Using Session Preparation

What is Session Preparation?

Talk clients will be invited to complete ‘Session Preparation’ in advance before every Talk session.

Session Preparation consists of 18 questions:

The PHQ-9 and GAD-7 clinical outcome measures asking about symptoms of depression and anxiety.
Two work impact questions about presenteeism and absenteeism.
The data will be visible to you in the Connect platform and we encourage you to review and reflect on the results ahead of your sessions.

Why has Unmind introduced this?

Session Preparation will help you to have a better understanding of the client and their progress before you see them, and so you can have information about how they are feeling that you can collaboratively discuss in the session and best tailor the sessions to their needs.

This will also help us better understand the clients who are using Talk, including the severity and types of symptoms that Talk clients are experiencing. We can then better shape our service for them.

Finally, this will enable us to measure the effectiveness of Talk. We can see whether the interventions we are offering are reducing symptoms and helping people to feel better.

Why the PHQ-9 and GAD-7?

We use the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Questionnaire-7 (GAD-7) self-report clinical outcome measures because they are the industry standard, globally recognised, validated extensively and have been translated into multiple languages. Many clients are accessing Talk for support with anxiety and depression and so these measures are clinically appropriate.

Why the two work impact measures?

These two questions were chosen as they capture absenteeism and presenteeism which are the two most important constructs that factor into workplace productivity and costs. This enables the client to reflect on how their mental health may be impacting their work, and helps us to calculate return on investment (ROI) for the companies we are working with. The questions come from the WPAI (Workplace Productivity and Activity Impairment Scale) with some very slight rewording. It's one of the most established measures of workplace productivity and also what we use in our RCT studies.

How does the client complete Session Preparation?

Session Preparation questionnaire now appears in the pre-call lobby in Unmind Meet, making it easy for clients to complete before the session begins. If you're using Zoom, clients will instead receive an email prompting them to complete the questionnaire ahead of time
We explain that by filling in the questionnaires they are helping their practitioner to get insight into their mental health and provide a better experience, and that their employer will not see this data.
They will be able to complete this up until the end of their session when the survey will close.
Clients' can only skip the questionnaire if they’re running late to the session

How can I view Session Preparation responses?

When a client completes Session Preparation, you will receive an email.

To view results, you will need to log into Unmind Connect.

Navigate to the Clients page in the left hand menu. Click on the name of the client you’d like to view more details of in the Client Table.

Navigate to the Sessions tab, you’ll then be able to view any Session Preparation responses next to the relevant session number.

You will also be able to check the clients page to see if any session preparation is outstanding:

What do I need to do?

Please read through this information carefully and familiarise yourself with the questions, what the scores mean and how to use these in the session.

Pease encourage your clients to complete their Session Preparation. Review the results of these before your session and consider how you might discuss these and tailor your sessions.

Where a client has scored 1 or above on question 9 of the PHQ-9 (how often have you had thoughts that you would be better off dead, or of hurting yourself in some way?) please consider carrying out a full clinical risk assessment. Note, a risk assessment should not be carried out solely on this basis. (For more information about risk assessment and management please see the HelpCentre article).

We are mindful of survey fatigue and that clients can be reluctant to complete multiple questionnaires, and so if you already send out or ask clients to complete the PHQ-9 and GAD-7 or other clinical outcome measures please ask them to complete our Session Preparation instead. We trust you to use your judgement on whether there are additional questionnaires you still want to send.

What are the exact questions?

Patient Health Questionnaire (PHQ-9):

The PHQ-9 is a 9-item questionnaire that assesses the severity of depression symptoms over the past 2 weeks. Each item is rated on a scale of 0 to 3, with higher scores indicating more severe symptoms. The total score for the PHQ-9 can range from 0 to 27. See below for scoring indications.

Over the last two weeks, how often have you been bothered by any of the following problems?

0=not at all
1=several days
2=more than half the days
3=nearly every day

Little interest or pleasure in doing things?

Feeling down, depressed, or hopeless?

Trouble falling or staying asleep, or sleeping too much?

Feeling tired or having little energy?

Poor appetite or overeating?

Feeling bad about yourself - or that you are a failure or have let yourself or your family down?

Trouble concentrating on things, such as reading the newspaper or watching television?

Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual?

Thoughts that you would be better off dead, or of hurting yourself in some way?

Scoring

0-4 none
5-9 mild
10-14 moderate
15-19 moderately-severe
20-27 severe

≥10 is the threshold for clinical ‘caseness’, not diagnostic but represents likely clinical depression. 5-point reduction is generally considered the threshold for clinically significant improvement. Final score <5 represents complete remission

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495268/ https://www.sciencedirect.com/science/article/abs/pii/S0165032710003666

Generalised Anxiety Disorder Questionnaire (GAD-7):

The GAD-7 is a 7-item questionnaire that assesses the severity of generalised anxiety disorder (GAD) symptoms over the past 2 weeks. Each item is rated on a scale of 0 to 3, with higher scores indicating more severe symptoms. The total score for the GAD-7 can range from 0 to 21. See below for scoring indications.

Over the last 2 weeks, how often have you been bothered by any of the following problems?

0=not at all
1=several days
2=more than half the days
3=nearly every day

Feeling nervous, anxious or on edge?

Not being able to stop or control worrying?

Worrying too much about different things?

Trouble relaxing?

Being so restless that it is hard to sit still?

Becoming easily annoyed or irritable?

Feeling afraid as if something awful might happen?

Scoring

0-4 none
5-9 mild
10-14 moderate
15-21 severe

≥8 is the threshold for clinical ‘caseness’, not diagnostic but represents likely clinical generalised anxiety.

4-point reduction is the threshold for clinically significant improvement.

References:
https://pubmed.ncbi.nlm.nih.gov/16717171/ https://www.sciencedirect.com/science/article/abs/pii/S0165032719313643

Work impact

During the past seven days, how many hours did you miss from work because of problems associated with poor mental health?

During the past seven days, how much did poor mental health affect your productivity while you were working?

Poor mental health can include things like stress, fatigue or low mood

Reference:
http://www.reillyassociates.net/WPAI_SHP.html

What if clients don’t complete the Session Prep?

If a client doesn’t complete the Session Preparation before the session, you can prompt them to complete it whilst in the session. Clients will not be able to complete it after the session has ended. We would encourage you to remind clients where possible.

Who will see the data?

You can access responses in your Unmind Connect account. Aggregated, anonymised insighted may be shared with the clients employer. Anonymised data will be seen by the Unmind team and we hope to publish findings on the effectiveness of Unmind Talk service.

Will clients accessing coaching and therapy be asked to complete the measures?

Yes. We have chosen to implement Session Prep for both therapy and coaching for several reasons:

So we can understand whether those accessing coaching are struggling with their mental health.
Given that we do not have any triage or eligibility checks, they may help coaches understand whether therapy is more suitable for someone (for further guidance on this see the Help Centre article on therapy vs coaching).

We will consider whether we need coaching-specific prep later, once we have some data and welcome your feedback and thoughts on this.

Will clients who are self-paying for session be invited to complete the Session Preparation questionnaires?

No, the questionnaires will not be available for clients on self-pay so if you wish to gather this information from them we encourage you to send these to them separately.