help for families in the armed forces ... - fim-trust.org · project is a collaboration between 3...

Healios changesthelivesofthoseaffectedbydisablingillnesses

HelpforfamiliesintheArmedForcesCommunityFinalProjectReportAugust2017

Familycasestudies

Clinicaloutcomes:Baseline,8th,12th,and3monthfollows-up

ProjectneedandProjectPartners

Summaryofresults

ProjectbackgrounddemographicsContent

• Projecthasmetalloutcomemeasures:

• Significantreduction inoveralldistress(anxietyanddepression)

• Significantreduction incarerburden

• Significantimprovement incarerworkandsocialfunctioning

• Improvementsshowsustainableeffectafter3monthspost-intervention

• HighsatisfactionwithHealiosonlinedeliveryservice

• Inmanycasescarersarereportingsignificantchangesintheirlovedoneslives– andbenefitstothewholefamily(thisisparticularlyrelevantforforcesfamilieswherethereareextendedperiodsofseparation)

• Demonstratesthepowerofcarerswhentrainedonclinicalinterventionsintheoutcomesoftheirloved-ones

• VerypositivefeedbackontheserviceandtheimpactHealiosishavingontheireverydaylives

Summaryofresults:DigitaldeliveryofserviceshashugebenefitforfamilieswithintheArmedForces

Whatwastheneedforthisproject

SubstantialincidencesofcommonmentalhealthdisordersintheArmedForcescommunity:• 20% experienceDepression,Anxietyor

AdjustmentDisorder• 4-7% diagnosedwithPTSD• 65% engagein‘higherrisk’drinking

MentalHealthPrevalence

EconomicImpact

BurdenofCaring

Mentalhealthcanhaveasignificanteconomicimpact,particularlyforthosetransitioningintocivilianlife.In2012:• 74%ofallepisodesofcareintheArmedForces

wereassessedashavingamentalhealthdisorder

• Failedtransitionofmilitarypersonnelcostthestateanexcessof£113millionirrespectiveoftheadditionalcoststotheindividualandcharitysectors

Mentalhealthhasastrongdetrimentalimpactoncarers(familymembers)• Higherlevelsofburdenanddistress• Time andeconomicpressures• Littlehelpandsupport– someemotional

supportavailable• Stigma associatedwithmentalhealth

GrowingNeed

ThereisagrowingneedformentalhealthsupportintheArmedForces• 20,000 UKArmedForcespersonnelleavethe

militaryeachyear• In2013,CombatStressreporteda57% increase

inAfghanistanVeteransseekinghelpfromthecharity

• 79%ofveteransinaFamilyInterventionstudyexpressedaninterestingreaterfamilyinvolvementwiththeirtreatment

Projectisacollaborationbetween3organisationsthatwasfundedbyForcesinMindTrust

HealiosistheUK’sleadingfamilyinterventionandbehaviouralchangedigitalhealthcaretechnologycompanyworkingtoempowerpatientsandfamiliesaffectedbymentalandphysicalillnesses.

Projectrole:Projectleadershipandmanagementalongsidedeliveringtheinterventioncomponentoftheprojectcomprisingof600sessionsto50familiesacross7mentalillnesses

VoluntaryindependentMentalHealthCharity,whichprovidescounty-wideservices.TheCharitylastyearsupportedover3000serviceuservisitstotheirpeersupportgroupsanddeliveredsome500counsellingsessions.

Projectrole:Projectoversighttoensureallaspectsdeliveredontimeandtotherequiredquality.Supportprovidedinrecruitmentofcarers.

TheArmyFamiliesFederation(AFF)isanindependentvoiceofArmyfamiliesandworkshardtoimprovethequalityoflifeforArmyfamiliesaroundtheworld-onanyaspectthatisaffectedbytheArmylifestyle.

Projectrole:ProvideInsightintoArmylife,terminologyandthechallengesoftransitioningbacktocivilianlife.Supportinrecruitmentofcarers.

