DIALOG and DIALOG+ Training Package in London
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Exploring both positive and
negative aspects of the situation in
the given domain. The person is
first asked to explain the reasons
for dissatisfaction and wishes for
more help (or distress/concern in
case of MH). Then the person is
encouraged to consider existing
strengths or coping strategies.
directing the patient from a
description of the problem to
considering desired alternative
scenarios. The patient is asked to
imagine what changes he/she
would like to see to replace the
current undesirable situation. This
can focus on long-term preferred
outcomes and more short term
small changes.
Asking the patient about what
practical actions might help
to bring about the desired
change. This covers actions
taken by the patient, the clinician
or someone else.
agreeing on defined actions to
improve the patient’s condition
and/or social situation. This step
involves an agreement on specific
and defined actions from the
patient or the clinician or both. The
agreed actions are briefly
documented.
DIALOG+ uses the scores identified
by the person to take a structured
approach to exploring their identified
needs and wishes. It’s a person-
centred approach that can support
care planning, find solutions and
solve problems between the person
and healthcare professional.
To find out more information see the
Operational Manual
How satisfied are you
with….
1.
Y
our mental health?
2.
Your physical health?
3.
Your job
situation?
4.
Your
accommodation?
5.
Your leisure activities?
6.
Your relationships with your partner/family?
7.
Your friendships?
8.
Your personal safety?
9.
Your medication?
10.
he practical help you receive?
11.
Your meeting with your mental health
professionals?
S
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1
How satisfied are you with your mental Health?
How satisfied are you with your physical health?
How satisfied are you with your job situation?
How satisfied are you with your accommodation?
How satisfied are you with your leisure activities?
How satisfied are you with your relationship with your partner/family?
How satisfied are you with your friendship?
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How satisfied are you with your personal safety?
How satisfied are you with your medication?
How satisfied are you with your practical help you receive?
How satisfied are you with your meetings with mental health professionals?
…
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The survey is designed to
measure how a person rates
their quality of life and
experience of the care that
they receive.
Totally
satisfied
Totally
dissatisfied
Very
dissatisfied
Fairly
dissatisfied
Fairly
satisfied
Very
satisfied
In the middle
… with one being totally
dissatisfied and seven
being totally satisfied.
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At the start of a
new
treatment
episode i.e
admission to an
inpatient treatment, home
treatment service, or other community service;
referral to new provider organisation
.) For
acute
treatment DIALOG should be carried out
within
48 hours
, for
community
setting–
obtained within
first or second meeting
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For
acute
treatment DIALOG should be
carried out within
48 hours
, for
community
setting– obtained within
first or second meeting
More frequent DIALOGs maybe carried
out if embedded within CPA process or
when carrying out DIALOG is clinically
indicated
At the end of treatment episode
(discharge from a team, service or
provider organisation).
London has agreed minimum time points in which DIALOG should be completed to ensure a standardised process
Why has DIALOG been chosen as a London Patient Reported Outcome Measure (PROM)?
The scale has been
shown to have good
psychometric
properties.
Service users
report
satisfaction in
using it.
It is simple to use.
The information
can be used for
planning for
individual
patients and
whole services.
It can be used to
evaluate treatment
and has the
advantage that each
item is meaningful.
The use of DIALOG +
has been shown to
improve quality of life
through a solution
focused approach.
London mental health partners came together to agree that DIALOG should be the London Patient
Reported Outcome Measure (PROM).
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(
P
R
O
M
)
.
It is an assessment of
health status and health-
related quality of life that
comes directly from the
patient.
PROMS provide services
with a measure of the
subjective impact of our
services on a persons
health and wellbeing.
In London DIALOG has been
agreed to be used for Early
Intervention in Psychosis (EIP)
and Care Programme Approach
(CPA) services. DIALOG can be
used in wider mental health
service in the future.
Having hope and optimism that
recovery is possible and
relationships that support this.
Characterised by: motivation to
change; positive thinking and valuing
success; having dreams and
aspirations
H
o
p
e
&
O
p
t
i
m
i
s
m
Living a meaningful and purposeful
life, as defined by the person (not
others). Characterised by: meaning
in mental ‘illness experience’;
spirituality; meaningful life and social
goals..
M
e
a
n
i
n
g
Having good relationships and being
connected to other people in positive
ways. Characterised by: peer
support and support groups; support
from others; community.
C
o
n
n
e
c
t
e
d
n
e
s
s
Regaining a positive sense of self
and identity and overcoming stigma
I
d
e
n
t
i
t
y
Having control over life, focusing on
strengths, and taking personal
responsibility.
E
m
p
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t
C
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+
[
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]
Trusts to invite service users to provide their perspective on how DIALOG/+
has supported their recovery.
Watch this
short video
to hear
what service users who have
used DIALOG think
S
e
c
t
i
o
n
3
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The data can be understood at an individual
level. Here you can see that at the same
time point satisfaction with physical health
and accommodation has decreased which
has also had an impact on the individuals
mental health.
