An Investigation into the Implementation of CYP-IAPT Routine Outcome Measures in their First Year of Integration into Child Psychotherapy Practice

This thesis examines the impact on child and adolescent
psychotherapists within CAMHS of the introduction of routine outcome
measures (ROMs) associated with the Children and Young People’s Improving
access to Psychological Therapies programme (CYP-IAPT). All CAMHS
therapists working within a particular NHS mental health Trust1 were required to
trial CYP-IAPT ROMs as part of their everyday clinical practice from October
2013-September 2014. During this period considerable freedom was allowed
as to which of the measures each therapist used and at what frequency.
In order to assess the impact of CYP-IAPT ROMs on child
psychotherapy, I conducted semi-structured interviews with eight
psychotherapists within a particular CAMHS partnership within one NHS Trust.
Each statement was coded and grouped according to whether it related to initial
(generic) assessment, goal setting / monitoring, monitoring on-going progress,
therapeutic alliance, or to issues concerning how data might be used or
interpreted by managers and commissioners.
Analysis of interviews revealed greatest concern about session-by
session ROMs, as these are felt to impact most significantly on psychotherapy;
therapists felt that session-by-session ROMs do not take account of negative
transference relationships, they are overly repetitive and used to reward /
punish the therapist. Measures used at assessment and review were viewed as
most compatible with psychotherapy, although often experienced as
excessively time consuming. The Goal Based Outcome Measure was generally
experienced as compatible with psychotherapy so long as goals are formed
collaboratively between therapist and young person. There was considerable
anxiety about how data may be (mis)used and (mis)interpreted by managers
and commissioners, for example to end treatment prematurely, trigger change
of therapist in the face of negative ROMs data, or to damage psychotherapy.
Use of ROMs for short term and generic work was experienced as less intrusive
and contentious.