Psychological therapies and interventions - national implementation guide 1: digital evidence based psychological treatments

National Implementation Guide 1: Digital Evidence Based Psychological Treatments

Digital Elements from the National Specification

Psychological therapies and interventions specification - gov.scot (www.gov.scot)

Introduction

Psychological practice can be delivered in person, in groups and remotely and/or digitally.

Psychological evidence-based treatments should be available to help improve quality of life. We also want people to have the tools and support to access more self accessed digital psychological interventions, as well as face to face therapies in person or virtually.

Outcome 2.9: When the individual needs psychological practice from an appropriately trained psychological professional, they will be offered the choice to:

• actively engage in the offers of treatment recommended to them which is based on evidence and best practice.
• where possible, and based on clinical recommendations, be supported to get access to the local options for therapy or interventions that are available and accessible to them (e.g., digital, group work, or in person). This should take account of the person’s ability to access the type of help recommended.

Outcome 5.5: Services and teams that provide psychological treatments and interventions will use referral systems that are clear, accessible, and efficient. Where appropriate, self-referral options can be offered for those needing less complex types of interventions (e.g., accessing a self-help digital intervention).

Digital Elements from National Waiting Times (WT) Guidance

Psychological Therapies and Interventions Waiting Times Standard Definitions (publichealthscotland.scot)

This document sets out what constitutes psychological therapies and interventions (by services, teams, individuals, or digitally (page 3).

The clock stops where an evidence-based, person-led, digital psychological practice is offered (pages 6 and 29).

The clock can also stop when an individual has been given a code to access evidence-based computerised digital interventions and supported by the clinical digital delivery team (page 4).

Referrals to evidence-based digital therapies, such as computerised cognitive behavioural therapy (cCBT) and other accepted evidence-based computerised programmes, specifically tailored to a range of different clinical conditions (page 11).

The standard exists where the individual accesses recommended evidence based digital interventions such as cCBT and when the individual is recommended to start an evidence based digital intervention and given the appropriate code/means to do so e.g. cCBT and is supported by an appropriately trained psychological professional (pages 12 and 13).

For in person and virtually delivered treatments or interventions, the clock stops on the date of appointment. For digital therapies, this is when the person’s individual activation code was given (page 14).

What counts as digital psychological interventions under the waiting times standard

All unsupported self-referral digital therapies (e.g. Sleepio) are not included in the waiting times standard i.e. those evidence based digital treatments not directly supported by the PT digital clinical team. Only the digital treatments approved for use nationally through appropriate clinical governance routes, supported by the clinical digital team, and offered where clinically appropriate to do so, will count to the waiting time standard.

Digital interventions that count towards the waiting times standard should be considered in the same way as any other evidence based treatment. If for any reason the individual does not complete the course of digital treatment, they should be supported by the clinical team to access relevant treatments as clinically appropriate. The flow chart below can be used as a guide and ‘digital as part of wider treatment plan’ should be used in these circumstances.

*With implementation of CAPTND access to ongoing treatments through whole service pathways will be captured, including after the clock stops.

Graphic text below:

Step 1 - Person seeks help for poor psychological health, for example anxiety, depression, from a registered health and social care professional.

Step 2 - Person is assessed as needing treatment for poor psychological health. They start referral to treatment as per WT guidance. At this point the person may get digital offer as part of treatment plan while waiting to be seen by wider clinical team.

For Digital PT Only

Step 3 - Person is sent an activation code or means to start evidence based digital cCBT

Step 4 - The waiting time clock is stopped and the person is supported by the PT clinical digital team.

For Digital PT as initial treatment

Step 1 - Person seeks help for poor psychological health, for example anxiety, depression, from a registered health and social care professional.

Step 2 - Person is assessed as needing treatment for poor psychological health. They start referral to treatment as per WT guidance. At this point the person may get digital offer as part of treatment plan while waiting to be seen by wider clinical team.

Step 3 - Person is referred for psychological therapies team or individual offering psychological practice.

Step 4 - The person is assessed and offered digital intervention / cCBT. They are given the activation code/means to start treatment.

Step 5 - The waiting time clock is stopped and the person is supported by the PT clinical digital team.

Step 6 - The person may need to go on to require further treatments or their case may be closed at the end of digital treatment

For Digital PT as part of wider treatment

Step 1 - Person seeks help for poor psychological health, for example anxiety, depression, from a registered health and social care professional.

Step 2 - Person is assessed as needing treatment for poor psychological health. They start referral to treatment as per WT guidance. At this point the person may get digital offer as part of treatment plan while waiting to be seen by wider clinical team.

Step 3 - Person is referred for psychological therapies team or individual offering psychological practice.

Step 4 - The person is assessed as needing treatment from a professional trained in psychological practice for example via face to face CBT or group therapy.

Step 5 - While the person is waiting for a specific psychological treatment, and where clinically appropriate, the person is sent activation code/means to start digital treatment.

Step 6 - The waiting time clock is stopped. The person is supported by the PT clinical digital team.

Step 7 - The person may go on to require further psychological treatments, or the case may be closed at the end of digital treatments. Please note with implementation of CAPTND access to ongoing treatments through whole service pathways will be captured, including after the clock stops.