A national survey of health service infrastructure and policy impacts on access to computerised CBT

Abstract Background: NICE recommends computerised cognitive behavioural therapy (cCBT) for the treatment of several mental health problems such as anxiety and depression. cCBT may be one way that services can reduce waiting lists and improve capacity and efficiency. However, there is some doubt about the extent to which the National Health Service (NHS) in the UK is embracing this new health technology in practice. This study aimed to investigate Scottish health service infrastructure and policies that promote or impede the implementation of cCBT in the NHS. Methods: A telephone survey of lead IT staff at all health board areas across Scotland to systematically enquire about the ability of local IT infrastructure and IT policies to support delivery of cCBT

Feasibility of a UK community-based, eTherapy mental health service in Greater Manchester: repeated-measures and between-groups study of ‘Living Life to the Full Interactive’, ‘Sleepio’ and ‘Breaking Free Online’ at ‘Self Help Services’

Objectives: There is increasing evidence to support the effectiveness of eTherapies for mental health, although limited data have been reported from community-based services. Therefore, this service evaluation reports on feasibility and outcomes from an eTherapy mental health service. Setting: ‘Self Help Services’, an Increasing Access to Psychological Therapies (IAPT) eTherapy service in Greater Manchester. Participants: 1068 service users referred to the service for secondary care for their mental health difficulties. Interventions: Participants were triaged into one of three eTherapy programmes: ‘Living Life to the Full Interactive’ for low mood, stress and anxiety; ‘Sleepio’ for insomnia; and ‘Breaking Free Online’ for substance misuse, depending on clinical need. Primary outcomes measures: Standardised psychometric assessments of depression, anxiety and social functioning, collected as part of the IAPT Minimum Data Set, were conducted at baseline and post-treatment. Results: Data indicated baseline differences, with the Breaking Free Online group having higher scores for depression and anxiety than the Living Life to the Full Interactive (depression CI 1.27 to 3.21, p<0.0001; anxiety CI 077 to 1.72, p<0.0001) and Sleepio (depression CI 1.19 to 4.52, p<0.0001; anxiety CI 2.16 to 5.23, p<0.0001) groups. Promising improvements in mental health scores were found within all three groups (all p<0.0001), as were significant reductions in numbers of service users reaching clinical threshold scores for mental health difficulties (p<0.0001). Number of days of engagement was not related to change from baseline for the Living Life to the Full or Sleepio programmes but was associated with degree of change for Breaking Free Online. Conclusion: Data presented provide evidence for feasibility of this eTherapy delivery model in supporting service users with a range of mental health difficulties and suggest that eTherapies may be a useful addition to treatment offering in community-based services

Clinicians’ attitudes towards, and use of, computerised cognitive behaviour therapy: a research portfolio

BACKGROUND: Computerised Cognitive Behaviour Therapy (cCBT) is effective for a range of mental health difficulties but research indicates that the rate of uptake is low amongst clinicians. Most of the literature regarding cCBT tends to focus on evidence demonstrating its effectiveness or patient views of cCBT, but there is limited research looking at clinician or provider views. AIMS: The systematic review and empirical research project aimed to examine staff attitudes towards cCBT. The empirical study also aimed to establish whether constructs of Normalisation Process Theory predicted clinicians’ a) self-reported attitudes towards cCBT and b) self-reported referral behaviour regarding cCBT. METHODS: A systematic review of four electronic databases was conducted. Nineteen studies were identified for inclusion in the review and subjected to data extraction, quality assessment and narrative synthesis. For the empirical study, an online survey was completed by 246 individuals who provide psychological input to people in the UK. Stepwise regression was used to examine predictors of attitudes and referral rates. RESULTS: Findings from the systematic review indicated that clinicians were generally of the view that cCBT is acceptable and effective to an extent. No firm conclusions could be drawn regarding the rate of use of cCBT by clinicians due to the heterogeneity between studies. Similarly, the empirical study found that clinicians reported both negative and positive attitudes towards cCBT. Fewer than half of respondents had ever referred a patient to cCBT and the rates of referral were typically low. Constructs of NPT were important predictors of both attitudes and self-reported referral rates. CONCLUSIONS: The current findings indicate that clinicians exhibit mixed attitudes towards cCBT. The empirical study indicates that NPT may be a useful theory in predicting attitudes and behaviours toward healthcare interventions but additional research is required to establish whether this finding is replicable in areas beyond cCBT

Rapid evidence review : challenges to implementing digital and data-driven technologies in health and social care

