A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service
Abstract Background Psychological treatment delivered by telephone is recommended by the National Institute for Health and Care Excellence (NICE) for mild to moderate depression and anxiety, and forms a key part of the Improving Access to Psychological Therapy (IAPT) programme in the UK. Despite evi...
Main Authors: | , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2019-12-01
|
Series: | BMC Health Services Research |
Subjects: | |
Online Access: | https://doi.org/10.1186/s12913-019-4824-4 |
id |
doaj-3f5960c69e5d44de932df2ff49ef71c4 |
---|---|
record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kelly Rushton Claire Fraser Judith Gellatly Helen Brooks Peter Bower Christopher J. Armitage Cintia Faija Charlotte Welsh Penny Bee |
spellingShingle |
Kelly Rushton Claire Fraser Judith Gellatly Helen Brooks Peter Bower Christopher J. Armitage Cintia Faija Charlotte Welsh Penny Bee A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service BMC Health Services Research Telephone therapy Psychological therapy Guided self-help Anxiety Depression Psychological wellbeing practitioner |
author_facet |
Kelly Rushton Claire Fraser Judith Gellatly Helen Brooks Peter Bower Christopher J. Armitage Cintia Faija Charlotte Welsh Penny Bee |
author_sort |
Kelly Rushton |
title |
A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service |
title_short |
A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service |
title_full |
A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service |
title_fullStr |
A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service |
title_full_unstemmed |
A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service |
title_sort |
case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the improving access to psychological therapies service |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2019-12-01 |
description |
Abstract Background Psychological treatment delivered by telephone is recommended by the National Institute for Health and Care Excellence (NICE) for mild to moderate depression and anxiety, and forms a key part of the Improving Access to Psychological Therapy (IAPT) programme in the UK. Despite evidence of clinical effectiveness, patient engagement is often not maintained and psychological wellbeing practitioners (PWPs) report lacking confidence and training to deliver treatment by telephone. This study aimed to explore the perspectives of professional decision makers (both local and national) on the barriers and facilitators to the implementation of telephone treatment in IAPT. Methods Sixteen semi-structured qualitative telephone interviews and one focus group were carried out with decision makers (n = 21) who were involved locally and nationally in policy, practice and research. The interviews and focus group were coded thematically, and then mapped onto the four core constructs of Normalisation Process Theory (NPT). Results The use of telephone for psychological treatment was universally recognised amongst participants as beneficial for improving patient choice and access to treatment. However, at service level, motives for the implementation of telephone treatments are often misaligned with national objectives. Pressure to meet performance targets has become a key driver for the use of telephone treatment, with promises of increased efficiency and cost savings. These service-focussed objectives challenge the integration of telephone treatments, and PWP acceptance of telephone treatments as non-inferior to face-to-face. Ambivalence among a workforce often lacking the confidence to deliver telephone treatments leads to reluctance among PWPs to ‘sell’ treatments to a patient population who are not generally expecting treatment in this form. Conclusions Perceptions of a need to ‘sell’ telephone treatment in IAPT persist from top-level decision makers down to frontline practitioners, despite their conflicting motives for the use of telephone. The need for advocacy to highlight the clinical benefit of telephone treatment, along with adequate workforce support and guidance on best practice for implementation is critical to the ongoing success and sustainability of telephone treatment in primary care mental health programmes. |
topic |
Telephone therapy Psychological therapy Guided self-help Anxiety Depression Psychological wellbeing practitioner |
url |
https://doi.org/10.1186/s12913-019-4824-4 |
work_keys_str_mv |
AT kellyrushton acaseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT clairefraser acaseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT judithgellatly acaseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT helenbrooks acaseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT peterbower acaseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT christopherjarmitage acaseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT cintiafaija acaseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT charlottewelsh acaseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT pennybee acaseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT kellyrushton caseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT clairefraser caseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT judithgellatly caseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT helenbrooks caseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT peterbower caseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT christopherjarmitage caseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT cintiafaija caseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT charlottewelsh caseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice AT pennybee caseofmisalignmenttheperspectivesoflocalandnationaldecisionmakersontheimplementationofpsychologicaltreatmentbytelephoneintheimprovingaccesstopsychologicaltherapiesservice |
_version_ |
1724369481788030976 |
spelling |
doaj-3f5960c69e5d44de932df2ff49ef71c42020-12-27T12:03:55ZengBMCBMC Health Services Research1472-69632019-12-0119111210.1186/s12913-019-4824-4A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies ServiceKelly Rushton0Claire Fraser1Judith Gellatly2Helen Brooks3Peter Bower4Christopher J. Armitage5Cintia Faija6Charlotte Welsh7Penny Bee8School of Health Sciences, Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science CentreSchool of Health Sciences, Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science CentreSchool of Health Sciences, Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science CentreDepartment of Health Services Research, Institute of Population Health Sciences, University of LiverpoolNIHR School for Primary Care Research, Centre for Primary Care and Centre for Health Informatics, Manchester Academic Health Science Centre, University of ManchesterSchool of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreSchool of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science CentreSchool of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science CentreSchool of Health Sciences, Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science CentreAbstract Background Psychological treatment delivered by telephone is recommended by the National Institute for Health and Care Excellence (NICE) for mild to moderate depression and anxiety, and forms a key part of the Improving Access to Psychological Therapy (IAPT) programme in the UK. Despite evidence of clinical effectiveness, patient engagement is often not maintained and psychological wellbeing practitioners (PWPs) report lacking confidence and training to deliver treatment by telephone. This study aimed to explore the perspectives of professional decision makers (both local and national) on the barriers and facilitators to the implementation of telephone treatment in IAPT. Methods Sixteen semi-structured qualitative telephone interviews and one focus group were carried out with decision makers (n = 21) who were involved locally and nationally in policy, practice and research. The interviews and focus group were coded thematically, and then mapped onto the four core constructs of Normalisation Process Theory (NPT). Results The use of telephone for psychological treatment was universally recognised amongst participants as beneficial for improving patient choice and access to treatment. However, at service level, motives for the implementation of telephone treatments are often misaligned with national objectives. Pressure to meet performance targets has become a key driver for the use of telephone treatment, with promises of increased efficiency and cost savings. These service-focussed objectives challenge the integration of telephone treatments, and PWP acceptance of telephone treatments as non-inferior to face-to-face. Ambivalence among a workforce often lacking the confidence to deliver telephone treatments leads to reluctance among PWPs to ‘sell’ treatments to a patient population who are not generally expecting treatment in this form. Conclusions Perceptions of a need to ‘sell’ telephone treatment in IAPT persist from top-level decision makers down to frontline practitioners, despite their conflicting motives for the use of telephone. The need for advocacy to highlight the clinical benefit of telephone treatment, along with adequate workforce support and guidance on best practice for implementation is critical to the ongoing success and sustainability of telephone treatment in primary care mental health programmes.https://doi.org/10.1186/s12913-019-4824-4Telephone therapyPsychological therapyGuided self-helpAnxietyDepressionPsychological wellbeing practitioner |