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Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
Big White Wall provides accessible, evidence based online therapy via a secure platform. Sessions are available 7 days a week between 7am and 11pm, providing enhanced accessibility. KPI's are fully reportable and the service is CQC regulated.
Overview of Innovation:
Big White Wall (BWW) is a digital mental health support service which has been operating since 2007 and has supported 150,000 members in distress.

BWW provides Live Therapy, which is face to face therapy via the secure platform. Our clients, can complete sessions via video, audio only or text only. We provide NICE guided, evidence based interventions for common mental health disorders, such as OCD, Social Phobias, PTSD, Panic, Depression, GAD, Health Anxiety and Specific Phobias.

Many of our existing commissioners are IAPT services and we are fully IAPT compliant in our delivery including the sessional collection and reporting of the minimum dataset (MDS). Performance data can be submitted by the referrer themselves, either by collecting and inputting data from our platform or through the IAPTus PRISM integration, which feeds session data (clinical notes, attendance data and MDS) directly into the referring IAPT service's own IAPTus system. Or BWW can also submit data through the BWW IAPTus system which allows us to report data directly via an N3 connection, into NHS Digital under the appropriate service code.

We provide both NICE guided evidence based CBT and Counselling interventions and all of our Counsellors are additionally trained in Counselling for Depression. We also have a team of Long Term Conditions specialists (IAPT LTC Top Up trained) who can provide specialised interventions for those experiencing physical health issues. All of our therapists are professionally accredited and are experienced with at least 2 years post-accreditation.

We are CQC registered for our Live Therapy provision and remain the only digital service to have received this registered status. Our governance systems are therefore acknowledged to be safe and robust. We are included in the NHS Apps Library, requiring stringent assurance that we meet national standards, regulations and industry best practice.

Live Therapy at BWW is available between the hours of 7am and 11pm, seven days a week. We are able to meet an accessibility standard that many IAPT services are unable to achieve.

We are able to scale up or scale down provision according to demand and our waiting times to assessment / first therapy session are often measured in days rather than weeks or months. We are able to implement new contracts at pace.

We also provide clinically moderated peer support on the platform 24/7, which can augment patient self-management and provide intersession and pre . post treatment support.

Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
Similar Content3
Innovation 'Elevator Pitch':
The groundbreaking, secure hub that allows therapists to seamlessly and securely refer patients for online psychological treatment, and receive progress notes and outcomes data directly back into their NHS electronic patient record.
Overview of Innovation:
The Prism referral hub connects psychological therapy services with a variety of online digital therapies. Prism enables services to seamlessly and securely refer patients to a chosen online therapy and receive progress notes and outcome measures back, all from within their NHS electronic patient record. 

The Five Year Forward view for mental health and NHS Long Term Plan set ambitious targets to widen access to Improve Access to Psychological Therapies (IAPT) services across the country. This can only be achieved with greater uptake of online therapy options alongside growth in face to face and group therapy.

Prism was designed to make it easy for IAPT services to make use of online therapies. When a referral is received into the iaptus patient management system used by the majority of IAPT services, that patient can be referred straight through to a chosen online therapy partner from within the patient's electronic health record in iaptus so they can start virtual treatement without delay. The online provider can then securely send progress notes and outcome measures straight back into their health record. Previously, referring to an online therapy provider required, at best, laborious copying and pasting, or, at worst, a serious data quality challenge often with significant administrative support. The Prism hub has overcome all of this. Services gain efficiencies, patients have an improved experience, therapists can focus on the patient rather than admin, and outcomes are maintained – or even improved.

Since launching in 2014 Prism has been used by more than 60 IAPT services and currently handles 3000 referrals to online therapies each month. Prism is already  connected to Big White Wall, Compass, Dr Julian, ICS Digital Therapies, Living Life to The Full, Minddistrict, Silvercloud, Wellmind Media and OxCADAT SAIT with new online therapy partners being added all the time.

Prism was developed and is managed by Mayden. We have worked with IAPT services since 2008 to provide iaptus, the leading patient management software for psychological therapies. During this time, we have seen first-hand the limited resources and growing demand for IAPT services and recognise a need to provide innovative solutions that increase capacity.

Prism was developed with support from the NHS SBRI Healthcare initiative. We continue to work closely with IAPT and with a variety of online therapy providers to offer a breadth of choice for patients and services.
 
