Evaluating the effectiveness of Improving Access to Psychological Therapies (IAPT) ‘Step 2’ interventions in addressing older people’s psychological distress: A service evaluation of one IAPT Service in the East Midlands

Abstract

Despite evidence that Improving Access to Psychological Therapies (IAPT; now NHS Talking Therapies) interventions can be effective for older people, ageism and stigma appear to block access. This research evaluated ‘Step 2’ clinical outcomes for older people and explored ‘drop out’ and ‘stepped up’ rates in one IAPT service. Outcome measure data from 226 people who completed a Step 2 intervention in 2022 were analysed. Significance of changes of low mood and anxiety scores, and any correlation between age and degree of change were explored. Results showed Step 2 clients were significantly older than those in Step 3. For Step 2 interventions, anxiety and low mood scores were significantly lower post-therapy than pre-therapy, with large pre- to post-effect sizes. Older people showed a similar degree of change regardless of age. Disparities in access were suggested for the oldest older people, older clients from racialised backgrounds, those identifying as lesbian, gay, or bisexual, and males, with all appearing marginally under-represented in the service’s caseload. Step 2 interventions were deemed not appropriate for a significant minority. Overall, Step 2 interventions were effective for many older people, suggesting services should be promoting IAPT for adult clients, regardless of age. Future research could explore possible barriers for the oldest older people and minoritised clients, and whether alternative outcome measures may be beneficial.