Case Study

ieso Case Study: Steps2Wellbeing and Dorset HealthCare University NHS Trust

2023

ieso

Summary

Dorset HealthCare University NHS Trust is responsible for all mental health services and many physical health services in Dorset, delivering both hospital and community-based care, serving a population of nearly 800,000 people and employing around 7,000 staff across 300 sites.

Dorset HealthCare’s University Trust status supports it in providing innovative care, promoting clinical excellence, and attracting and retaining high-quality staff.

One of the services that Dorset HealthCare provides is Steps2Wellbeing (S2W), the local NHS Talking Therapies Service for depression and anxiety (which provides psychological therapies across Dorset and Southampton City).

S2W partnered with ieso in 2014 to assist with managing waiting times, and to provide psychological therapy options for patients to increase accessibility.

ieso achieved this by providing their typed therapy service, which helped reduce wait times through its out-of-hours provision. The provision of typed therapy also offered an alternative remote treatment approach for those who may find video calls or telephone appointments difficult.

Through good clinical governance, the partnership has added value to S2W’s offering and giving their patients more choice, with consistently high outcomes.

S2W partnered with ieso in 2014 to assist with managing waiting times, and to provide psychological therapy options for patients to increase accessibility.

‍

Challenges faced by Steps2Wellbeing

As with many NHS Talking Therapies services, S2W was facing longer wait times for some of its more intensive talking therapies interventions. It was looking for novel approaches to wait list initiatives to try and reduce the waiting times for their patients.

As an innovative service, S2W is also always keen to try new ways of delivering therapy. Impressed by the evidence base that supported ieso’s service it decided to commission a partnership.

‍

Initial apprehensions around typed therapy

Angela Turner, PWP and Assessment Team Lead at S2W, described her initial thoughts when the decision was made to partner with ieso: “Online therapy was very novel at the time, even telephone work within some treatment approaches was novel at the time and unusual for psychological therapy. So then to do it by typed therapy was an even newer way of delivering it. So, the initial concerns were about whether or not it was going to work. Would it feel the same? Would patients still feel listened to, like their therapist was being empathic? Had they understood them? Did it feel robotic? It was quite a big culture change for the staff. Initially, people were a bit hesitant, but maybe curious, and then over time that changed.”

ieso's network of BABCP-accredited clinicians have been helping people with their mental health through confidential, one-to-one, typed conversations for over a decade, treating over 120,000 NHS patients during that time. This has allowed us to gather a significant evidence base, enabling our research that has shown that typed therapy is as effective as face-to-face therapy, which reassured S2W that partnering with ieso would be a good solution to address their needs.

ieso's network of BABCP-accredited clinicians have been helping people with their mental health through confidential, one-to-one, typed conversations for over a decade, treating over 120,000 NHS patients during that time.

How ieso addressed Steps2Wellbeing’s needs

ieso was commissioned to address S2W’s needs in the below two ways, each with their corresponding outcomes:

Waitlist relief

Helped relieve their waitlists by adding capacity, including out-of-hours provision.

ieso has an affiliate network of over 600 BABCP clinicians, who achieve above-average recovery rates in fewer sessions than the NHS average. This is made possible through ieso’s high standard of clinical governance, which is also supported by tools such as the Therapy Insights Model (TIM), an AI-powered tool that measures patient outcomes to discover what works in therapy, revealing specific insights which are presented to the clinicians so they can reflect on and improve their practice. ieso’s typed therapy service is available through S2W, with waits to enter treatment being as little as three weeks.

A significant proportion of ieso’s network of affiliate clinicians offer out-of-hours provision, with 60% of ieso appointments taking place outside of working hours, meaning ieso was able to help provide a wide range of appointment times for S2W’s patients.

Outcome

Angela Turner confirmed that the out-of-hours provision from ieso was particularly effective in helping them reducing waitlist times, as it helped get people with certain work or home commitments into treatment when otherwise they potentially may have faced longer waits for treatment:

“It was really good to hear about the availability of the therapists and that a lot of them work outside your usual clinical hours. So having that expectation that people who work night shifts for example will be able to book appointments during that time they need it, there's a lot more flexibility.

