How does IAPT and EAP performance compare? What does a comparison of the two tell us about the relative strengths of each model? At the invitation of the EAPA UK, we set about the task of finding out. Below we present a snapshot of our key findings.

A recent Centre for Mental Health report has estimated that 20% of adults England will need mental health support in the wake of the coronavirus pandemic. Not surprisingly, the Employee Assistance Professionals Association UK (EAPA UK) has been keen to demonstrate the complementary additional resource to NHS provision provided by EAP services. It was in this context that we were invited by the EAPA UK to look at the relative performance of IAPT and EAP services.

I’ve been involved in benchmarking therapy service key performance indicators (KPI’s) over the best part of two decades. Even so, I was under no illusion that this was a straightforward task. Two models with very different delivery mechanisms, different outcome measures and different KPI’s. Given those differences, how to find valid points of comparison?

You can find the full report of our analysis titled IAPT and EAP service Provision: A comparative analysis of key performance data on the EAPA UK website. Below, we provide some of the main headlines.

Data sources and caveats

The analysis draws on two key data sources:

A study profiling performance benchmarks for six EAP programme providers published in 2013.

We’ve commented regularly on IAPT, including in our most recent blog on IAPT’s 2019 – 20 performance data. IAPT services contribute local data, using a standard minimum data set, to provide a national picture of overall IAPT performance. Alongside other condition specific measures (where appropriate) IAPT uses GAD-7 and PHQ-9 measures as standard.

The six EAP providers in the study from 2013 all used the CORE System as a common method of data collection and profiling. Not only did this entail using the CORE measures, it also involved using the system’s Therapy Assessment and End of Therapy forms. These enabled capture of key dates and other assessment and therapy variables in clients’ journeys through the services.

Given the different delivery systems, outcome measures and KPI’s used by IAPT and the EAP providers, providing valid comparisons has required some finessing. Nonetheless, we’re broadly content that the indicators we’ve used allow a good enough level of comparison to be made.

So, how does IAPT and EAP performance compare?

The comparators we’ve used are in our analysis are:

Average waiting time

Proportions of clients starting therapy following initial assessment

The average number of sessions used by clients

The proportions of clients completing therapy (IAPT) or reaching a planned end to therapy (EAPs)

Percentage of clients achieving a reliable improvement in their psychological health/symptoms

Below, we outline the relative performance of IAPT and EAP providers against four of these indicators. Each is accompanied by a brief explanation of how we arrived at the comparative data.

How long do clients wait for IAPT and EAP services?

IAPT: The average waiting time to enter treatment was 22.9 days. 87.4% waited less than six weeks for their first treatment appointment and 98.4% were seen within 18 weeks

EAP’s: The average waiting time from referral to first assessment date was 8.8 days

Only IAPT referrals that finish treatment are assessed for waiting time and outcomes. Data here is for 606,192 referrals, based on the time between referral date and first attended treatment appointment.

The EAP waiting time average is drawn from 27,437 clients and based on the time elapsed between the referral date and the first recorded assessment date.

How many sessions did IAPT and EAP clients use on average?

IAPT: Across all forms of treatment, clients finishing treatment received an average of 6.9 sessions

EAP’s: The average number of sessions attended by clients that came to a planned end of therapy was four.

Across all the treatment types offered by IAPT, clients that completed a course of treatment received on average 6.9 sessions.

Within EAP services the average number of sessions used by clients that completed therapy was four. In total, 96% of clients that completed therapy used five or fewer sessions.

What proportions of IAPT and EAP completed therapy?

IAPT: Of the 1,095,739 clients that started treatment in the year, 55.3% completed treatment

EAP’s: Of 22,662 valid cases, between 73% and 84% reached a planned end to their therapy.

IAPT: 1,095,739 clients either received one treatment session only, or finished treatment having received two or more sessions. 489,547 (44.7%) of those received one session only and are not counted as having completed treatment. Thus, we’ve counted 55.3% as completing treatment.

EAP: Ending type data (i.e., planned v. unplanned) was missing for 5.5% of cases. Hence, two rates of unplanned ending were calculated: the ‘declared’ rate of 16% (where ending type was specified) and the ‘estimated’ rate of 27% (calculated to compensate for missing data). The true rate of unplanned ending lies somewhere between these two rates. A mid-point estimate would 21.5%, which would give a planned ending rate of 79.5%.

 

What level of IAPT and EAP clients showed improvement?

IAPT: Over all treatments, 67.0% of referrals completing treatment showed a reliable improvement

EAP’s: For clients with valid pre-and post-therapy data, the rate of reliable improvement was 70.5%

Across IAPT services, 94.0% of clients completing therapy were over the clinical cut-off on one or both of the PHQ-9 and GAD-7 measures at the outset of their treatment. 67% showed a reliable improvement on completion.

Among EAP clients, for those with valid CORE-OM data, 87.5% scored over the clinical cut-off at assessment. 70.5% of those with valid pre- and post-measures showed reliable improvement.

In summary: IAPT and EAP performance compared

Given the different systems for service delivery, outcome and performance measurement, like for like comparisons of performance between IAPT and EAP providers will always be problematic. In addition, as highlighted in the full report, IAPT deals with a wider range of cases, and offers a wider range of interventions than EAP provision.

Nonetheless, we believe we’ve been able to provide reasonable and defensible comparison of performance for waiting times, session utilisation, therapy completion, and improvement rates. Our comparison shows that EAP services, on average, out-perform their IAPT counterparts on all of these performance measures. Given this, it would appear that that EAP’s do provide an accessible, efficient, acceptable and effective complement to NHS provision.

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Posted by:Barry McInnes

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