title: Enhancing recovery rates: lessons from year one of IAPT.
abstract: BACKGROUND
  The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines.
  
  
  METHODS
  Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7).
  
  
  RESULTS
  Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff.
  
  
  CONCLUSIONS
  Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.
authors.affiliation: School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Gyani
authors.forename: Roz
authors.initials: R
authors.lastname: Shafran
authors.forename: Richard
authors.initials: R
authors.lastname: Layard
authors.forename: David M
authors.initials: DM
authors.lastname: Clark
mesh_terms: D001008:Anxiety Disorders / Q000534:rehabilitation / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000592:standards / Q000706:statistics & numerical data*; D003376:Counseling / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000534:rehabilitation / Q000628:therapy*; D004059:Diffusion of Innovation; D004739:England; D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D016015:Logistic Models; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D015397:Program Evaluation / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012648:Self Care; D012720:Severity of Illness Index; D013222:State Medicine / Q000592:standards; D016896:Treatment Outcome
keywords: Anxiety disorders; CBT; Depression; Dissemination; IAPT; NICE; Outcome monitoring; Psychological therapies