Triage, Referral Engagement and PWPs

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Triage, Referral Engagement and PWPs

• David Richards
• Clinical Informatics Advisor

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PWP role

• The primary purpose of the Psychological
  Wellbeing Practitioner (PWP) is to increase
  access to evidence based psychological therapies
  for people with depression and anxiety.
• They also support patients with managing common
  medications, particularly antidepressants, and
  case-manage referrals or signposting to other
  agencies such as social care organisations

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Psychological Wellbeing Practitioners are

• graduate and post-graduate skilled clinicians
• trained to identify common mental health
  disorders
• able to come to a shared treatment plan with a
  patient that is both personalised and
  evidence-based
• skilled in delivering psychological interventions
  whose specific content is less intense than
  high-intensity treatments
• explicitly educated and skilled in common as
  well as specific therapeutic factors
• know how to establish, develop and maintain
  therapeutic alliances with patients, to be
  responsive and deal with real or potential
  ruptures in the alliance

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Caseloads

• In Training
• 61 (PWP Hi-Intensity Therapist)
• When Qualified
• 3.51 (PWP Hi-Intensity Therapist)

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Stepped Care Principles

• least burden
• requires the provision of low-intensity treatment
  which should always be the least restrictive,
  delivering good outcomes whilst burdening the
  patient and the health care system as little as
  possible
• self-correction
• requires a system to be in place to detect
  non-improvement leading to alternative more
  intensive treatments being offered

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Operating Points for Principles
Principle 2
Principle 1
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Triage?

• Psychological Wellbeing Practitioners are well
  trained to conduct patient-centred assessments
• It is, therefore, unnecessary for patients to be
  triaged through a lengthy and comprehensive
  mental health assessment by a highly qualified
  high-intensity therapist before they are
  allocated to a PWP
• To do so would misuse precious HI resource
• To do so would irritate patients

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Referral Engagement

• telephone welcome patient to the service within
  48 hours of referral
• brief assessment by a high intensity therapist or
  experienced low-intensity practitioner against
  criteria for suitability
• risk managed and allocated to (usually) a
  low-intensity worker unless there are clear
  indications not to do so.
• given a detailed person-centred assessment by a
  low-intensity worker
• discussed in supervision with a suitably
  qualified supervisor, to validate the proposed
  patient allocation to the appropriate step and
  (choice of) treatments intervention(s).