Or people can have evening appointments if they have childcare or work at the weekends, and from our experience that has been the case for many, and people do sometimes choose ieso for that reason because we can't always provide the appointments when they require them. And it's been well managed and sustained throughout our time with you .”

And explained that as S2W has received positive feedback from patients about how well this has worked for them, it has reassured S2W clinicians about it’s effectiveness:

“As time's gone on, speaking to patients and receiving their feedback who have used ieso it maybe changes any beliefs that clinicians initially had, because actually it's been proven over time now that people will access therapy again, and actually request ieso again, because it worked for them and they say positive things about it.”

Access via increased patient choice

Adding an extra option for their patients to choose from, to increase accessibility, especially for hard-to-reach populations.

Impressed by ieso’s operating model, and patient responsiveness to the typed therapy modality, S2W was keen to add this to the range of services it offered. S2W expected that by offering therapy in this way, as well as during out-of-hours, it would expand the service’s reach to include patients who may have struggled, for various reasons, to engage with other modalities such as face-to-face or telephone therapy.

Outcome

S2W has noticed that the online typed therapy ieso provides does indeed make therapy more accessible to more people who come to the service for treatment – this is partly due to the out-of-hours provision. But is also due to the nature of online therapy – Angela Turner notes that they received feedback that it was beneficial for some people to have their sessions from a device, for instance:

“Some of the reasons people choose ieso is generally because they're seen quicker. It can be a much quicker way of accessing High Intensity CBT individual therapy. There's a lot of flexibility around the appointments in terms of not being tied to the set time every single week, but also having later evening or weekend appointments, being able to quickly go to your car and your lunch break, and access from a tablet or from your phone. It's very accessible. And they also find that actually, they do still build a rapport with their therapist. They like being able to send in their homework and feed that back in between sessions and get the updates. So, it's an added bonus.”

‍

Whilst S2W staff have training on working with people with neurodiversity and work closely with the local Adult Autism Service, having typed-therapy with ieso as another option available to access treatment, can be particularly attractive for this patient group.

Angela explains that for some people, the increased level of anonymity of not being face-to-face with a therapist can be hugely beneficial and make them more likely to seek and complete treatment:

‍

“Sometimes we get people who are neurodivergent in some way and by not feeling as though they need to make eye contact, and instead engage in the therapy through typed therapy, it’s easier for them. And that may be a reason that they choose type therapy over telephone or face-to-face. It just feels a bit more comfortable.

Obviously, clinicians are mindful if they think someone's just avoiding something that causes them anxiety - sometimes it’s better not to feed into that because it can make things more difficult for them in the long run, so sometimes typed therapy is not going to be the most beneficial for them.

But sometimes it can make things a lot easier because people find it easier to be open in text where they're not seeing someone. And it's quite anonymous, so you can share your feelings and your experiences with less worry about being judged or identified.”

Some of the reasons people choose ieso is generally because they're seen quicker. It can be a much quicker way of accessing High Intensity CBT individual therapy. There's a lot of flexibility around the appointments in terms of not being tied to the set time every single week, but also having later evening or weekend appointments, being able to quickly go to your car and your lunch break, and access from a tablet or from your phone. It's very accessible.

- Angela Turner

‍

Building a strong partnership between ieso and Steps2Wellbeing

ieso makes sure to start partnerships on strong collaborative foundations, with our team working with partners to show them how best our services can help assist with their needs and reassure staff on their effectiveness. Angela Turner recalls this at S2W:

“When ieso was first introduced at S2W, the ieso clinical and commercial team visited our service to deliver a presentation using screenshots of what the platform would look like from the perspective of a patient accessing it, explained the nuances, features, and benefits of it and addressing all our of our questions about it – like a clinical skills type session. Having that opportunity really helped us to feel confident explaining it to patients. It really helped the clinicians.”

