Rapidly implementing virtual therapeutic solutions: Northern Ireland

Overview

By using a quality improvement methodology, psychological therapies service was able to pivot quickly to virtual therapeutic solutions in response to the pandemic. As a result, the service improved access to therapies and has seen an uptick in service users achieving reliable clinical improvement.

Key benefits and outcomes

• No inequalities of access to virtual therapy compared to face-to-face therapy.
• Improved access in the 56-64 and 65+ year age groups.
• Reduction in travel costs, increased opportunities for clients to engage during the working day and improved access for those with clinical presentations (such as social anxiety and agoraphobia) and for those living in remote locations, including offshore islands.
• Percentage of service-users achieving clinical improvements rose from 40 per cent to 46 per cent

The challenge

The Psychological Therapies Service (PTS) within the Northern Health and Social Care Trust provides a range of talking therapies for adults with moderate-to-severe mental health difficulties.

Like many services during the pandemic, it needed to find a way to maintain an accessible, acceptable and effective service for its clients. Online delivery was identified as the best route for doing so, but the PTS team needed to understand how to implement a new service with clients and staff; the efficacy of virtual delivery; and the acceptability and accessibility of virtual delivery for service users.

The solution

To do this, it used a range of quality improvement (QI) methodologies, including driver diagrams and fishbone analysis, to identify the areas of service delivery needing the most attention. PDSA cycles (plan, do, study, act) were used to redesign administrative and clinical processes with 55 staff members.

The PTS team also used the literature and evidence base for virtual care, along with a synthesis of regulations from numerous professional bodies, to co-produce step-by-step guides with service users on the new virtual therapy solution.

Since implementing virtual therapeutic solutions, the PTS team has made use of routine outcomes measurement (ROM), which enables continual analysis and benchmarking against previous years’ statistics. This helps to ensure safe and effective care provision focused on treatment quality.

Results and benefits

The move to virtual delivery resulted in benefits for service users and staff in terms of access, with effectiveness and acceptability scores comparable to pre-pandemic levels:

• 46 per cent of PTS clients accessing virtual therapeutic solutions achieved reliable clinical improvement (a widely used statistical metric), compared to 40 per cent in a matched sample.
• 96 per cent of clients felt they were “treated with courtesy and respect”
• 100 per cent reported they were seen promptly for their appointments
• concerns about indirect age discrimination were not supported, as access increased in the 56-64 and 65+ year age groups.

Overcoming obstacles

An early issue was an unfamiliarity among service users and staff with certain technology and how to maintain choice when choosing a platform. PDSA cycles were used to determine service users’ preferred platforms and guides were developed to assist service users and staff.

QI literature has identified that up to 85 per cent of improvement projects fail between the ideas stage and sustained implementation. To overcome this, the PTS funded the time for a 0.5 whole-time equivalent (WTE) assistant psychologist and 0.1wte consultant clinical psychologist. Their roles were to maintain progress by undertaking ongoing monitoring and holding others too account.

Takeaway tips

• Co-creation of new services with staff and service users is crucial to overcome the potential stumbling blocks of implementing virtual services
• Early adopters can be encouraged to be champions of change
• Ongoing monitoring and holding to account are essential, requiring protected time and identified responsibilities for staff.