CPN conference 2013 Outcome orientated approaches Timimi S
How to Build Services that Maximise the Chances of a Positive Outcome: The Outcomes Orientated Approaches to Mental Health Services (OO-AMHS) project
Sami Timimi
OO-AMHS is a whole service model designed to put the patient (their narrative, choices, and ideas on change) at the centre of the treatment process. Current dominant approaches (such as NICE guidelines) tend to recommend organising services using pathways that match treatments to particular diagnoses. However, a large body of evidence finds that matching diagnosis to a specific therapeutic technique or model has a clinically insignificant impact on outcome when compared to factors that influence outcome across therapeutic modalities. There is a large international evidence base that has consistently shown certain extra-therapeutic factors (such as social context) and intra-therapeutic factors (such as therapeutic relationship) are most likely to influence outcome. Furthermore regular session by session measurement of outcome and therapeutic alliance has been shown to improve outcomes, reduce dropout rates, and save money through improved therapeutic efficiency. OO-AMHS aims to incorporating this evidence into a whole service model.
Using clinically feasible session by session ratings of outcomes and alliance, OO-AMHS focuses on the goal of producing positive change for patients whilst decreasing the chances of ‘getting stuck in the system’ with an intervention that is of no long term benefit, at the same time as ensuring that the service user’s opinions and choices are included in co-constructing an intervention. The OO-AMHS model involves a simple methodology for a service delivery model that can embed a recovery focus and service user involvement philosophy into mainstream services. It improves accountability, challenges the nature of power relationships in the consulting room, provides data for personal and team reflection, interests commissioners (because it provides data), uses clinically feasible ideas and methodologies, and makes the collection of meaningful outcome data more than just another tick box exercise.
I will outline the rationale and methodology behind the OO-AMHS approach and report on our experience so far of implementation projects in CAMHS and similar implementation projects in other parts of the world. You can find out more on the following websites: