A qualitative study of clinicians’ experiences and attitudes towards telephone triage mental health assessments

Abstract

This qualitative study investigated clinicians’ experiences and attitudes towards conducting mental health assessments over the telephone in an IAPT service. Nine participants completed a semi-structured questionnaire and data were evaluated using a Thematic Analysis model. Participants were largely apprehensive about telephone working, but many reported positive experiences. Telephone assessments were felt to be structured, focused and comprehensive, and therapeutic rapport was able to be established. However, concerns persisted around whether risk assessments could be adequately conducted over the telephone. Reports of spontaneous feedback from patients during telephone triage suggested that there was appreciation for this method of assessment and that it increased access to the service. Further research is needed to better understand what, for clinicians, contributes to acceptable assessment of complex and subjective situations, such as risk and feeling states, over the telephone.

A naturalistic pilot study assessing the impact of assessment pathways and intake methods within Improving Access to Psychological Therapies services

“…As part of the stepped‐care model within IAPT services, there has been a growing deployment of Psychological Wellbeing Practitioners (PWPs) delivering telephone‐based, low‐intensity interventions to cope with the volume of referrals accessing treatment (IAPT Manual, ; Jones, Bale, & Morera, ). Accordingly, this has had ramifications for intake processes and in particular, the assessment session.…”

“…Service models vary widely between services due to numerous organisational factors, including staff and treatment availability, local geography and commissioning requirements (Clark et al, ). Perhaps in a bid to optimise intake capacity, PWPs and less expensive therapists working within closely defined clinical parameters are being expected to undertake assessment duties, including triaging and risk appraisals, often over the phone (Cairns, ; IAPT Manual, ; Jones et al, ; Rizq, ). The stepped‐care model permits a broader group of practitioners, including PWPs, to conduct assessments, as any issues in allocation can be corrected during the course of treatment.…”

“…The stepped‐care model permits a broader group of practitioners, including PWPs, to conduct assessments, as any issues in allocation can be corrected during the course of treatment. There is evidence to suggest telephone working can be preferable for patients as it helps resolve geographical boundaries and offers a platform of relative anonymity (Bennett‐Levy et al, ; Jones et al, ). Although patients might be initially apprehensive about over‐the‐phone working, with appropriate early support, this can be overcome (Bennett‐Levy et al, ; Jones et al, ).…”

“…There is evidence to suggest telephone working can be preferable for patients as it helps resolve geographical boundaries and offers a platform of relative anonymity (Bennett‐Levy et al, ; Jones et al, ). Although patients might be initially apprehensive about over‐the‐phone working, with appropriate early support, this can be overcome (Bennett‐Levy et al, ; Jones et al, ). Elsewhere, research has reported outcome equivalency between high‐ and low‐intensity over‐the‐phone therapies, with the latter delivering cost savings overall (Hammond et al, ).…”

“…Intake assessments can be undertaken in various ways and for different purposes. It is an opportunity to screen and triage incoming referrals for their eligibility and level of priority, including activities such as problem formulation, risk screening, mental health condition clustering, treatment planning and, in some cases, therapeutic support (Jones et al, ). Indeed, many IAPT services now combine both the assessment and the first therapeutic session into one appointment (Clark et al, ) IAPT, ).…”