lessons from early intervention in psychosis

Lessons from working in and managing an EI service

Early Intervention in Psychosis

11th September 2014

Sarah AmaniEarly Intervention Network Manager

1 Background

2 Proactive Intervention to Enhance Recovery (PIER)

3 My Journey Mobile Health App

4 Reach Out Project

Overview

5 Q & A

“Preventive endeavors in psychotic disorders have been hampered by many obstacles over the past century.

One important barrier has been the corrosive pessimism which has attached to the treatment prospects for schizophrenia in particular since the time of Kraepelin, and the

isolation of this disorder from progressive models of preventative intervention which operate in general health care.”

Patrick McGorry, 2004

2008 2012 20132009 2010 2011

Started work at EIP +University of Surrey

Vision Unclear

Noted frequentStaff turnover

Poor pt satisfactionPoor staff moralePoor clinical outcomes

Manager leftStaff posts cutStaff sickness rocketed

PIER Projectawarded £10,000 (National Leadership Council)

Took up management of teamBegan developing a vision

Completed Transformational Leadership Programme

Reach Out Projectawarded £12,500 Mary Seacole Award(DoH)

YMHN ProjectAwarded £20, 000 (SHA)

Started Proactive Intervention to Enhance Recovery (PIER) project

YMHN *Awarded £35, 000 for YMH economic evaluation by LSE(NHS Confed)

After numerous rejected proposalsMy Journey App awarded £40,000 for evaluation (Burdett Trust)

2014

EnergisersKeeping clinicians enthused

EnablersEnabling clinicians to shine

EssentialsDelivering what is expected “Must Dos”

“Differentiators”

“Distinguishers”“Aspirations”

“Wants”

“Needs”

Developing a way to sustain improvements

Slide 7 © Fjord 2012 | Confidential

Proactive Intervention to Enhance Recovery(PIER) Project

2

1. Create a youth orientated & accessible online resource for first episode psychosis & mental health.

2. Raise awareness & reduce Duration of Untreated Psychosis & enhance Recovery.

3. Embed leadership, innovation & service user involvement in EIP.

Triple Aim

1. Online questionnaires - Surveymonkey2. Website Analytics - Google Analytics3. Video Views - YouTube Analytics4. EIP Benchmarking - measure any changes in:

- Number of referrals- Source of referrals- Demographics - Hospital admission rates & bed stay- Use of sectioning & private provider beds- Post 3 year employment/education status etc- Discharge ‘Destinations’

Evaluation of PIER Project

Number of Young People Admitted to Hospital

Number of Young People Admitted Under Section

Slide 17 © Fjord 2012 | Confidential

My Journey Mobile App3

Released: 1998CPU: 233 MHz

RAM: 32 MB (512 MB max)Storage: 4 GB (+ optical drive)

Display: 38.1 cm Millions of coloursDimensions: 40.1 x 38.6 x 44.7 cm

Weight: 17.3 kgs

Released: 2007CPU: 412 MHzRAM: 128 MBStorage: 4 GB (8 GB max)Display: 8.9 cm Millions of coloursDimensions: 11.4 x 6.1 x 1.2 cmWeight: 135 g

This was ‘portable’...

<10 years...

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Engaging young people with familiar tools

92% of 14-25 year olds own a

smartphone

Sensors, devices, networks, software and

data

worklearning

navigation

discoveryWith a button or two!

creativityvideo

a big screen...

web browser+

applicationlayer

+ APIs

communicationplay camera

sharing

Enabling users to determinemusic their own experience

chat

Health

P

Phase one – 3 months

Final phase – 6 weeks

Future Possibilities

Source: www.openmhealth.org

Slide 34 © Fjord 2012 | Confidential

Reach Out Project4

Community Health Ambassadors should be members of the communities where they live, work, study, play… should be selected by their communities, should be answerable to the communities for their activities, should be supported by the health system but not necessarily a part of its organization,

and have shorter training than professional workers.

World Health Organization (2007)

“

”

Community Health Ambassadors

Slide 38 © Fjord 2012 | Confidential

Key Lessons5

ComplacencyApathy

Fear

Exhaustion

The Four Horsemen

“The patient is the most underused resource in

medicine”e-Patient David deBronkart

Without people its just a whole pile of s….

Stuff.

Slide 43 © Fjord 2012 | Confidential

Thank You