This document summarizes findings from outcomes data collected by the Child and Young Person Improving Access to Psychological Therapies (CYP IAPT) program in the UK. It discusses findings for both practice and evaluation. For practice, it outlines how outcome measures can be used at different stages of therapy to inform treatment and track progress. It also shares views from young service users on how outcome measures can help make therapy more collaborative and meaningful. For evaluation, it provides an example annual report analyzing outcomes data from the first year of the program, including who was seen, common problems, interventions offered and emerging outcomes. It concludes by looking ahead to future practice guidance and evaluation reports.

1. Findings so far from outcomes data
and looking to the future
Miranda Wolpert
CYP IAPT National Informatics Lead
Chair Outcomes and Evaluation Group
Director CAMHS Outcomes Research Consortium (CORC)
Director Evidence Based Practice Unit (EBPU) UCL & AFC
http://www.iapt.nhs.uk/cyp-iapt
http://www.corc.uk.net

2. Acknowledgments
Outcomes and Evaluation Group
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Duncan Law- Clinical and outcome monitoring expertise in CAMHS and lead
for COOP
Margaret Murphy- Clinical and outcome monitoring expertise in CAMHS
David Clark - Adult IAPT measurement and analysis expertise
Kate Martin – Young Minds, service user participation expertise
Jessica Deighton – CAMHS measures and psychometric analysis expertise
Paul Wilkinson – CAMHS Psychiatrist with focus on outcome evaluation
Barbara Rayment – Youth Access, Young people’s counselling services
expertise
Margaret Oates – Adult IAPT data collection and collation expertise
Cathy Troupp – Research in use of ROMS in psychotherapy
David Trickey – Service Lead and expert in PTSD
Paul Stallard - CBT and service development expertise
Stephen Scott – Parenting expertise
Ro Rossiter – Learning Disabilities
Emma Morris - Service lead, Cultural issues
Philippe Mandin - Cultural issues
Rabia Malik - Cultural issues
Anne York – CAMHS S specialist
Anne O Herlihy - Service transformation
David Lowe - expert in use of proms in Family therapy
Peter Stratton – Family work
Cathy Street – CYP participation
CORC Nexus consortium
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Dr Isobel Fleming, CORC Programme Lead
Jenna Bradley, CORC Project Manager
Rachel Argent, CORC Research Assistant
Dr Dan Brown, MegaNexus Operations Lead
Lee Murray, MN Project Manager
Phanindra Kaza, MN Senior Software Engineer
Nadia Kuftinoff, MN Project Support
Dan Reader-Powell, MN Systems Administrator
Data managers
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Alex Papdakis
Andrea Shand
Barbara Snaith
Bill Clarke
Claire Newall
Craig Colling
David Markwick
Diana Viscusi
Elaine Blagden
Emma Broda
Fatima Blade
Hannah Mendoza-Wolfsaon
Husman Rafiq
Jacqui legge
Jess Parsons
Julia Yu
Laura Cunnen
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Liam Connolly
Maris Vainre
Mark Coughlin
Mark Lowe
Mary Urquhart
Mel Jarvis
Michelle McFarlane
Michelle Adams
Lesley French
Mike Presneill
Muhammad Akram
Paul Fry
Paul Townley
Sara Barnes
Sarah Oliver
Wendy Geraghty

3. Outcomes for practice
Outcomes for evaluation

4. Outcomes for practice and evaluation

5. Findings so far: outcomes for practice

6. Outcomes for practice
Assessment/Choice
Partnership/ongoing
work
Review & Close
• What’s the problem?” (assessment) This is understanding the issue the young person
or family have come for help with
• “What do you want to change?” (goals or aims of therapy) – this is understanding
the specific goals the young person or family have - the things they want to work on
in coming to a service
• How are we getting on together?” (engagement or alliance) It is important to get
things right from the start
• “How are things going?” (Symptom/goal tracking) – this is tracking to see if things
are progressing during and intervention
• Have we done as much as we can/need to?” (collaborative decision to close or refer
on) – re-review of question 1 e.g. Time2 SDQ (if not used as tracker in long-term case)
• “How has this experience been generally?” (experience of service overall).

7. Practice rules
The 4M principles
Minimal Burden
No unnecessary form-filling.
Multiple Perspectives
Consider collecting different people’s views.
Meaningful Use
Only select forms that could provide meaningful
information that will be used by somebody.
Missing Something?
Consider whether any of the forms could fill a gap that
you may not have covered in some other way that
might be useful to know about.

8. Practice rules
Some Do’s and Don’ts of using clinical outcome tools
Do
Make sure you have the forms you need, ready before the session
Do
Always explain why you are asking anyone to fill out a form
Do
Look at the answers
Do
Discuss the answers with service users
Do
Share the information in supervision
Do
Always use information from the forms in conjunction with other
clinical information
Don’t
Give out a questionnaire if you think the person doesn’t understand
why they are being asked to complete them
Don’t
Give use any forms if you don’t understand why you are using it
Don’t
Insist on someone filling out forms if they are too distressed
Don’t
See the numbers generated from outcome tools as an absolute fact
Don’t
See your clinical judgment as an absolute fact