ArmedForcesProjectBackground

Projectscope,aim,anddetails

Projectaim

• Deliver600sessionsbyrecruiting50familieswhowilleachreceiveupto12sessions

• Thementalhealthdifficultiesinthestudyincludeadjustmentdisorder,mooddisorders(includinganxietyanddepression),PTSD,andpsychosis(includingschizophreniaandbipolar)

• Outcomeassessmentstobeperformedat4stages:Baseline,after8sessions,after12sessionsand3-monthsafterlastsession

• EnrolmentofcarersstartedMonday10th November2014

Tosupportandempower50familiesofpeoplewithmentalhealthdifficultiesintheArmedForcescommunity,throughapsycho-educationandskillstrainingonlinesupportserviceprovidedbyHealios.

Otherdetails b

• Onlinebooking

• Email/textsessionreminders

• Accessibleonlineandviamulti-device

• AutomaticNHStreatmentteamnotifications*

• Outofhourssupportline

• Clinicianmessaging

• Onlineoutcomeassessments

• LiveHealiosclinicianvideostreaming

• Interactivemultimedialearningexperience

• MySkillsareaforassessingsessionmaterial

• Sessionsummariesmadeavailable

Accessandconvenience BetweensessionsupportClinician-ledinteractive

experience

ARMEDFORCESPROJECT:AUNIQUEANDPERSONALISEDEXPERIENCEFORTHEENTIREFAMILYAclinician-ledonlineserviceofevidence-basedpsychologicalinterventionsintegratedwithdigitaltoolstoengagetheentirefamilyforbestlong-termoutcomes

Familymembersofsomeonewith

mentalillnessintheArmedForces

*consentrequiredfromfamily

9

TheprojectwassupportedbyHealios’highlyexperiencedclinicalgovernanceteamwithanextensivementalhealthbackgroundinNHS

• PreviouslyConsultantClinicalPsychologistinanNHSEIPteam

• Nearly20yearsexperienceinmentalillness

• ExpertiseinCognitiveBehaviour Therapy,mindfulnessandFamilyWorkforPsychosis

• TrainedandsupervisedEarlyInterventionServicestaffinfamilyworkacrosstheSouthernHealthNHSTrust

• MentalHealthPractitionerwitharangeofexperienceinmentalhealthandrelationshipinterventionsspanning18years

• WorkedinanNHSEIPteamfocusingonthedeliveryofBehaviouralFamilyTherapyandpreviouslyshiftleaderonaPsychiatricIntensiveCareWard

• Personalexperienceofcaringforfamilymemberwithpsychosisandtheimpactoftrauma

• Consultantpsychiatristwith20yearsofexperience

• LeadsanNHSEarlyInterventioninPsychosis(EIP)team

• Publishedover100articlesonmentalillness

• ParticipatedinmentalhealthprogramsforITV,ChannelFour,BBCradioandtelevision

• Along-termdedicationtothewell-beingofthewholefamily

LARSHANSSEN,MDMedicalDirector

KATIEASHCROFT,PhDAdultServiceLeader

ALISONJOYCEClinicianTeamManager

• ChildClinicalPsychologistwith14yearsexperienceworkingwithchildrenandtheirfamilieswithinCAMHSservicesacrosstheUKandindependently

• ExperiencedsupervisorandtrainerwithservicedevelopmentroleshavingincludedJointActingTeamLeadforaPrimaryMHT(CAMHS)

• ClinicalTutorandChildModuleCoordinatorontheDoctorateinClinicalPsychologycourseatSouthamptonUniversity

ANGHARADRUDKIN,PhDC&YPServiceLeader

Ateamofhighlytrainedclinicians,allwithanextensivebackgroundintheNHS,deliverclinicalsessions

ProjectOutcomes

TheHealiosinterventionwillleadtoasignificantimprovementinfamilyworkandsocialfunctioning.

Outcome1

Outcome2

TheHealiosinterventionwillleadtoasignificantdecreaseinfamily-reportedburden.

TheHealiosinterventionwillleadtoasignificantdecreaseinfamily-reporteddistress.

Outcome3

Outcome4Familiesreportontheirperceptionsofhowmuchtimetheyspendcaring,thetypeofcaretheydeliver,andtheirownactivityandconfidencelevelswillbeexamined.

