Method

1
Service Evaluation Project Evaluating a CBT
Hearing Voices Group (HVG) within Croydons
Promoting Recovery teamsAnna Ruddle and Steven
LivingstonePsychosis CAG (Clinical Academic
Group), South London and Maudsley (SLAM) NHS
Trust

• Results
• Feasibility
• Recruitment Numerous appropriate referrals were
  made, primarily by care coordinators and
  psychologists. More referrals arose from teams
  where the facilitators worked and a notable
  proportion were for clients just
  completing/having completed individual CBT.
• Attendance and drop-out Attendance exceeded
  expectation. All 11 assessed clients attended
  the first session and 10 attended 4 sessions (an
  adequate dose of therapy), with eight attending
  5 sessions. The eleventh client was admitted to
  hospital following a relapse.
• Resources The group was facilitated by two
  Clinical Psychologists with experience of running
  HVGs, taking up 1 session/week over several
  months. A room was booked in the resource centre
  most clients used and there was a small budget
  for refreshments/stationery.
• 2. Quantitative Outcomes
• Descriptive statistics were performed and mean
  pre-post changes reported.
• 3. Qualitative Feedback
• Feedback in qualitative interviews was
  overwhelmingly positive. For most, the primary
  benefit was normalisation, There were other
  people who experience similar things I didnt
  feel so alone and isolated and acknowledging
  anyone can be affected by voices, Shows it
  happens to any kind of person, even rational down
  to earth people. People felt inspired by and
  learnt from one another, Liked that people were
  taking control of their life. Learnt you can get
  on with things if you try. Many reported
  changing their beliefs about the power of the
  voices, Inspired me to challenge my voices and
  how I look at them not as powerful. Clients
  reported improvements in confidence and
  self-esteem, Know that Im not worthless or
  stupid. Many reported engaging in activities
  they were not previously doing, I tend to be
  more active now I go to a music group once a
  week, opening up more to others, Im more open
  with my friends about my condition, and being
  able to do more despite the voices themselves
  being unchanged, I seem to be able to ignore
  them not too stressed for as long as I was, due
  to realising theyve got no power over me. A
  minority of clients felt the group was too big to
  start with and one or two felt it could have gone
  on for a few more sessions. Some clients
  reported finding the CHOICE confusing to
  complete.

• Introduction
• Method
• Design
• This was a service evaluation project using a
  within-subjects pre-post design. The study was
  not powered or designed to statistically assess
  the efficacy of HVGs, rather to evaluate the
  local feasibility and benefits for clients.
• Participants

Background The experience of hearing voices
carries great stigma and distress and often
persists despite medication. However, many people
hear voices and never reach mental health
services, undermining a purely medical model.
The Hearing Voices Network operates outside of
mental health services and began unstructured
self-help groups in the late 1980s. CBT HVGs are
more common in the NHS and there is an emerging
evidence base (Ruddle, Mason, Wykes, 2011). For
clients with a diagnosis of schizophrenia, HVGs
can increase access to CBT where resources are
scarce promote normalisation reduce social
isolation and provide a safe space for people to
explore and test new beliefs and coping
strategies. Despite this, recruitment and
attrition are common problems.
Service Context SLaM is part of Kings Health
Partners, one of five national Academic Health
Science Centres. Services have been reorganised
to bridge the gap between research and clinical
practice. Clients with psychosis previously seen
in CMHTs are now treated within Promoting
Recovery teams within the Psychosis CAG.
Project Aims 1) To evaluate the feasibility,
acceptability and benefits of a CBT HVG in
Croydons Promoting Recovery teams. 2) To
establish measures that are acceptable to clients
and sensitive to change.
CORE-OM Average change in overall Mean score was
-0.34. 8/10 participants scores decreased three
had clinically reliable decreases (lt0.5), two
approached this (0.47) and the final three had
pre- and post- scores in the non-clinical range.
Improvements were observed on the CORE-OM,
PSYRATS and individually-defined goals. Some
clients also improved on coping strategies. No
notable changes were observed on the other
measures.
PSYRATS Average change in total score was -6,
with all clients showing a reduction (range -2 to
-14), reflecting improvements in distress and
functioning..
Individual Goals on the CHOICE Clients ratings
on individualised therapy goals improved by an
average of 2 points on a 0-10 scale.
Assessment Invite clients for individual asst to
engage, assess suitability, answer questions and
complete outcomes send appt letters and reminders
Planning Recruitment Identify potential clients
via team promote group plan and prepare group
acquire necessary resources book rooms
Running The Group 7 weekly 1hr sessions pre- and
post-session briefing time chase DNAs write
session summaries liaise with care coordinators
Evaluation Dissemination Invite clients for
post-group questionnaires and interviews report
findings disseminate results implement
trust-wide