The data can be used to better understand team needs. Here this
shows why patients come in to the service beyond their mental health
such as physical health, job situation and leisure activities. This can
be used to direct focus around patients needs or for example staff
skills and expertise.
T
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.
S
o
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:
t
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a
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L
F
T
When DIALOG data
is collected it can be used to
shape and inform and make improvements to the service.
H
o
w
t
o
u
s
e
D
I
A
L
O
G
o
n
E
P
R
[
P
l
a
c
e
h
o
l
d
e
r
]
Trusts to add in EPR information e.g
screenshots and instructions of how to
navigate your EPR system in relation to
DIALOG
H
o
w
t
o
a
c
c
e
s
s
D
I
A
L
O
G
o
n
l
i
n
e
[
P
l
a
c
e
h
o
l
d
e
r
]
Trusts to add in EPR information e.g
screenshots and instructions of how to
navigate your EPR system in relation to
DIALOG
U
s
i
n
g
D
I
A
L
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G
+
i
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a
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p
l
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n
[
P
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a
c
e
h
o
l
d
e
r
]
Trust might want to add examples of their
care plans.
•
DIALOG can improve the care plan
process
•
Where Trusts move towards DIALOG+
there may be an opportunity to
streamline this process.
Explore the DIALOG training package in London, covering topics such as what DIALOG involves, examples of data usage, patient feedback, rating criteria, use in electronic patient records, and more. Learn about the structured approach of DIALOG+ in addressing individual needs and wishes through a person-centered approach. Discover the 4-step process of DIALOG+ and how it can support care planning and problem-solving between patients and healthcare professionals.
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Presentation Transcript
DIALOG Pan London Training package
Section 3 Section 1 Section 2 What is DIALOG? Useful examples of how data is starting to be used Patient feedback on DIALOG and DIALOG+ How to rate DIALOG DIALOG and DIALOG+ How to use DIALOG on EPR When should DIALOG be completed? How you can access DIALOG online Using DIALOG+ in the care plan Why DIALOG was agreed as the London PROM DIALOG as an outcome measure Recovery principles
What is DIALOG? DIALOG is a set of 11 simple questions that cover different area of a persons life. Relationships with friends and family Meeting with your mental health professional Practical help you receive Accommodation Medication Mental health Physical health Leisure activities Job Personal safety situation Friendships
DIALOG + DIALOG+ uses the scores identified by the person to take a structured approach to exploring their identified needs and wishes. It s a person- centred approach that can support care planning, find solutions and solve problems between the person and healthcare professional. DIALOG+ uses a 4 step approach Agreeing on actions agreeing on defined actions to improve the patient s condition and/or social situation. This step involves an agreement on specific and defined actions from the patient or the clinician or both. The agreed actions are briefly documented. Exploring options Looking forward Asking the patient about what practical actions might help to bring about the desired change. This covers actions taken by the patient, the clinician or someone else. directing the patient from a description of the problem to considering desired alternative scenarios. The patient is asked to imagine what changes he/she would like to see to replace the current undesirable situation. This can focus on long-term preferred outcomes and more short term small changes. Understanding Exploring both positive and negative aspects of the situation in the given domain. The person is first asked to explain the reasons for dissatisfaction and wishes for more help (or distress/concern in case of MH). Then the person is encouraged to consider existing strengths or coping strategies. To find out more information see the Operational Manual
Section 1 How to rate DIALOG How satisfied are you with . 1. Your mental health? 2. Your physical health? 3. Your job situation? 4. Your accommodation? 5. Your leisure activities? 6. Your relationships with your partner/family? 7. Your friendships? 8. Your personal safety? 9. Your medication? 10.he practical help you receive? 11.Your meeting with your mental health professionals? How satisfied are you with your meetings with mental health professionals? How satisfied are you with your mental Health? How satisfied are you with your physical health? How satisfied are you with your job situation? The first eight questions cover different areas of your life How satisfied are you with your accommodation? How satisfied are you with your leisure activities? How satisfied are you with your relationship with your partner/family? How satisfied are you with your friendship? How satisfied are you with your personal safety? How satisfied are you with your medication? and the last three are about your treatment How satisfied are you with your practical help you receive? DIALOG can help facilitate a person-centred approach by supporting meaningful conversations between service users and the healthcare professional about what aspects of their mental health are priorities for them.