Multipleagencieshavebeenengagedwiththeproject

HelpforHeroes ✓

BandofBrothers/Sisters ✓

HiddenWounds ✓

CombatStress ✓

GazetteHerald ✓

RipplePond ✓

AFF ✓

• AFFHubs• TheWarriorProgramme• SSAFA• DMWS• VeteransinAction• SouthWestVeterans• ArmedForcesNetwork• BlindVeterans• BLESMA• WiltshireCouncil• CarersSupportWiltshire• ArmyWelfareServices• RoyalBritishLegion• Timebank Project(CarersTogether&Shoulder

toShoulder)

Otheragencycollaborations&engagementReferrals

Sessionstatus:Usageofthe600sessionpool

SessionPool Number

SessionsDelivered 601

SessionsAvailable 0

TotalSessions 601

100%

Referralstatus

ReferralStatus NumberCurrentlyengaged 0Interventioncomplete(full) 26

Interventioncomplete(early) 7

Didnotengage 37*Droppedout(3+sessions) 17**Inappropriate referral 1

* Thisfigureincludesfamiliesdecidingnottoproceedduetoexternalpressures**Thisfigureincludesthosewhocouldnotcontinueastheywerenolongerinacaringrole(e.g.ex-partners)

0

30%

8% 42%

19%

1%

Interventioncomplete(allsessions)

Interventioncomplete(earlycompletion)

Didnotengage

Droppedout(3+sessions)

Inappropriatereferral

Numberofsessionsreceivedperfamily

StageofIntervention Number0sessions 9*1-3 sessions 23

4-6 sessions 117-9sessions 1210-12sessions 1813-15sessions 15

* Thisfigurerepresentsthosewhodidnotengagefromthestartand/ordidnotcompletebaselinemeasures

0

5

10

15

20

25

0sessions 1-3sessions 4-6sessions 7-9sessions 10-12sessions 13-15sessions

Family/CarerClinicalOutcomes:baseline

Demographics

Carer Patient

Number 81

Male 4% 96%

Female 96% 4%

Age(mean) 41.6 40.9

Age(range) 26-68 25-74

Childrenunder18 62%

Relationwithpatient

Parent 4%

Spouse/Partner 92%

Ex-partner 4%

Diagnosis

PTSD 87%

Anxiety+Depression 3%

Anxiety 1%

Schizophrenia 1%

DrugandAlcoholuse 1%

NoDiagnosis 7%

Demographics

Service n %

59 73%

7 9%

5 6%

4 5%

1 1%

1 1%

1 1%

Army

RAF

Marines

Royal Navy

FrenchForeignLegion

SouthAfricanPoliceForceUNProtection

Unknown 3 4%

Service

Army

RAF

Marines

Royal Navy

FrenchForeignLegion

SouthAfricanPoliceForce

UNProtection

Unknown

DISTRESS:CarersshowonaverageamildtomoderatelevelofdistressasmeasuredwiththeanxietyanddepressionsubscaleoftheHADSatbaseline

DistressmeasuredusingtheHospitalAnxietyandDepressionScale(HADS)whichisa14itemscaleratedona4ptLikertscale.Overalldistressscorerange0-42.

Severity Cut-offNormal 0-7

Mild 8-10

Moderate 11-15

Severe 16-21

(Snaith&Zigmond,1994)0

2

4

6

8

10

12

14

Anxiety Depression

Meanscore

Subscales

Distressatbaseline(n =79)

Normal

0

5

10

15

20

25

Meanscore

Overalldistressatbaseline(n =79)

CARERBURDEN:CarersshowanaveragetomoderatelevelofburdenacrossthefoursubscalesoftheIEQatbaseline,withthegreatestlevelofburdenontheworryingsubscale

BurdenismeasuredwiththeInvolvementEvaluationQuestionnaire(IEQ)whichconsistsof29itemsacross4domains;eachdomainhasavaryingnumberofitemsbetween6-9.Maxscoreforeachitem;Tensionmaxscore=36,Supervisionmaxscore=24;Worrying=maxscore=24;Urgingmaxscore=32

0

2

4

6

8

10

12

14

16

18

20

Tension Supervision Worrying Urging

Meanscore

Subscales

Burdenatbaseline(n =79)

0

10

20

30

40

50

60

70

Meanscore

Overallburdenatbaseline(n =79)

WORKANDSOCIALFUNCTIONING:CarersshowonaverageasevereimpairmentonworkandsocialfunctioningasmeasuredwiththeWSASatbaseline

Impairment ScoreSubclinical <10

Significant 10-20

Severe >20

WorkandsocialfunctioningismeasuredwiththeWorkandSocialAdjustmentScale(WSAS)whichmeasuresselfreportedimpairmentona8ptLikertscale.Scalescorerange=0(noimpairment)to40(verysevereimpairment),Totalmaxscore=40.