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
Services gain efficiencies by making use of online therapies for appropriate patients which can be cheaper and more cost effective than face to face treatments. Patients have an improved experience with immediate access to treatment, and virtual treatment being more convenient or preferred to face to face therapy. Therapists can focus on the patient, rather than administration of referrals and can maintain an overview of the patient using digital treatments. They may also blend digital with face to face where clinically appropriate. Outcomes are maintained – or even improved - through online therapies.
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
As for the NHS as a whole.
Current and planned activity: 
Prism is connected to ten digital providers. It handles around 3000 referrals a month now, and is used by 60+ IAPT services across England. We continue to add new online digital partners to the Prism platform.
What is the intellectual property status of your innovation?:
Mayden holds the IP for Prism.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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Innovation 'Elevator Pitch':
Ieso Digital Health delivers NICE recommended cognitive behavioural therapy (CBT) one-to-one between patients and IAPT trained therapists via online (live) typed conversation. Appointments are available when suit patients on any web enabled device.
Overview of Innovation:
Ieso Digital Health (“Ieso”) provides NICE recommended cognitive behavioural therapy (CBT) through our proprietary 'ThinkWell' web-based platform. Both Step 2 and Step 3 therapy is delivered one-to-one between a patient and an IAPT-trained PWP or a BABCP-accredited high intensity therapist online through typed conversation, supported by offline messaging in-between sessions; treating all IAPT-applicable conditions:
  • depression
  • generalised anxiety disorder
  • social anxiety disorder
  • panic disorder
  • agoraphobia obsessive-compulsive disorder (OCD)
  • specific phobias (such as heights or small animals)
  • PTSD
  • health anxiety (hypochondriasis)
  • body dysmorphic disorder
Ieso’s fully-managed service has been developed in association with, and operating within, the NHS IAPT services since 2011. We have steadily built up our customer base and are now commissioned in over 65 CCG areas across England, either working directly with the CCGs or as sub-contractors to NHS Trusts and independent healthcare providers. To date Ieso have treated in excess of 43,000 patients and conducted over 210,000 hours of therapy within the IAPT programme.

Ieso summary information sheet is attached for review.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Digital health / Innovation and adoption
Benefit to NHS:
With growing demand for psychological therapies, traditional services can struggle to maintain NHS service standards relating to access, waiting times and recovery. As a result, services from around the NHS need to consider how to extend their care to patients without increasing their costs; including delivering digital interventions for appropriate cohort of patients. Although our service utilises the same human resources for the therapy itself, we have no additional overheads with regards to room hire, travel costs or other traditional overheads seen within the NHS.

Ieso's financial model is focused around patient treatment with no limit on session numbers. Pricing is based upon per episode of care, meaning a certain number of patients will be treated as part of allocated budget rather than assumed therapist capacity. 
 
Analysis of that data (Jan-Dec 2017) shows that Ieso delivers:
  • 22% better outcomes than the national average
  • 48% more patients’ complete treatment than the national average
  • 96.5% accessing treatment within 6 weeks, compared to 93.7% nationally, but with no waits for subsequent appointments.
In addition, Ieso’s “patient experience questionnaire” data shows that 82% of patients rate Ieso as good or excellent, and 66% of patients’ treatment is conducted outside of normal office hours.
 
The benefits of our innovation are not limited to quick and flexible access to treatment and better outcomes for patients. Our unique position of having access to extensive patient data can be used in clinical research to develop improvements in mental health care:
• Catarino, A. et al. (2018) Demographic and clinical predictors of response to internet-enabled cognitive–behavioural therapy for depression and anxiety. BJPsych Open (attached.
• Ewbank, M. et al (2019) Quantifying the Association Between Psychotherapy Content and Clinical Outcomes Using Deep Learning (attached)
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
Patients are able to access clinically validated, NICE-approved, one-to-one typed CBT with an IAPT-trained PWP or BABCP-accredited high intensity therapist from the comfort of their own home using nothing more than their smartphone, tablet or computer to access our ThinkWell platform via a reliable internet connection.

With appointments available 24/7, traditional CBT can be conducted at a time and place that suits the patient. This means that those who are time poor, struggle to access traditional services due to geography, physical difficulties or personal boundaties are able to access the treatment that's right for them.

