A service evaluation of the assessment process in a Step4 Psychological Therapies Service

Abstract

Purpose This study aims to improve the efficiency of the assessment process within a Step4 Psychological Therapies Service by identifying factors related to assessment non-attendance and service suitability for referred clients. Design/methodology/approach Referral and assessment information was accessed between October 2019 and March 2020 from Step4 routine service data, electronic client records where necessary and Step4 staff self-report questionnaires. Findings All clients offered an assessment during this time attended. Findings indicated several factors could influence service suitability in meeting client need. These included individual differences such as readiness to change, which was not necessarily identified at referral or prior to assessment, and potential systemic factors, such as the opt-in procedure, which possibly impeded access. Though the necessity for assessment in clarifying client needs and treatment was indicated, an assessment (from referral to assessment appointment) that led to discharge could take an excess of one working day of service time, associated with considerable opportunity cost to other clients awaiting assessment. Recommendations are made for improving assessment efficiency. Originality/value With a high prevalence of poor mental health in the UK, efforts must be made to identify and reduce additional demand upon service time and resources within mental health services to effectively meet people’s needs. Recommendations to improve assessment process efficiency include the use of a standardised referral form, offer of follow-up support procedures, increased client involvement, a streamlined opt-in battery and ongoing monitoring to ensure shared practice between clinicians. These are transferable to other mental health services, with implications for subsequent quality and timeliness of care.

Assessing the use of the transtheoretical model to manage referrals in mental health services

“…Therefore, a recommendation for the service is to review the use of the URICA and consider removal which would reduce clinical and patient burden or use alternative measures. Another benefit of removing the URICA would be it potentially would reduce barriers to access the service, as a limitation of having people complete questionnaires to access the service is in can reinforce health inequalities faced by people with literacy difficulties (Hawker, 2007; Houghton et al , 2010; Robinson et al , 2023). If the service insisted on needing a measure to assess motivation to change the service could either adapt the measure or use the shorter version of it, the URICA-S (Mander et al , 2012), or trial a new measure such as the Readiness for Therapy Questionnaire (RTQ; Ghomi et al , 2021).…”

“…This is challenging between primary and secondary care services in the UK, as an issue with increasing demands and waiting lists potentially increases clinical risk, reflecting the need for necessary and appropriate referrals (Blank et al , 2014; Wadoo et al , 2021). Services exist within a context where they have a relationship between itself and the people it serves; therefore, one must consider the systemic factors that act as a barrier, but also facilitate engagement from the community (Robinson et al , 2023). Further systemic issues which impact non-attendance include long waiting times between the point of referral and first assessment as this can lead to poor engagement and increased attrition (Grunebaum et al , 1996; Foreman and Hanna, 2000; Robinson et al , 2023).…”

“…Services exist within a context where they have a relationship between itself and the people it serves; therefore, one must consider the systemic factors that act as a barrier, but also facilitate engagement from the community (Robinson et al , 2023). Further systemic issues which impact non-attendance include long waiting times between the point of referral and first assessment as this can lead to poor engagement and increased attrition (Grunebaum et al , 1996; Foreman and Hanna, 2000; Robinson et al , 2023). The knock-on effect of this is services with high levels of non-attendance often leads to longer waiting lists (Trusler et al , 2006), and waiting lists can have a negative impact on care and outcomes [National Institute for Health and Care Excellence (NICE), 2011].…”

“…Further barriers that can impact engagement that is faced by people accessing services is completing assessment forms and questionnaires to opt-in to services (Houghton et al , 2010). These processes can further exacerbate health inequalities faced by people from lower socio-economic backgrounds especially those with literacy difficulties (Hawker, 2007; Robinson et al , 2023). Another significant difficulty faced by services is treatment dropout having a detrimental impact on both services and patients (Barrett et al , 2008; Karekla et al , 2019; Wierzbicki and Pekarik, 1993).…”