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Problem Descriptors – A Confusing IAPT Signpost Leading to Crashes

‘ I think it is social anxiety disorder, from my problem description my manager thinks its’ generalised anxiety disorder’  should treatment be determined by the power holder or should they just spin a coin with a ?50% chance of the client getting the right treatment. Such is the soap opera acted out in IAPT.

IAPT uses problem descriptors to determine what treatment to give to whom. But problem descriptors are a rule of thumb to determine treatment. In randomised controlled trials treatment was based on a reliable diagnosis, which would typically take an hour or more to determine. IAPT has come up with a problem descriptor shortcut of undetermined reliability and which it seeks to legitimate by asking therapist to provide an ICD-10 code.

The IAPT Manual considers it best practice if a service provides an ICD-10 code for at least 80% of cases. Can it be acceptable for up to 1 in 5 people to have rudderless treatment? When clients are assigned an ICD-10 code it is usually a single code and a Manager may advise that a another code is appropriate rather than the one the clinician selects.  Whilst the IAPT Manual advises that more than one code can be appropriate, it also advises that treatment should be dictated by the principle problem, this likely has the effect of making for single awards of ICD-10 codes.

The IAPT Manual claims that ICD-10 codes are the basis of the NICE recommended treatments, but they are not. Most of the mental health trials considered by NICE are based on the more reliable and stricter DSM criteria. Notwithstanding this ICD-10 provide diagnostic criteria for each disorder, but IAPT also contends that it does not make diagnosis. It is therefore difficult to escape the conclusion that IAPT pays lip service to ICD-10 codes for its’ own credibility.  Despite this the IAPT Manual insists that the treatment protocol should follow the identified problem but the protocols have never been matched to problems but to disorders!

Dr Mike Scott

 

480 replies on “Problem Descriptors – A Confusing IAPT Signpost Leading to Crashes”

Like most services we do an initial telephone assessment taking around 45 minutes. I was speaking to a senior colleague who told me the purpose of this assessment is for the client essentially to tell their story, and for therapist and client to come up with an agreed description of the problem(s) broken down into ‘typical’ thoughts, emotions, behaviour and physical responses. This strikes me as ripe for misunderstanding and ambiguity, as you say Mike probably often resulting in the wrong treatment for a disorder the person doesn’t have. For example in my experience it is not uncommon for someone who is depressed to describe thoughts and emotions associated with anger, this is a symptom their depression – based on the initial assessment process as it stands currently there is a danger of the person being signposted to something like anger management. The initial assessment procedure urgently needs a revisit and review.

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Envejecimiento y danos: El uso prolongado, el temperatura elevada y los danos mecanicos llegan a alterar la cantidad y conducir en desequilibrio.
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Imprecisiones de produccion y ensamblaje: Hasta leves diferencias en la geometria de los componentes podrian originar desbalance.
Desgaste y problemas: El funcionamiento prolongado, el sobrecalentamiento y los danos mecanicos llegan a afectar la volumen y resultar en falta de equilibrio.
Colocacion o arreglo inadecuada: Una montaje inadecuada de la compartimento de embrague o reparaciones deficientes de igual manera tienden a generar falta de equilibrio.

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富遊娛樂城為 VIP 會員提供無上限的返水優惠，最高可達 0.7%。此活動讓玩家在遊戲的同時，還能享受額外的回饋。

結論
選擇合適的娛樂城不僅能為您的遊戲體驗增色不少，還能通過各種優惠活動獲得更多的利益。無論是新會員還是資深玩家，都能在這些推薦的娛樂城中找到適合自己的遊戲和活動。立即註冊並體驗這些優質娛樂平台，享受無限的遊戲樂趣！

娛樂城推薦與優惠詳解

在現今的娛樂世界中，線上娛樂城已成為眾多玩家的首選。無論是喜歡真人遊戲、老虎機還是體育賽事，每個玩家都能在娛樂城中找到自己的樂趣。以下是一些熱門的娛樂城及其優惠活動，幫助您在選擇娛樂平台時做出明智的決定。