Subclinical

0

5

10

15

20

25

Meanscore

Workandsocialfunctioningatbaseline(n - 79)

(Mundtetal.,2002)

Severe

Family/CarerClinicalOutcomes:comparisonofbaselineand8thsessions

Healios significantlyreducescareranxietyanddepressionlevelsaswellasoveralldistressover8sessions– clinicaldepressionreducestonormallevels


0

5

10

15

20

25

30

Baseline 8Sessions

Meanscore

Timepoint

Overalldistresschangeovertime(n=31)

0

2

4

6

8

10

12

14

16

18

Anxiety Depression

Meanscore

Subscale

Distresschangeovertime(n=31)

24%

26%29%

Baseline(

8(Sessions(

0

10

20

30

40

50

60

Baseline 8Sessions

Meanscore

Timepoint

Overallburdenchangeovertime(n=32)

Healios significantlyreducescarerburdenacrossallfoursubscales,withoverallburdenreducingby32%after8sessions

0

2

4

6

8

10

12

14

16

18

Tension Supervision Worrying Urhing

Meanscore

Subscale

Burdenchangeovertime(n=32)

33%

25%

31%

32%


32%

Baseline(

8(Sessions(

Healios significantlyimprovescarer’s workandsocialfunctioningafter8sessions,withself-reportedimpairmentreducingby20%

WorkandsocialfunctioningismeasuredwiththeWorkandSocialAdjustmentScale(WSAS)whichmeasuresselfreportedimpairmentona8ptLikertscale.Scalescorerange=0(noimpairment)to40(severe),Totalmaxscore=40.

20%

0

5

10

15

20

25

Baseline 8Sessions

Meanscore

Timepoint

Functioningchangeovertime(n=31)

Changingthelivesoffamiliesaffectedbydisablingillnesses www.healios.org.uk

Family/Carer ClinicalOutcomes:comparisonofbaseline,8th sessionand12th session

Anxietyanddepressionsignificantlydeclineovertimecomparedtobaseline.Bothanxiety anddepressionreducetonormallevels


Baseline(

8(Sessions(

12(Sessions(

0

2

4

6

8

10

12

14

Anxiety Depression

Meanscore

Subscale

Distresschangeovertime(n=22)

29%

41%40%

51%

Overalldistresssignificantlydeclinesovertimecomparedtobaseline,demonstratingimprovedfamilymentalwellbeing


0

5

10

15

20

25

Baseline 8sessions 12sessions

Meanscore

Timepoint

Overalldistresschangeovertime(n=22)

34%46%

Carer burdensignificantlydeclinesovertimeacrossallsubscalescomparedtobaseline


Baseline(

8(Sessions(

12(Sessions(

0

2

4

6

8

10

12

14

16

18


Meanscore

Subscale

Burdenchangeovertime(n =23)

40%42%

34% 36%

35% 36%36%

42%

Overallcarer burdensignificantlydeclinesovertimecomparedtobaseline


0

10

20

30

40

50

60


Meanscore

Timepoint

Overallburdenchangeovertime(n =23)

37%40%

Impactoncarer’s workandsocialfunctioningsignificantlyimprovesovertime,reducingfromseveretoclosetonormallevels


0

5

10

15

20

25


Meanscore

Timepoint

Functioningchangeovertime(n =22)

31%

47%

Severe

Subclinical

Clientsatisfactionatendofintervention

Healiosdeliversexceptionalcustomerexperienceandsatisfactionratingswhilstprovidingincreasedpatientaccess&choice

CustomerexperiencemeasuredwiththeClientSatisfactionQuestionnaire(CSQ-8).

