College ◽

Community Medicine ◽

Work Setting ◽

Public Health Medicine ◽

Work Settings ◽

Main Work

We compared the work settings and “community-oriented clinical practice” of Community Medicine (CM) specialists and family physicians/general practitioners (FP). We conducted secondary data analysis of the 2004 National Physician Survey (NPS) to examine main work setting and clinical activity reported by 154 CM (40% of eligible CM in Canada) and 11,041 FP (36% of eligible FP in Canada). Text data from the specialist questionnaire related to “most common conditions that you treat” were extracted from the Master database for CM specialists, and subjected to thematic analysis and coded. CM specialists were more likely than FP to engage in “community medicine/public health” (59.7% vs 15.3%); while the opposite was found for primary care (13% vs. 78.2%). CM specialists were less likely to indicate a main work setting of private office/clinic/community health centre/community hospital than were FP (13.6% vs. 75.6%). Forty-five percent of CM provided a response to “most common conditions treated” with the remainder either leaving the item blank or indicating that they did not treat individual patients. The most frequently named conditions in rank order were: psychiatric disorders; public health program/activity; respiratory problems; hypertension; and metabolic disorders (diabetes). There is some overlap in the professional activities and work settings of CM specialists and FP. The “most commonly treated conditions” suggest that some CM specialists may be practicing primary care as part of the Royal College career path of “community-oriented clinical practice.” However the “most commonly treated conditions” do not specifically indicate an orientation of that practice towards “an emphasis on health promotion and disease prevention” as also specified by the Royal College for that CM career path. This raises questions about the appropriateness of the current training requirements and career paths as delineated for CM specialists by the Royal College of Physicians & Surgeons of Canada. Bhopal R. Public health medicine and primary health care: convergent, divergent, or parallel paths? J Epidemiol Community Health 1995; 49:113-6. Pettersen BJ, Johnsen R. More physicians in public health: less public health work? Scan J Public Health 2005; 33:91-8. Stanwell-Smith R. Public health medicine in transition. J Royal Society of Medicine 2001; 94(7):319-21.

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WikiRecs primary care: developing rapid recommendations for primary care through effective collaboration between systematic review and guideline teams

British Journal of General Practice ◽

10.3399/bjgp18x697085 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X697085

Author(s):

Trudy Bekkering ◽

Bert Aertgeerts ◽

Ton Kuijpers ◽

Mieke Vermandere ◽

Jako Burgers ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Clinical Practice ◽

Primary Care Physicians ◽

Urinary Stones ◽

Care Practice ◽

Supporting Evidence ◽

Supervised Exercise ◽

Review Team ◽

New Evidence

BackgroundThe WikiRecs evidence summaries and recommendations for clinical practice are developed using trustworthy methods. The process is triggered by studies that may potentially change practice, aiming at implementing new evidence into practice fast.AimTo share our first experiences developing WikiRecs for primary care and to reflect on the possibilities and pitfalls of this method.MethodIn March 2017, we started developing WikiRecs for primary health care to speed up the process of making potentially practice-changing evidence in clinical practice. Based on a well-structured question a systematic review team summarises the evidence using the GRADE approach. Subsequently, an international panel of primary care physicians, methodological experts and patients formulates recommendations for clinical practice. The patient representatives are involved as full guideline panel members. The final recommendations and supporting evidence are disseminated using various platforms, including MAGICapp and scientific journals.ResultsWe are developing WikiRecs on two topics: alpha-blockers for urinary stones and supervised exercise therapy for intermittent claudication. We did not face major problems but will reflect on issues we had to solve so far. We anticipate having the first WikiRecs for primary care available at the end of 2017.ConclusionThe WikiRecs process is a promising method — that is still evolving — to rapidly synthesise and bring new evidence into primary care practice, while adhering to high quality standards.

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