Angela has also been pleased with how well ieso’s service has integrated with S2W, making online typed therapy one of their standard options of therapy:

“It's now part of our standard treatment options that we offer at the end of assessment (where appropriate). We’ve found it really beneficial to be able to offer different modalities, whether video calls, telephone, face-to-face, and now typed-therapy therapy too, it's a normal part of practise now for PWPs within the service.

For those staff that have come into the service in the last six years, they don't know a time when ieso wasn't available as an option to offer, it's just seen as a normal part of practise now.”

When ieso was first introduced at S2W, the ieso clinical and commercial team visited our service to deliver a presentation using screenshots of what the platform would look like from the perspective of a patient accessing it, explained the nuances, features, and benefits of it and addressing all our of our questions about it – like a clinical skills type session. Having that opportunity really helped us to feel confident explaining it to patients. It really helped the clinicians.

- Angela Turner

‍

Angela also explained how easily ieso’s systems have integrated operationally too:

“From a clinician's side, it's really simple. You do your normal admin, you tick on their referral tab, ‘refer on to’, and then select ‘ieso’ as the provider, and it does the rest for you. So that is really simple, really easy, because ieso links in with our IAPTUS records, and the clinical notes get populated into IAPTUS for us. So, if we're ever looking back over a previous episode for a new referral, you can see all the work that's been completed prior. And so, it's really transparent and really easy and doesn’t impact patients that ieso is outside the service. It's just like a member of the team who works in an extended way.

And regarding clinical governance, the service is aware that all the ieso clinicians are audited regularly, that the notes from the clinical appointments are looked at and keywords are taken out to make sure that they're sticking to protocols in the evidence base. And I think that leads to really good outcomes, because they are using the support and interventions that are shown to be effective for people. As a service provider, that’s really reassuring.”

At ieso, we consider the most important thing that we achieve are good outcomes for the patients we treat on behalf of our partners in the NHS, in the way that works best within their existing systems – we were very pleased to her from Angela Turner that this has been and continues to be the case in our nine-year strong partnership with S2W:

“I really would recommend working with ieso. If it didn't work well and it was difficult to work alongside ieso as a partner, we wouldn't have used them within S2W for so many years. It's added value to what we're able to offer. It's another way of offering the interventions, and it's so good to be able to give patients choice.

All the outcomes that we get are consistently high, which speaks for itself because you don't get good outcomes without having good quality therapy and a system that works. It's been really effective within Dorset Healthcare.”

I really would recommend working with ieso. If it didn't work well and it was difficult to work alongside ieso as a partner, we wouldn't have used them within S2W for so many years. It's added value to what we're able to offer. It's another way of offering the interventions, and it's so good to be able to give patients choice.

- Angela Turner

‍

S2W and ieso’s partnership has also been recognised by being shortlisted for Best Mental Health Partnership at the 2022 HSJ Awards. And in August 2023, Dorset HealthCare NHS Trust and ieso co-authored a study published in Nature Mental Health journal, that showed shortening treatment and waiting times for mental health conditions from twelve months to three months, could reduce the financial burden on the NHS and improve treatment outcomes and therefore quality of lives for millions of people across the UK. This could also mean a future annual saving of around £600 million on average for people with all levels of anxiety and depression severities, by helping the estimated nearly 7.1 million people currently in need but are not accessing NHS Talking Therapies.

Key takeaways

Out-of-hours provision is an effective way of increasing capacity and bringing down wait times.
It is important when offering relatively new forms of treatment such as typed therapy that staff are aware of how and why it works.
Training can be important in helping clinicians to understand who and why typed therapy works and to give them a sense of what it will be like for patients to receive treatment this way, so they are better equipped to assess which populations may benefit from it the most.
Typed therapy can access some hard-to-reach populations who may, for various reasons, be reluctant to engage with other modalities such as face-to-face therapy.

All the outcomes that we get are consistently high, which speaks for itself because you don't get good outcomes without having good quality therapy and a system that works.

We are advised that ieso clinicians are supervised and they complete appropriate training. It's been really effective within Dorset Healthcare.”