The aim of this rapid evidence review was to identify the main challenges involved in implementing digital and data-driven technologies in health and social care. We aimed to address the following research questions: RQ1: what are the main challenges involved in successfully implementing and using digital and data-driven technologies in health and social care? RQ2: what is the nature of these challenges and how do they arise? RQ3: what does the literature suggest is required to overcome these challenges? The review was carried out in two stages: an initial scoping phase (phase 1) followed by more detailed analysis of selected evidence (phase 2). Studies were selected for inclusion in phase 2 mainly on the basis of relevance to real-world implementation in the UK NHS and similar health systems in high-income countries

UK-wide support infrastructure for low frequency noise sufferers ('LFN Network')

The project was set up to meet a need for improved treatment of Low Frequency Noise (LFN) complaints in cases where no noise source could be found. Such cases can be highly distressing for the complainant and difficult to handle by the Environmental Health Officers (EHOs) concerned and so tend to result in disproportionate use of resources. The hypothesis is that, irrespective of the (unknown) cause of the LFN perception, the perception may be lessened through application of techniques specifically adapted from the field of tinnitus and hyperacusis therapy. The aim of the project was therefore to establish, on a trial basis, a national network of treatment centres for sufferers of LFN located within the existing network of tinnitus clinics in the UK. A network of nine audiology centres was established, including eight with a good geographical spread in England and one in Scotland. A treatment protocol, specific to LFN cases, was then developed through discussions with the centres and a referral pathway was also established. Each centre made contact initially with EHOs in one or two local authorities in their vicinity to offer the service which was widened to a larger catchment area if sufficient referrals were not forthcoming. Fourteen subjects took part, eleven of which were referred from EHOs, the remaining three being self-referred. Outcome measures were based on a combination of validated questionnaires for general health, anxiety, depression, tinnitus handicap (with LFN substituted for tinnitus) and hyperacusis, combined with visual-analogue scales specifically developed for LFN to measure the pitch and loudness of the perceived LFN and the associated distress. Qualitative and open questions were also used. Potential benefits to EHOs of being able to make referrals were evaluated by semi-structured telephone interviews in which five EHOs participated. Generally, EHOs were very positive about the service and wanted it to continue. It was clear that LFN cases require significant resources which can be reduced if the referral service is available. Audiologists’ experience was evaluated in a similar way: they were generally willing to take part in the scheme and wanted it to continue and there was a feeling that they would have liked more referrals to get more experience in the use of the protocol. The results showed a mixed picture with some clients, three in particular, showing improved scores across a range of measures with little or no benefit for others and a worsening for one case. The improvement of some clients is positive given the lack of options available for this client group, however, the success of the approach can be considered partial at best. The questionnaire scores indicated that individuals taking part were significantly agitated, stressed and distressed. Those individuals with LFN complaint have a significant clinical need although in the main they were not clinically anxious or depressed. The model proposed of stress and increased auditory gain is a plausible explanation for the symptoms noted in LFN cases. In particular, the involvement of the sympathetic autonomic nervous system, and of the emotional brain, is likely to be a faithful representation of the clinical situation. A number of useful signposts for future development were derived. First, EHOs as well as audiologists should ideally receive training in best practice to help them to handle the particular sensitivities of LFN cases. More awareness and information for GPs is also recommended. A simplification of the referral route, potentially going direct to the audiologist rather than via the GP would also be beneficial. A strong argument for the continuation of the service is that some EHOs are now taking the initiative in contacting audiologists independently to refer LFN complainants in ‘No Noise Found’ cases. Without adequate training things could be made worse but access to a specific LFN protocol and associated training is likely to increase the chances of success significantly. It is recommended that existing guidance for EHOs be extended to include details of audiology services, guidelines for EHOs in making referrals and reference to the LFN treatment protocol. Using data from the study two independent estimates of the incidence rates of LFN cases can be derived. It is estimated that there are up to 160 complainants per year in the NHS corresponding to 0.32 cases per 100 thousand per year. The incidence rate based on referrals made by EHOs is 1.01 per 100 thousand per year within local authorities. It is not known to what extent, if any, these populations overlap

Digital divide and its impact on the performance of students taking high-stake computer-based university entrance examination in Nigeria

