{"id":190,"date":"2023-03-10T10:40:19","date_gmt":"2023-03-10T10:40:19","guid":{"rendered":"https:\/\/oxfordhealth.nhs.uk\/talking-therapies-bucks\/?page_id=190"},"modified":"2023-04-14T13:09:10","modified_gmt":"2023-04-14T12:09:10","slug":"nice","status":"publish","type":"page","link":"https:\/\/oxfordhealth.nhs.uk\/bucks-talking-therapies\/professionals\/nice\/","title":{"rendered":"NICE guidance"},"content":{"rendered":"<h2>Useful links<\/h2>\n<ul>\n<li><a href=\"https:\/\/www.nice.org.uk\/guidance\/cg123\/chapter\/1-guidance\">Common mental health problems: identification and pathways to care<\/a><\/li>\n<li><a href=\"https:\/\/www.england.nhs.uk\/mental-health\/adults\/iapt\/\">NHS England: Adult Improving Access to Psychological Therapies programme<\/a><\/li>\n<\/ul>\n<h2>Stepped care model<\/h2>\n<div id=\"46\" class=\"tabbed\">\n                            <ul><li><a href=\"#section-step-1\">Step 1<\/a><\/li><li><a href=\"#section-step-2\">Step 2<\/a><\/li><li><a href=\"#section-step-3\">Step 3<\/a><\/li><li><a href=\"#section-step-4-amht\">Step 4 &amp; AMHT<\/a><\/li><\/ul>\n<div class=\"ohft-tab-content\" id=\"section-step-1\">\n<ul>\n<li>Identification<\/li>\n<li>Assessment<\/li>\n<li>Psychoeducation;<\/li>\n<li>Active monitoring by primary health care professionals<\/li>\n<\/ul>\n<\/div>\n<div class=\"ohft-tab-content\" id=\"section-step-2\">\n<ul>\n<li>Depression, GAD, Insomnia (where it is a symptom of Depression\/GAD), OCD, Health Anxiety, Social Anxiety, Panic Disorder, Agoraphobia, Specific Phobia.<\/li>\n<li>Mild to moderate symptoms and\/or where no previous CBT based treatment has been tried.<\/li>\n<\/ul>\n<\/div>\n<div class=\"ohft-tab-content\" id=\"section-step-3\">\n<ul>\n<li>PTSD, Depression, GAD, OCD, Health Anxiety, Social Anxiety, Panic Disorder, Agoraphobia, Specific Phobia.<\/li>\n<li>Those that have not responded to step 2 interventions, and\/or severe presentations with marked functional impairment.<\/li>\n<\/ul>\n<\/div>\n<div class=\"ohft-tab-content\" id=\"section-step-4-amht\">\n<p><strong>Step 4 Psychological Services<\/strong><\/p>\n<ul>\n<li>Complexity; several or frequent recurrences; multiple traumas; childhood abuse.<\/li>\n<li>Poor response to other treatment, has had a treatment of CBT in the past (if appropriate).<\/li>\n<li>Significant and sustained impact on daily functioning or relationships with others.<\/li>\n<li>History or continuing risk of moderate to severe harm to self or others.<\/li>\n<li>Several mental health diagnoses or several different areas of difficulty.<\/li>\n<li>Duration is greater than 12 months.<\/li>\n<li>No current drug use or alcohol dependency<\/li>\n<\/ul>\n<div>\n<p><strong>Adult Mental Healthcare Team AMHT<\/strong><\/p>\n<p>If a client is presenting with a high level of risk and\/or requires a psychiatric assessment:<\/p>\n<ul>\n<li>EMERGENCY- to be seen within 4 hours<\/li>\n<li>URGENT \u2013 to be seen within 7 days (inclusive of weekends)<\/li>\n<li>ROUTINE \u2013 to be seen within 28 days, for mental health assessment, psychiatric diagnoses or medication review.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<h2>Talking Therapy questionnaires<\/h2>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Depression symptoms (PHQ-9)<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>To measure depression symptoms, score ranges:<\/p>\n<p>0 \u2013 4: normal<\/p>\n<p>5 \u2013 9: mild<\/p>\n<p>10 \u2013 14: moderate<\/p>\n<p>15 \u2013 19: moderately severe<\/p>\n<p>20 \u2013 27: severe<\/p>\n<p>A score of 9 or above would be determined as in caseness for depressive symptoms.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Generalised anxiety symptoms (GAD-7)<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>To measure generalised anxiety symptoms, score ranges:<\/p>\n<p>0 \u2013 4: normal<\/p>\n<p>5 \u2013 9: mild<\/p>\n<p>10 \u2013 14: moderate<\/p>\n<p>15 \u2013 21: severe<\/p>\n<p>A score of 7 or above would be determined as in caseness for anxiety symptoms.<\/p>\n<p>An additional measure can also be used to assess for GAD, the Penn State Worry questionnaire (short version) a score of 45 or above would indicate caseness.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Phobia<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Talking Therapies phobia scale for assessing avoidance due to fear of outlined situations (panic attacks, social situations, or specific situations such as driving, flying, heights, confined spaces, vomit, blood, animals, etc.)<\/p>\n<p>0 \u2013 would not avoid<\/p>\n<p>2 \u2013 slightly avoid<\/p>\n<p>4 \u2013 definitely avoid<\/p>\n<p>6 \u2013 markedly avoid<\/p>\n<p>8 \u2013 always avoid<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Work and social adjustment scale (WSAS)<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Work and social adjustment scale, assessing the impact on different areas of day-to-day activities due to experienced difficulties. This includes work, home management, social leisure activities, private leisure activities, family and relationships.