Approximately 66% of Ieso’s therapy sessions happen outside the traditional Monday-Friday 9-5 window,
with the majority taking place on week day evenings; in addition, Ieso’s “patient experience questionnaire” data shows that 82% of patients rate Ieso as 'good' or 'excellent'.

You can view an Ieso explainer video here:
https://www.youtube.com/watch?v=H5cID-JGSXU

As well as a 'people' video showing some of the people behind Ieso Digital Health here:
https://www.youtube.com/watch?v=ryIFZNBVkhk

We have also attached a patient case study.
Current and planned activity: 
Ieso manages IAPT contracts with large footprints, such as in Surrey, where we treat approximately 20% of the total number of patients accessing IAPT across the five CCGs within the AQP contract. In addition to Surrey, Ieso holds 26 IAPT contracts delivering a Primary Care Psychological Therapies Services. These contract areas are listed below;
•        Bolton
•        Bromley
•        Camden
•        Cambridgeshire and Peterborough
•        Derbyshire
•        Devon
•        Dorset
•        Dudley
•        East Riding of Yorkshire
•        Gloucestershire
•        Buckinghamshire
•        Herefordshire
•        Islington
•        Lancashire
•        Leeds
•        Medway
•        Merton
•        Norfolk
•        Nottinghamshire
•        Salford
•        Southampton
•        Southwark
•        Suffolk
•        Sussex
•        Wandsworth
•        West Kent

We continue to expand enabling more and more people to access clinically-validated CBT at a time and place that suits them.
What is the intellectual property status of your innovation?:
All IP is owned by Ieso Digital Health.

Ieso is ISO9001 and ISO27001 compliant and our IG Toolkit for 2017-18 (v14.1) had an overall score of
95%.

Ieso is fully operable with all major patient management systems (IAPTus, PCMIS).
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
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Innovation 'Elevator Pitch':
GRiST is a web-based mental health risk identification and safety management service. It works alongside assessors to evaluate risks and formulate care plans for service users based on expertise developed over 17 years.
Overview of Innovation:
GRiST (www.egrist.org), is a web-based system designed to assess and manage mental health and wellbeing, including risks of suicide, self-harm, self-neglect, vulnerability, and harm to others. Developed by cognitive and computer scientists at Aston University over a period of 17 years, it was recently spun out into its own company, eGRiST Ltd.

GRiST allows IAPT practitioners to work collaboratively with service users on improving mental health and wellbeing. It integrates patient data, mental-health practitioners’ expertise and empirical evidence to support comprehensive clinical risk evaluations, formulations and safety plans. The built-in machine learning algorithms working on a million separate risk assessments from trained clinicians, enables it to flag up areas of concern and point people to the most appropriate resources for addressing them. These can be configured to their local availability within each IAPT service as well as to the specific life circumstances of each service user.
 
Service users also have access to a self-assessment version, myGRiST. It allows them to see how their plans and interventions are impacting their mental health and wellbeing on a continuous basis. The reports produced can be shared with IAPT counsellors if agreed, to help both parties ensure care plans are working and to focus therapies on the most important concerns.

The goal is co-creation of mental health that encourages services users to monitor and manage their own wellbeing. It was the original intention for developing GRiST: to disseminate expertise where it does not exist and empower people to identify and address their own mental health issues. People are thus connected to mental health services without having to rely exclusively on face-to-face appointments, which creates the opportunity for more effective use of resources.
 
The GRiST innovation has been adopted by a number of mental-health NHS Trusts, charities, and private organisations. It currently holds almost two million individual risk judgements in 400,000 completed assessments from 200,000 patients. These assessments cover all ages and the complete care pathway, from screening to full and focused repeat assessments. Versions have been developed for IAPT in primary care through to specialist forensic services and learning disabilities. All assessments are easily accessible at any point on the care pathway so that IAPT practitioners, for example, can see a person’s full GRiST history wherever it was recorded.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Wellness and prevention of illness / Education, training and future workforce / Clinical trials and evidence / Digital health / Person centred care
Benefit to NHS:
GRiST allows for the advanced discovery of mental health issues, which leads to better, earlier interventions. This can prevent mental health issues from escalating and reduce costs by, for example, decreased use of hospital facilities due to suicide and self harm attempts and fewer emergency-service calls. It also helps improve general mental health and wellbeing, which means people are more likely to remain in work or live at home rather than in full-time care.