85% 85% 89%

ofclientsareVerySatisfiedand15%areMostlySatisfied

ofclientsrateHealiosservicequalityasExcellent

and15%asGood

ofclientswouldDefinitely recommend

Healiosservice

Family/CarerClinicalOutcomes:comparisonofbaseline,8th sessions,12th sessionsand3monthsfollowup

Anxietyanddepressionsignificantlydeclineovertimecomparedtobaseline.Bothanxietyanddepressionaremaintainedatnormallevelsat3monthsfollowup


Baseline(

8(Sessions(

12(Sessions(

3(Months(

ns

ns0

2

4

6

8

10

12

14

Anxiety Depression

Meanscore

Subscale

Distresschangeovertime(n =15)

32%

45%36%

44%

54%45%

ns ns

Overalldistressdeclinesovertimecomparedtobaseline.Thechangeismaintainedat3monthsfollowup


ns0

5

10

15

20

25

Baseline 8sessions 12sessions 3Months

Meanscore

Timepoint

Overalldistresschangeovertime(n =15)

38%

49% 40%

Carer burdenreducesovertimeacrossallsubscalescomparedtobaseline,witheffectmaintainedfor2subscalesat3monthswithnosignificantdifference


Baseline(

8(Sessions(

12(Sessions(

3(Months(

0

2

4

6

8

10

12

14

16

18


Meanscore

Subscale

Burdenchangeovertime(n =15)

44% 42%

29%

43%41%

12%

44% 45%

31%36%

48%

30%

ns ns* *

* *

* **

*

*

* Significantdifferencefrombaseline(p<0.05)

Overallburdensignificantlydeclinesovertime,witheffectmaintainedat3monthswithnosignificantdifference


ns

0

10

20

30

40

50

60


Meanscore

Timepoint

Overallburdenchangeovertime(n =15)

41%45% 28%

Impactonworkandsocialfunctioningsteadilyimprovesovertime.Thechangecontinuesinthe3monthsaftertheendofintervention


0

5

10

15

20

25


Meanscore

Timepoint

Functioningchangeovertime(n =15)

30%42% 46%

Familycasestudies

Improving Relationships and Supporting Employmentthrough empowering the carer with new skills

Background facts

Illness:PTSD

Description:Husband, medically discharged from Army. Struggling to cope at work after treatment ended

Symptoms:Flashbacks, angry outbursts, depression, paranoia, hyper-vigilance, panic attacks

“It was a revelation to me when I realised

that I need to change the way I think

rather than the way he does. I have a

better understanding of his illness and I

can see big changes in him. He is more

relaxed – he doesn’t feel picked on or

judged. It’s so much better now …

normal!”Wife

IssueCouple had little understanding of each other or how to manage the PTSD symptoms; and were treading on eggshells. Wife on sick leave from work with high anxiety and concentration difficulties. She was living with her parents after a violent episode. She felt overwhelmed, exhausted and fearful about their future. She felt she had tried everything.

Our work• Work on communication helped wife recognise her need to accept his diagnosis

and difficulties. Provided enhanced skills to change her approach rather thanseeking to change him.

• Provided background information on PTSD and a range of groundingtechniques which she shared with her husband to promote sharedunderstanding and symptom management.

• Developed collaborative problem-solving and decision making approaches.

Ø Wife returned home and back at workØ Husband more relaxed and doesn’t feel picked on or judgedØ Couple have developed open, honest and effective communications and

have worked on identifying shared goals which they are now beginning toachieve

Ø Wife feels more confident that they can tackle any obstacles that arise

Healios impact

Service offered:Carer psycho-education and support

Strengthening Families …Reducing carer distressby empowering the family with new skills

Background facts

Illness:PTSD

Description:Husband diagnosed 2 years ago, working and accessing services

Symptoms:Withdrawn, isolated and distant “Our life has changed

immensely. We have now got a relationship where before we had no relationship” Wife

IssueFamily life was tense and they had not had fun as a family for several years. There was a huge distance between the couple and they couldn’t get their closeness back. Husband was struggling with his symptoms but he did not talk about them with her. His wife was scared he was going to take his own life.

