Scheduled telephone interventions - from guided self help to therapy: An accessible approach to engaging with service

1. Scheduled telephone interventions� -� from guided self help to therapy:�An accessible approach to engaging with service users and their families Karina Lovell School of Nursing, Midwifery and Social Work

2. Aims: To examine the use of the telephone in mental health care To identify the evidence base To examine some recent research and service delivery To explore the practicalities of delivering GSH or therapy by telephone

3. Why the telephone? Increases access for those with physical/ psychological, social or economic difficulties who are unable to attend scheduled clinic appointments Increases equity and access for those who live in geographical areas with poor psychological provision

4. Telephone has been used to deliver the following Collaborative care of depression Guided self help Minimal interventions Full therapy

5. Mental health problems Depression (mild, moderate and major) OCD Agoraphobia Depression in multiple sclerosis Agoraphobia Panic disorder

6. Evidence base The use of the telephone to deliver therapy has been found to be: Superior to no treatment/wait list (Swinson, 1995) Superior to treatment as usual (Simon, 2004) Superior to a to an alternative psychotherapy by telephone (Mohr,2005) Equal and similar to face to face delivered therapy in some studies (Griest, 2002; Lovell,2005) Less superior to face to face in GSH (Palmer,2002)

7. Current work RCT which compared CBT delivered by face to face with telephone Pilot study of young people and their families with OCD in specialist setting Telephone clinic for those unable to access scheduled clinic appointments in primary mental health care Telephone clinic in partnership with the National Phobic Society Systematic review of therapy delivered by telephone

8. 23/08/2012 A comparison of face-to-face therapist contact vs telephone contact in the treatment of OCD Karina Lovell, Gillian Haddock, Debbie Cox, Chris Jones, Rachel Garvey, David Raines, Chris Roberts, Sarah Hadley, Funded by NHS Executive NE

9. Design and hypothesis A randomized controlled equivalence trial comparing exposure therapy and response prevention delivered either face-to-face or by telephone. Hypothesis (i) Exposure therapy and response prevention delivered by a therapist either face-to-face or by telephone will result in equivalent clinical outcomes in the treatment of OCD,

11. YBOC�s

12. BDI

13. Client satisfaction 0-32 (CSQ) mean scores

14. Clinical significance (total sample)

15. Clinically significantly improved (by group)

16. Conclusions Equivalent clinical outcome between CBT delivered face to face or by telephone No difference in costs except for therapist time costs CBT was delivered by telephone in 40% less therapist time than face to face contact. Equivalent high levels of user satisfaction It offers services another option of increasing access

17. Cognitive Behaviour Therapy for OCD:A Pilot Study of Telephone CBT with adolescents and their families Cynthia Turner, Karina Lovell, Isobel Heyman and Annabel Furth

18. Aims of the pilot Establish feasibility and likely success Determine acceptability Improve access to and availability of CBT Help eliminate geographical inequalities

19. CY-BOCS Results

20. Sample qualitative responses from parents �...because we don�t live locally, it made the treatment accessible.� �We appreciated the flexibility. Our son moved abroad for work, left home and school, and was able to continue TCBT through this. He has always found change difficult & TCBT helped him through major changes in his life.� �The telephone sessions have worked incredibly well for us. The help & support from our therapist has been great. We�ve felt fully involved and able to do things to help our child. TCBT has helped us to cope & look to the future.�

21. Innovations in clinical practice: Working in Partnership with a National User Group -Delivering CBT via the telephone Karina Lovell and Nicky Lidbetter

22. Aims To develop a CBT telephone service in partnership with the National Phobic Society To offer a CBT service to those people who are unable to access scheduled clinic appointments (for geographical, psychological and social reasons).

23. Progress so far Service commenced in May 2005 Requested by 59 People Number of mental health workers delivering CBT by phone (n=11) Currently been evaluated using patient centred measures Future plans � to conduct some in-depth interviews with people receiving the service, and to evaluate on a larger scale

24. Delivering telephone interventions in Primary Care Referrals taken from clinicians when patients unable to attend scheduled clinic appointments Reason for referrals are agoraphobia (with or without substance abuse), disability, work commitments etc Future plans � to formally evaluate

25. Practical application Calls should always be scheduled Emphasise that it is an appointment and ask client to prepare (ie questions, feedback, diaries ready etc) Agree a code for when client is unable to talk eg �Mary� �Mum� �Dad� Most patients want appointments between 6-8pm

26. Conclusion There is an emerging evidence base for the use of the telephone to deliver therapy It offers an accessible delivery system to those unable to access scheduled clinic appointments It is acceptable to patients It is less clear whether it is acceptable to clinicians or service providers

27. �Most of all we need to understand why the telephone, after being part of our lives for so long, has met with so much suspicion and so many irrational assumptions, and why there is so little evidence on how best to use this simple piece of communication technology �(Toon, Editioral, BMJ, 2002).

28. Thanks for listening Karina.Lovell@manchester.ac.uk