GRiST is not just a questionnaire; it models the intuitive knowledge and reasoning processes used by mental-health practitioners to capture information on areas relevant to mental illness as they naturally arise in conversation. This encourages a collaborative and free flowing assessment that helps the patient feel valued and respected. Collaboration is enhanced by the self-assessment version, myGRiST, which lets patients update their own record remotely at any time. These self-assessments can be shared with IAPT services so that staff can identify issues without having to wait for appointments and prioritise time for those with potentially higher risk factors. It reduces the load on primary care services without leaving people vulnerable.

GRiST can be fully integrated with existing care record systems, which is already the case for RiO, Carenotes, Salesforce, and IAPTus. IAPTus is currently used by 70% of all IAPT services and has over 20,000 registered users across England, all of which are potentially able to access GRiST. It gives them a chance to improve risk governance without having to change their information technology or patient records.

Machine learning algorithms in GRiST accurately predict risk judgements. Significantly, if an individual clinician judges the risk level to be low when GRiST predicts it to be high, the likelihood of a suicide attempt increases by a third. This shows that GRiST can help reduce the probability of suicides by detecting potential errors in judgements. Practitioners are able to reflect objectively on the answers they have given and revisit the assessment or provide reasons for why they feel their judgement differs. Legitimate exceptions to the general template will build a portfolio of special cases that will detect people at risk when their general profile looks similar to others who are not at risk.
Initial Review Rating
4.80 (2 ratings)
Benefit to WM population:
In the WM, GRiST is used by Worcestershire Health and Care NHS Trust (WHCT) and Birmingham Children’s Hospital, as well as independent services. We are working with Birmingham City Council (BCC) on improving adult social care with the use of GRiST particularly for older adults in the community. It helps care services assess mental health and wellbeing needs and links carers with older adults to ensure their health and safety is maintained on an ongoing basis. Simple versions of myGRiST that automatically alert carers have already been developed and pilots are underway with a large provider of independent living villages in Birmingham.

At the other end of the age range, our EduGRiST version for schools and universities is being configured to meet the specific needs of young people in education. It addresses increasing concerns about student mental health by identifying the issues and directing students to the most appropriate resources, from peer support and self-help groups, through to institutions’ own counselling services and primary care as necessary. This ensures people access the right help at the right time, reducing load on services to which they are unnecessarily referred and ensuring their problems are addressed before they escalate.

Increasing access to GRiST by IAPT services provides continuity of care for patients with assessments in secondary care, such as for those in WHCT and BCC.  This has already been accomplished in Cumbria where IAPTus and RiO both have GRiST and can share the assessments across service boundaries. An important benefit is with discharge planning. Many risk episodes occur when people leave secondary care and return to the community because the risk context and resulting care packages are so different. GRiST projects risk evaluations into the community and produces a more accurate discharge plan that can include patients conducting self-assessments with myGRiST. The local IAPT service could form part of the monitoring process and help prevent untoward incidents at this particularly vulnerable time.
 
The greatest general benefit is that people can engage with IAPT services more effectively by managing therapeutic regimes through GRiST. They can record their activities within myGRiST and see how interventions are impacting the areas of concern. The results ensure counsellors maintain the most appropriate treatments and encourage collaborative co-creation of health where the service users take active control of their therapy.
Current and planned activity: 
We are currently engaged with NHS Trusts, IAPT services, third sector organisations, and private hospitals, all of which use one or more versions of GRiST. The NHS organisations in particular have scrutinised and approved the security and governance arrangements for GRiST. The servers are currently held in Aston University but we plan to move them into approved cloud services within the next year.

Although we are accessible via IAPTus, we are looking for better integration through more sophisticated information flows and decision support. Accessing outcome data in IAPTus, for example, will validate the advice within GRiST as well as provide a holistic picture of care for both counsellors and service users. 
 
We also want to increase adoption by front-line services such as the police, fire and 111 services, all of whom have expressed an interest in GRiST and could benefit from an interface with IAPT services.
What is the intellectual property status of your innovation?:
IP is owned by EGRiST Ltd and Aston University.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
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