Our work• We gave the carer new communication skills to help her motivate

her husband to share more about himself• We helped her understand her husband’s difficulties and how

these were interacting with their family life.• We supported her to problem solve the issues with him

Ø PTSD is no longer the couple’s primary focus. They arenow working together as a team and recently had a greatfamily day out together

Ø Wife is now more confident to ask for the support sheneeds from other services

Ø Husband is coming to the end of his treatment

Healios impact on the patient and familyService offered:Carer psycho-education and support

Improving Family Relationshipsthrough empowering the family with new skills

Background facts

Illness:PTSD

Description:Husband diagnosed 20 years ago, also has depression and brain damage

Symptoms:Memory loss, anger, depression, flashbacks, insomnia

“Doing this has really validated my

belief in our family. It’s helped to

empower my husband and bring our

fragmented family together.”

Wife

IssueConflict was having a strong effect on family relationships. The children did not interact with their dad and the carer reported constant arguments between all of them.

Our work• We spoke to the carer about modelling good

communication skills to the family. This was quickly embraced by them all.

• Problem solving helped the family work together as a team. The husband grew in confidence to take more responsibility for decisions in the home, instead of leaving it to his wife.

Ø Husband and wife now spend 15 minutes together each morning to discuss their concerns

Ø The whole family is working together to communicate better and express how they feel


Improving Confidencethrough empowering the family with new skills

Background facts

Illness:PTSD

Description:Husband: unemployed withdrawn and with low confidence.

Symptoms:Flashbacks and anger

“My husband is more confident and I am more relaxed, less guarded”

Wife

IssueCouple have been married for 5 years. Wife reported communication difficulties, arguments and lack of support for each other. Although unemployed, husband had limited engagement with her or household responsibilities and showed low motivation for returning to employment.

Our work• We gave the carer new communication and problem-solving

skills to strengthen their relationship and tackle issues and goals as a team.

• We supported her to gain improved understanding of PTSD through us and from her husband.

• We helped her develop emotional coping skills to improve her own well-being.

Ø Wife is now less reactive and manages her emotions in a more positive way.

Ø Couple are now working together as a team. Their relationship is calmer and they have fewer arguments.

Ø They worked together to plan and successfully achieve his recent trip abroad to speak at an international event about his experiences

Healios impact on the patient and familyService offered:Carer psycho-education and training

Rebuilding Livesby empowering the family with new skills

Background facts

Illness:PTSD

Description:Husband diagnosed 6 months ago. Already completed 6-week programme with Combat Stress

Symptoms:Hyper-vigilance, Panic attacks, negative and suicidal thoughts, claustrophobia

“We are both so happy, things have changed for the better already. I can’t believe it. Doing this work is changing our lives. I can’t thank you enough”

Wife

IssueCouple had lost the ability to communicate openly to avoid putting pressure on each other. Wife felt exhausted from working full time and taking on all the household responsibilities and feeling they had drifted apart. Husband felt rejected if she took any time for her own activities or friends. Couple had very little joint social/leisure activities due to husband’s negative beliefs about being able to cope.

Our work • We gave the carer new communication skills and encouraged her

to share these with her husband• Developed collaborative and flexible goal setting and achievement

strategies, particularly focused on small steps and regular reviewsto capture positives

• Beginning to work on building strategies to reduce symptom impact

Ø Wife was open about her difficulties and couple are nowusing the new communication skills to identify issues

Ø Couple working well as a team to agree goals and allocateresponsibilities. They make and review specific plansregularly

Ø Husband feeling more confident and wife has spent aweekend away with her friend

Healios impact on the patient and family

Service offered:Carer psycho-education and support

Improving Outcomesthrough empowering the family with new skills

Background facts

Illness:PTSD

Description:Husband diagnosed 1 year ago

Symptoms:Angry outbursts, physical flashbacks, hyper-vigilance

“Before it was like a kettle that would

blow. Now I can catch it before it

blows. It’s bought me back down to

earth and saved our relationship in a

way.”Wife

IssueCarer expressed the concerns around communication with her husband. They could not go out to public places and her husband would have angry outbursts.

Our work• We gave the carer new communication skills to offer

alternative approaches to communicate with her husband• Tailored education helped the carer to understand her

husband’s hyper-vigilance to threat • Trained carer on new skills to interact with him positively

Ø Carer is able to empathise with him through a better understanding of her husband’s symptoms

Ø Husband’s anger is reduced as the carer is reacting to his outbursts differently


RichardAndrewsFounder,[email protected]:+44(0)3301244222

help for families in the armed forces ... - fim-trust.org · project is a collaboration between 3...

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