9. Findings in practice: young peoples’ views
PROMs help make
the balance of power
more equal.
Gives us a shared understanding of
…where we’re starting from.
…where we’re heading to.
…how we’re going to get there.
Enables us to get an in-depth
understanding of what we’re
feeling, why we’re feeling it
and what we can do about it.
It means if we go
off track or get a
bit lost along the
way, we can both
figure out how to
find the way
back again.
Makes us feel like it’s a shared experience
between us and the clinician... like we’re in
this together.
It is important to
monitor outcomes to
make sure the person
feels better not worse
It makes us feel like there is a
point to our therapy
Quotes from young people from YoungMinds consultation in Devon. Reference : Talking About Talking Therapies/Devon CAMHS
Views of members of VIK Young Minds

10. Findings in practice
“Using outcome measures in a therapy session needs to
be done in a collaborative way with the young person
and they must feel that it is important. Looking at the
data and assessing it both with the young person and
away from the session is key. Don’t just gather the
information; use it to make the therapy better!”
Young person with experience of service use
To join the conversation and see user perspective go
to..
http://www.myapt.org.uk

11. Findings so far from outcomes for
evaluation data

12. Outcomes for evaluation

13. Evaluation rules
The dreaded 90%!
Time 1 Patient Reported
Outcome Measure (PROM)
PROM with clinical norms.
[1]
[2]
Time 2 PROM
Education,
employment and
training (EET)
PROM from same
EET information
reporter using same recorded by
questions as Time 1 practitioner
The last recorded measure at point of closure will be used in calculations of outcome
If EET is recorded only once this will be taken as both T1 and T2 measure

14. Evaluation rules: PROMs with clinical
norms
•SDQ (and/or impact scale separately)
•RCADS (and/or subscales for depression and
different forms of anxiety)
•C/ORS
•Impact of Event Scale
•Behavioural difficulties child and parent
measures.

15. Annual Report
Evaluation data : who seen Y1
Jan-Dec 2012
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1366 cases opened, 255 cases closed
Mean age 11.9 (SD=4.2; peaks at 8 and 15 yrs)
41.9% male, 57.7% female (0.4% missing)
59.2% White British, 11.6% other ethnicity
(29.2% missing)
• 18.4% of closed cases were only seen once
– of these, 42.6% closed on professional advice

16. Annual Report
Evaluation data : What sort of problems
(NB mainly from CYP IAPT trainees)
N= 565, Missing N= 678
Behaviour difficulties
Family relationship difficulties
Substance abusing
Depression, low mood
Panic disorder
Anxious socially
Compelled to do or think
ADHD
Severe inter-personal difficulties
Anxious away from home
Traumatic event
Avoids specific things
Anxious generally
Carer management difficulty
Habit problem
Attachment difficulties
Eating difficulties
Self harming
Avoids going out
Toilet difficulties
Gender discomfort
Selective mutism
Psychosis
Mild
Moderate
Severe
0.0
5.0
10.0
15.0
Percentage
20.0
25.0
Note high proportion of missing
data. Not sure this is
representative of all data
submitted.

17. Annual Report
Evaluation data : Interventions Offered
(NB mainly from CYP IAPT trainees)
N= 688, Missing N= 678
Note high
proportion of
missing data
Note: Categories are not mutually exclusive.

18. Annual Report
Evaluation data : Information about outcomes
Closed cases seen at least three times with a measure completed at assessment
Percentage
Frequency
% (of all
closed cases)
Minimum cases
sent by
individual site
(percentage of
closed cases in
submission)
Maximum cases
sent by
individual site
(percentage of
closed cases in
submission)
Closed cases with a
symptom specific outcome
149
85.1
0.0
100.0
Closed cases with symptom
or general functioning
outcome
154
88.0
0.0
100.0
Closed cases with symptom
and education outcome
42
24.0
0.0
84.6
Closed cases either
symptom or general
outcomes and educational
outcome
44
25.1
0.0
84.6

19. Annual Report
Evaluation data : emerging outcomes
• Significant improvement in average scores between
first and last time points for:
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CYP rated panic
CYP rated OCD
CYP rated separation anxiety
CYP rated generalized anxiety
CYP rated general wellbeing (CORS)
Parent rated depression
Goals
• No significant improvement in average scores between
first and last time points for:
– CYP rated depression

20. Looking to the future: Evaluation
reports

21. Looking to the future: Practice Guidance
The guide to collecting and using service user feedback and outcomes information
Editors:
Duncan Law and Miranda Wolpert
Contributors include:
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David Trickey
Cathy Street
Peter Stratton
Cathy Troup
Gill Walker
Barry Nixon
Andy Fugard
David Low
Emma Kawartzki
Melanie Jones
Jenna Bradley
Celia Beckett
Mark Dadds
Shona Falconer
Peter Fonagy
Evette Girgis
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Sajid Humayun
Karl Huntbach
Steve Kingsbury
Duncan Law
Claire Maguire
Anita Marsden
Susannah Marks
Nick Midgley
Scott D. Miller
Emma Morris
Kate O’Hara
Kathryn Pugh
Rebecca Putz
Barbara Rayment
Stephen Scott
Brigitte Squire
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Sarah Stewart-Brown
Cathy Street
Frances Taggart
Nick Waggett
Sally Westwood
Paul Wilkinson
Miranda Wolpert
Matt Woolgar
Ann York
Young Sessional Workers from
the GIFT Team

22. Looking to the future:
practice and evaluation