North Yorkshire IAPT service covers the largest county in England with an area of 8,654 square kilometres. Created in April 2010 and provided by Tees Esk and Wear Valley NHS Foundation Trust, the service covers the Yorkshire Dales and North Yorkshire Moors as well as significant towns including Scarborough, Harrogate and Northallerton.

The service was aware of a growing body of research evidence which highlighted under-representation of people aged 65 and above in IAPT referral rates, nationally and locally. In addition, managers were aware that national data showed older adults referred into IAPT engage with and complete treatment with a better recovery rate than other aged cohorts.

An older people’s project began with a review of data held by the service to ensure managers had a clear understanding of the referral sources and rates of older people.

A Service Improvement Group (SIG) was developed comprising the clinical lead as project sponsor, a senior psychological wellbeing practitioner (PWP) as project lead and representation from clinicians across the service. The project group took part in bespoke project management training provided by Tees Esk and Wear Valleys NHS Trust Senior Planning and Business Development Manager who promoted the use of plan, do, study, act (PDSA) project methodology. On completion of the training four work streams were identified:

• The development of older people’s champions. We encouraged staff who had a particular interest or experience in this area to put themselves forward for the champion role which was to
• represent older people’s issues within the team
• ensure older people were considered in wider service developments
• develop good links and effective working alliances with local voluntary and statutory services for older people
• collaborate and share good practice across North Yorkshire IAPT via the older people’s project.
• Engaging with stakeholders. The SIG undertook a mapping exercise locally to identify key stakeholders within North Yorkshire. Links are being established with those stakeholders who are internal to our Trust as well as external. To enhance these new relationships the service is undertaking a full review of its promotional materials to develop an older age-specific approach.
• Investing in continuous professional development. We looked nationally for guidance, and our project lead attended training in Working with Older People: CBT Skills for High Intensity (HI) and PWP Practitioners. We developed an in-house training event for all our PWPs utilising ‘A Clinicians guide to: Low Intensity CBT with older people’ by Chellingsworth, Kishita, Laidlaw. The service focused on consolidating the learning from training, and each attendee was asked to develop an individual action plan to be discussed in clinical supervision.
• Enhancing the core IAPT offer. As a service we do not make assumptions about what older adults may or may not respond best to. However, we do make sure that we attend to patient choice, for example routine assessment modality and timing of interventions.

We are reviewing all our step two interventions to ensure the materials are inclusive and include age-appropriate examples. We already have volunteers within North Yorkshire IAPT service but aspire to recruit older adults who can support older people who may need assistance in attending psycho-educational courses. We hope they will also be able to contribute to peer-to-peer promotion of IAPT services.

Additionally, we have updated our internal performance reports to support future data-informed decision-making. We have created bespoke GP packs for service visits which show national and local key performance indicator information as well as older adult data. This provides a clear rationale for GPs to increase access to IAPT for older adults.

The implementation of the older people’s project started in June 2017. So far, there have been a number of observable changes in the service on the back of this work. These include

• a sense of increased confidence in PWP clinicians working effectively with older people
• an increased awareness of the importance of adapting approaches to ensure that IAPT is accessible and relevant to older people
• a new appreciation of the high level of engagement and recovery for this cohort
• an increase in the number of referrals for this cohort
• clinicians reporting a high level of enjoyment in working with individuals within this cohort – illustrated by these two examples:

“Working with older people has been some of the most satisfying interventions as a PWP… they really engage well, are good attenders and we can have a significant impact on their physical and mental health for the good. As a group it can be challenging but also seeing and hearing their delight on making progress is one of the best bits of the role!”

“I find it a pleasure to work with older adults. I have worked with this age group in several different services and roles and I’ve always found it a very enjoyable and rewarding experience. In the context of a PWP, I’ve found that older adults have really appreciated the support and guidance that we give and do use the CBT techniques to make a positive difference in their lives.”

The service is focusing on embedding the older people’s champions into business as usual. The champions meet bi-monthly to share best practice, any new research, lessons learned from data and major achievements. This information is shared by the champions at their respective monthly team meetings in a slot which has become a standard agenda item.

An area identified for future focus has been developing stakeholder relationships within the local community. We are developing a general wellbeing in older age presentation which can be delivered to interested organisations. We have also met with and taken advice from our colleagues who work with older adults and have identified a number of health clinics where we can promote our services – for example flu clinics and carers’ meetings. If these initiatives follow similar lines to work we have undertaken in perinatal mental health and long-term conditions, we hope eventually to co-locate clinics with external stakeholders.

For further information please contact:

Alison M Hobbs
North Yorkshire IAPT Clinical Lead
Improving Access to Psychological Therapies
Tees Esk and Wear Valley Foundation Trust

Phone: 01423 852137
Website: www.tewv.nhs.uk