How to rate DIALOG with one being totally dissatisfied and seven being totally satisfied. The survey is designed to measure how a person rates their quality of life and experience of the care that they receive. Fairly satisfied Totally satisfied Totally dissatisfied Fairly dissatisfied 2 Very 6 Very satisfied 1 7 3 4 5 In the middle dissatisfied
When should DIALOG be completed? London has agreed minimum time points in which DIALOG should be completed to ensure a standardised process Every 4 weeks for acutetreatment inpatients and crisis teams; no longer than 6 months ongoing treatment in community services and outpatient clinics). At the start of a new treatment episode i.e admission to an inpatient treatment, home treatment service, or other community service; referral to new provider organisation.) For acute treatment DIALOG should be carried out within 48 hours, for community setting obtained within first or second meeting Review For acute treatment DIALOG should be carried out within 48 hours, for community setting obtained within first or second meeting Episode start More frequent DIALOGs maybe carried out if embedded within CPA process or when carrying out DIALOG is clinically indicated At the end of treatment episode (discharge from a team, service or provider organisation). Episode end
Why has DIALOG been chosen as a London Patient Reported Outcome Measure (PROM)? London mental health partners came together to agree that DIALOG should be the London Patient Reported Outcome Measure (PROM). DIALOG was agreed to be used because .. The information can be used for planning for individual patients and whole services. The scale has been shown to have good psychometric properties. It is simple to use. It can be used to evaluate treatment and has the advantage that each item is meaningful. The use of DIALOG + has been shown to improve quality of life through a solution focused approach. Service users report satisfaction in using it.
DIALOG as an outcome measure PROMS provide services with a measure of the subjective impact of our services on a persons health and wellbeing. Healthcare professionals call this a patient reported outcome measure (PROM). It is an assessment of health status and health- related quality of life that comes directly from the patient. In London DIALOG has been agreed to be used for Early Intervention in Psychosis (EIP) and Care Programme Approach (CPA) services. DIALOG can be used in wider mental health service in the future.
CHIME framework Hope & Optimism Connectedness Having hope and optimism that recovery is possible and relationships that support this. Characterised by: motivation to change; positive thinking and valuing success; having dreams and aspirations Having good relationships and being connected to other people in positive ways. Characterised by: peer support and support groups; support from others; community. Identity Meaning Regaining a positive sense of self and identity and overcoming stigma Living a meaningful and purposeful life, as defined by the person (not others). Characterised by: meaning in mental illness experience ; spirituality; meaningful life and social goals.. Empowerment Having control over life, focusing on strengths, and taking personal responsibility. Source: Leamy et al 2011
Patient feedback on DIALOG and DIALOG+ Service users have described the benefits of using DIALOG and DIALOG+ Watch this short video to hear what service users who have used DIALOG think Monitor [Placeholder] Trusts to invite service users to provide their perspective on how DIALOG/+ has supported their recovery.
The data can be understood at an individual level. Here you can see that at the same time point satisfaction with physical health and accommodation has decreased which has also had an impact on the individuals mental health. Useful examples of how data is starting to be used There are different ways that the data can be understood and used to support a persons mental health and improve the quality of the service. The data can be used to better understand team needs. Here this shows why patients come in to the service beyond their mental health such as physical health, job situation and leisure activities. This can be used to direct focus around patients needs or for example staff skills and expertise. Source: this data is anonymised data taken from ELFT
Analysing DIALOG data DIALOG data can be analysed at an individual items level or represented as mean scores Reflection of scores: 1-3 = explicit dissatisfaction, 4 neutral middle, 5-7 explicit satisfaction High initial levels of satisfaction scores provide less scope for improvement (so called ceiling effect) whilst very low scores make improvements more likely (so called regression to the mean). For treatment satisfaction, absolute scores at a given time point more relevant than changes over time, ratings should consistently stay above 4 demonstrating a fair degree of satisfaction Organisation Individual Service Scores of single items of people in a service can be shown as means =average satisfaction scores or as a % of patients who have explicit dissatisfaction/satisfaction When considering changes over time global mean scores and single item analysis can be used depending on analysis Average subjective quality of life score of ALL patients in a service should not improve yet scores for the same patients should A change of overall means scores of >0.125 reflects an average improvement at least one scale point in at least one domain and may be a guide for overall meaningful improvement Treatment scores should consistently stay above 4 and % of patients with dissatisfaction kept to a minimum Used for an assessment of the personal problems and areas of strength Mean scores allows for review of data across every item For subjective quality of life scores below 4 require particular attention When evaluating treatment, any improvement in subjective quality of life is a meaningful increase Patients in long term care unrealistic to expect consistent and ongoing improvements personal context important Follows same principles as the interpretation for all patients in a service. Aggregating up means patient groups are very large, differences between mean scores tend to become smaller. % of explicit dissatisfaction or satisfaction rather than mean scores may be more informative
How to use DIALOG on EPR [Placeholder] Trusts to add in EPR information e.g screenshots and instructions of how to navigate your EPR system in relation to DIALOG
How to access DIALOG online [Placeholder] Trusts to add in EPR information e.g screenshots and instructions of how to navigate your EPR system in relation to DIALOG
Using DIALOG+ in the care plan [Placeholder] Trust might want to add examples of their care plans. DIALOG can improve the care plan process Where Trusts move towards DIALOG+ there may be an opportunity to streamline this process.