Using computers for assessment has various advantages for both educators and test takers. However, the literature has no consensus on the impact of ICT individual differences on CBT performance and experience. As a result, additional evidence is required, particularly for students from digitally divided regions. In Nigeria, the Unified tertiary matriculation Examination (UTME), a large-scale university admission examination, was fully computerised in 2015. However, the learning mode in most high schools does not align with the computer-based assessment method adopted for the high-stakes examination, resulting in a potential disadvantage for some applicants. This study investigated ICT-related individual differences (computer familiarity and computer-based tests anxiety and attitudes) among secondary school students taking large-scale high-stake CBT university entrance examinations in Nigeria and its effects on their performance on the test. In order to achieve this aim, we conducted a review of relevant literature, conducted two quantitative surveys and a qualitative enquiry. The quantitative study’s findings revealed significant variations in the access and use of computers among students taking UTME, especially when comparing students in publicly owned and privately owned schools. Furthermore, computer familiarity positively correlates with students’ performance in UTME. However, computer attitude and anxiety before and after UTME were moderate and had no significant relationship with test performance. The qualitative study explores the students’ experiences in more depth and gains more insights into the factors contributing to their attitudes and anxiety. This thesis thoroughly describes the procedure above and its results. This study underlines the necessity of addressing the digital gap in education in Nigeria by demonstrating inequalities in access to technology and infrastructure among students taking high-stake computerised examinations in Nigeria and its impact on their performance.Using computers for assessment has various advantages for both educators and test takers. However, the literature has no consensus on the impact of ICT individual differences on CBT performance and experience. As a result, additional evidence is required, particularly for students from digitally divided regions. In Nigeria, the Unified tertiary matriculation Examination (UTME), a large-scale university admission examination, was fully computerised in 2015. However, the learning mode in most high schools does not align with the computer-based assessment method adopted for the high-stakes examination, resulting in a potential disadvantage for some applicants. This study investigated ICT-related individual differences (computer familiarity and computer-based tests anxiety and attitudes) among secondary school students taking large-scale high-stake CBT university entrance examinations in Nigeria and its effects on their performance on the test. In order to achieve this aim, we conducted a review of relevant literature, conducted two quantitative surveys and a qualitative enquiry. The quantitative study’s findings revealed significant variations in the access and use of computers among students taking UTME, especially when comparing students in publicly owned and privately owned schools. Furthermore, computer familiarity positively correlates with students’ performance in UTME. However, computer attitude and anxiety before and after UTME were moderate and had no significant relationship with test performance. The qualitative study explores the students’ experiences in more depth and gains more insights into the factors contributing to their attitudes and anxiety. This thesis thoroughly describes the procedure above and its results. This study underlines the necessity of addressing the digital gap in education in Nigeria by demonstrating inequalities in access to technology and infrastructure among students taking high-stake computerised examinations in Nigeria and its impact on their performance

Investigating the Comprehensive Inventory of Thriving (CIT) as a rehabilitation outcome measure

Reliable and valid outcome measures are needed in community rehabilitation settings following acquired neurological injury. The Comprehensive Inventory of Thriving (CIT) (Su, Tay and Diener, 2013) was investigated for this purpose. The CIT is a 54 item self-report measure that provides 18 subscales and seven main scales of thriving: Relationships, Engagement, Mastery, Autonomy, Meaning, Optimism and Subjective Well-being. Participants (n=76) were administered the CIT on admission to a community rehabilitation service. The mean age of participants was 54.8 (SD = 17.7), with 43% being male. The main diagnostic groups were cerebrovascular disease (28%), traumatic brain injury (17%) and Parkinson's disease (12%). Internal consistency was moderate to high (α =.6 to .9) for all subscales with the exception of Support (Relationships) and Skills (Mastery); and high (α=.79-.93) for all indexes with the exception of Subjective Wellbeing. Correlational analyses supported the scale groupings. However, the subscales of Support (Relationships) and Skills (Mastery) did not correlate significantly with any subscales. Additionally the Subjective Well-being scale should not be calculated, but instead its three subscales (Negative Feelings, Life Satisfaction, Positive Feelings) used individually. In terms of demographic variables, there were no significant gender differences on CIT scales. Age had low correlations with two Relationships subscales only (Trust r=.23, p=.04; Loneliness r=-.25, p=.03). Diagnostic group minimally influenced CIT scores. Significant between-group differences were only found for Accomplishment (Mastery), with post-hoc analyses indicating higher levels for the cerebrovascular group. The CIT shows considerable promise in rehabilitation outcomes as a reliable and valid multi-component measure of wellbeing

A wide-angle international review of evidence and developments in mental health policy and practice. Evidence review to inform the parameters for a refresh of A Vision for Change (AVFC).

This report presents the results of an evidence review to inform the parameters of the planned refresh of mental health policy in Ireland ten years after the publication of the existing policy framework set out in A Vision for Change (AVFC). The approach encompassed a stock-take of mental health developments in Ireland and a review of international developments, innovation, evidence and good practice. The review had a broad brief covering the various dimensions of the mental health terrain that might have relevance for informing the parameters of a refresh of mental health policy in Ireland. As the timeframe for the exercise was short (approximately 12 weeks) the review took a structured, but pragmatic, broad sweep or ‘wide-angle’ perspective and approach