<\/p>\n<p>0 \u2013 would not avoid<\/p>\n<p>2 \u2013 slightly avoid<\/p>\n<p>4 \u2013 definitely avoid<\/p>\n<p>6 \u2013 markedly avoid<\/p>\n<p>8 \u2013 always avoid<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Obsessive compulsive inventory (OCI)<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Obsessive Compulsive Inventory, to measure symptoms of OCD, using the distress scale:<\/p>\n<p>0 \u2013 not at all<\/p>\n<p>1 \u2013 a little<\/p>\n<p>2 \u2013 moderately<\/p>\n<p>3 \u2013 a lot<\/p>\n<p>4 \u2013 extremely<\/p>\n<p>A score of 40 or above would indicate symptoms of OCD.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Health Anxiety Inventory (HAI)<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Health Anxiety Inventory (short version), to measure symptoms of health anxiety. Each question consists of 4 statements, with the patient choosing which statement best fits with their feelings over the last week.<\/p>\n<p>A score of 18 or above would indicate symptoms of health anxiety.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Social phobia inventory (SPIN)<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Social Phobia Inventory, to measure symptoms of social anxiety, using the following scale:<\/p>\n<p>0 \u2013 not at all bothered<\/p>\n<p>1 \u2013 a little bothered<\/p>\n<p>2 \u2013 moderately bothered<\/p>\n<p>3 \u2013 bothered a lot<\/p>\n<p>4 \u2013 extremely bothered<\/p>\n<p>A score of 19 or above would indicate symptoms of social anxiety.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Mobility inventory (MI)<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Mobility Inventory, to measure symptoms of agoraphobia, using the following scale:<\/p>\n<p>1 \u2013 never avoid<\/p>\n<p>2 \u2013 rarely avoid<\/p>\n<p>3 \u2013 avoid about half of the time<\/p>\n<p>4 \u2013 avoid most of the time<\/p>\n<p>5 \u2013 avoid always<\/p>\n<p>A score of 60 or above would indicate symptoms of agoraphobia.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Panic disorder severity scale (PDSS)<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Panic Disorder Severity Scale, to measure symptoms of panic disorder, using the following scale:<\/p>\n<p>0 \u2013 none<\/p>\n<p>1 \u2013 mild<\/p>\n<p>2 \u2013 moderate<\/p>\n<p>3 \u2013 severe<\/p>\n<p>4 \u2013 extreme<\/p>\n<p>A score of 8 or above would indicate symptoms of panic disorder.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Post traumatic check list (PCL-5)<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Posttraumatic Check List (PCL-5), to measure for symptoms of PTSD, using the following scale:<\/p>\n<p>0 \u2013 not at all bothered \/ distressed<\/p>\n<p>1 \u2013 a little<\/p>\n<p>2 \u2013 moderately<\/p>\n<p>3 \u2013 quite a bit<\/p>\n<p>4 \u2013 extremely bothered \/ distressed<\/p>\n<p>A score of 32 or above would indicate symptoms of PTSD.<\/p>\n<\/div>\n                <\/details>\n","protected":false},"excerpt":{"rendered":"<p>Useful links Common mental health problems: identification and pathways to care NHS England: Adult Improving Access to Psychological Therapies programme Stepped care model Talking Therapy questionnaires<\/p>\n","protected":false},"author":1,"featured_media":393,"parent":172,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"class_list":["post-190","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/oxfordhealth.nhs.uk\/bucks-talking-therapies\/wp-json\/wp\/v2\/pages\/190","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/oxfordhealth.nhs.uk\/bucks-talking-therapies\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/oxfordhealth.nhs.uk\/bucks-talking-therapies\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/bucks-talking-therapies\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/bucks-talking-therapies\/wp-json\/wp\/v2\/comments?post=190"}],"version-history":[{"count":4,"href":"https:\/\/oxfordhealth.nhs.uk\/bucks-talking-therapies\/wp-json\/wp\/v2\/pages\/190\/revisions"}],"predecessor-version":[{"id":522,"href":"https:\/\/oxfordhealth.nhs.uk\/bucks-talking-therapies\/wp-json\/wp\/v2\/pages\/190\/revisions\/522"}],"up":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/bucks-talking-therapies\/wp-json\/wp\/v2\/pages\/172"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/bucks-talking-therapies\/wp-json\/wp\/v2\/media\/393"}],"wp:attachment":[{"href":"https:\/\/oxfordhealth.nhs.uk\/bucks-talking-therapies\/wp-json\/wp\/v2\/media?parent=190"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}