各大熱門娛樂城介紹
1. 富遊娛樂城
富遊娛樂城以其豐富的遊戲選擇和慷慨的優惠活動吸引了大量玩家。新會員只需註冊即可免費獲得體驗金 $168，無需儲值即可輕鬆試玩。此外，富遊娛樂城還提供首存禮金 100% 獎勵，最高可領取 $1000。

2. AT99娛樂城
AT99娛樂城以高品質的遊戲體驗和優秀的客戶服務聞名。該平台提供各種老虎機和真人遊戲，並定期推出新遊戲，讓玩家保持新鮮感。

3. BCR娛樂城
BCR娛樂城是一個新興的平台，專注於提供豐富的體育賽事投注選項。無論是足球、籃球還是其他體育賽事，BCR都能為玩家提供即時的投注體驗。

熱門遊戲推薦
WM真人視訊百家樂
WM真人視訊百家樂是許多玩家的首選，該遊戲提供了真實的賭場體驗，並且玩法簡單，容易上手。

戰神賽特老虎機
戰神賽特老虎機以其獨特的主題和豐富的獎勵機制，成為老虎機愛好者的最愛。該遊戲結合了古代戰神的故事背景，讓玩家在遊戲過程中感受到無窮的樂趣。

最新優惠活動
富遊娛樂城註冊送體驗金
富遊娛樂城新會員獨享 $168 體驗金，無需儲值即可享受全場遊戲，讓您無壓力地體驗不同遊戲的魅力。

VIP 日日返水無上限
富遊娛樂城為 VIP 會員提供無上限的返水優惠，最高可達 0.7%。此活動讓玩家在遊戲的同時，還能享受額外的回饋。

結論
選擇合適的娛樂城不僅能為您的遊戲體驗增色不少，還能通過各種優惠活動獲得更多的利益。無論是新會員還是資深玩家，都能在這些推薦的娛樂城中找到適合自己的遊戲和活動。立即註冊並體驗這些優質娛樂平台，享受無限的遊戲樂趣！

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Пеларгонии элитные: лучший выбор для вашего квартиры и сада

Если ты подбираете растения, которые будут удивлять тебя их внешним видом и запахом, вместе с тем не требуя сложного присмотра, сортовые герани — превосходный вариант. Этих растения обладают уникальными преимуществами, что превращают их ведущими между эстетических растений.

Почему элитные герани?

Простота и легкость в уходе
Пеларгонии не требуют специальных требований для роста и без проблем адаптируются к многим климатам. Они замечательно чувствуют себя как в жилище, так и на открытом воздухе. Забудьте о капризных растениях — герани хватает поливать по степени высыхания грунта и восхищаться их процветанием.

Интенсивные и различные тона
Любой сорт пеларгоний имеет свои исключительные цвета и формы. Разновидности, например как, Ю Полонез, удивляют интенсивными цветами и впечатляющими соцветиями. Это растения, что мгновенно притягивают интерес и обеспечивают заметные подчеркивания в разном окружении.

Нежный аромат, создающий уют
Пеларгонии не только декорируют жилище — они снабжают его приятным, незаметным запахом. Этот естественный запах помогает создать чувство уюта и спокойствия, а также работает как природный отпугиватель для вредителей.

Долгое цветение
Разновидные пеларгонии продолжают долго удивлять вид своим красотой в течение долгих периодов. Люди будут наслаждаться их красотой с начала лета и до холодов периода. Такое длительное цветение — уникальное качество среди декоративных растений.

Идеальный вариант для каждого пространства
Пеларгонии универсальны — их можно разводить как в контейнерах на окнах, так и в на участке. Небольшие растения, такие как ЮВ Кардинал, хорошо подходят в эстетичных вазонах, а такие сорта, как Магнус, будут декорацией цветника.

Зачем следует выбрать точно пеларгонии?
Данные растения — не только декоративный элемент декора. Они значительно доминируют по сравнению с других цветов из-за своей легкости в уходе, эстетичности и долгому цветению. Их яркие оттенки формируют особенную атмосферу, будь то в помещении или на открытой территории. Герани — это прекрасный сочетание красоты и удобства.

Выбирайте пеларгонии — формируйте вокруг себя эстетику без ненужных трудностей!

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