Measuring Outcomes for Delivery of Therapy to Veterans
There are four features of the charity PTSD Resolution’s service delivery that particularly distinguish the mental health treatment it delivers to the UK armed forces veterans’ community. The trauma therapy service includes:
- veterans who are suffering from alcohol or substance addiction
- those who are in the criminal justice system
- family members, where their mental health has been affected; and
- the rigorous collection of clinical outcome measurement data
PTSD Resolution was founded in 2009 by Colonel Tony Gauvain, retired, charity chairman, and Piers Bishop; both are therapists trained in Human Givens Therapy. The charity has had over 3,000 referrals to date, delivering each therapy programme free of charge through a network of 200 therapists throughout the UK, in person and increasingly online since the Coronavirus pandemic.
The four pillars of service provision by PTSD Resolution enable treatment to be delivered and carefully monitored across the UK, addressing cases that are often complex and distinguish the veterans’ community, and can result in addiction, imprisonment and family breakdown.
Practice-based evidence is at the heart of the work of PTSD Resolution, to accurately and comprehensively report on the therapeutic journey of every veteran or family member treated.
This is important in the management of the programme because it enables precise monitoring of results to ensure a consistent standard of care across the network of therapists. It also provides evidence of the effectiveness of treatment, which is essential when promoting the service to veterans, who are often highly sceptical about, and reluctant to access mental health support.
A strong indicator of the level of satisfaction with the service is the very low drop-out rate, with 78 per cent of cases arriving at a planned treatment conclusion where both the client and therapist agree that no further treatment is required. Treatment is efficient and cost-effective, costing the charity £750 for a completed programme, with clients in front of therapists for their first appointment typically within a week of contact and with an average of six outpatient treatment sessions in total, with further sessions provided where necessary.
Using Outcome Measurement Data
Measurement is considered invaluable in the service to veterans, bringing the client's voice into the process. It provides the opportunity to observe progress in treatment through each client’s self-reporting, and they can express dissatisfaction with any aspect of support.
The client journey is mapped from the point of referral right through to after-care, sometimes years after the end of active treatment.
In the first contact with clients, the screening process is conducted by the charity’s administration team over the telephone, to gather essential information including the client’s mental health experience to date.
When clients first see a therapist they are invited to fill in three different measures before treatment starts:
- the CORE-10 scale, a highly respected and widely used measure of general distress;
- the IES, a 15 item measure of the impact of psychological trauma that has been used internationally for 50 years; and the
- PRN-14, which is focused on an audit of emotional needs and functioning, developed by Human Givens therapists
This provides the client with the ability to offer multiple perspectives on their current experience and presents the therapist with a comprehensive overview of the client’s current situation.
Metrics are used throughout the therapy, with feedback measures employed after each session to ensure client and therapist are on the same page. This process provides a map and compass for the therapist and client to understand and assist on the shared journey.
Yet the value of practice-based evidence goes well beyond the individual client-therapist interaction. The most recent analysis of PTSD Resolution data on closed cases where treatment has been completed, in October 2021, demonstrates that 87 per cent of cases had at least two measurement points with CORE-10 and 74 per cent of these cases improved reliably in treatment, with 46 per cent of cases demonstrating final scores below the cut-off - scoring in the normal healthy range.
These comprehensive results accurately reflect what is taking place in the service, building confidence for clients, for therapists and for the organisation.
Since the very beginning, PTSD Resolution has committed to working with practice-based evidence. The charity encourages all veterans’ mental health service providers to join this journey, so they can all learn from and support each other in an open and transparent manner. This would benefit everyone, especially the clients they seek to help.
For further information www.PTSDresolution.org.
Results at 16/11/2021: CORE-10 results are plotted in the scatter chart. Each dot on the chart represents the 1st (X-axis) and most recent (Y-axis) administration of the measure for clients who have attended more than one session. The position of the dot shows how much change occurred.
The diagonal line running from bottom left to top right across the chart shows the zone where no change has occurred. Below the diagonal shows improvement, above shows deterioration (Chart by Pragmatic Tracker - see www.pragmatictracker.com )
Quality Network for Veterans’ Mental Health Services.
PTSD Resolution is a participating member of the Royal College of Psychiatrists QNVMHS programme