Starting Therapy:
From Allocation to First Session
Activating the Therapy Room
An initial appointment (assessment) is required for all new patients before therapy begins (unless otherwise specified by contract).
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Required Action (within 48 hours of allocation):
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Open the patient record in IAPTUS
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Go to the Clinical Pathway tab
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Select Refer to provider
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Click Access this room to activate the Therapy Room
The Therapy Room must be activated before any patient communication can occur.
Entering the Therapy Room for the First Time
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When entering the Therapy Room for the first time, you will be asked to confirm access
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Select “Join as patient’s clinician”
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If you believe you should not have access to the patient’s transcripts (e.g. conflict of role):
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Contact Patient Services or your Supervisor immediately
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Welcome Message & Confirming the First Appointment
Welcome Message (Mandatory)
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Send a welcome message within 48 hours of allocation
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This enables patient engagement and confirms the therapeutic relationship
Requirements:
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Use the approved Welcome Message Template Here
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You may adapt the tone, but legal wording must remain unchanged
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e.g. video sessions being recorded and retained
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Keep the tone warm, clear, and reassuring
Patients cannot message until the clinician has entered the Therapy Room.
Preparing for the First Appointment
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Before the first session, review all available patient information to assess suitability and plan the session.
Where to Find Information:
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Referral Information
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Self-referrals: Referral tab
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Service referrals: Clinical Contacts → “Referral Information Contact”
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Risk Information
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Assessment tab (where available)
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Current MDS scores
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GP Consent
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Mandatory for all new patients
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Earlier referrals: Check consent status on the boarding card
Reading referral information is essential for both self and service referrals.
Expectation-Setting in the First Session
You may be the first therapeutic contact, particularly for self-referrals.
Use the first session to:
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Clarify what Mindler can and cannot offer
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Assess ongoing suitability
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Set expectations about treatment, modality, and next steps
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Facilitate timely onward referral if required
Starting and Ending the Session (Therapy Room)
You must start and end every session correctly to ensure:
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Notifications are managed correctly
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CTSR-R data is captured (Step 3 / 3+ CBT only)
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You are paid correctly
Required Actions:
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Click Start Session at the beginning
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Click End Session at the end of every session
Conducting the Initial Session
The initial session (and sometimes a second session) focuses on:
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Assessing the presenting problem
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Setting therapy goals
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Assessing and documenting risk
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Observing engagement with typed or video therapy
Agreeing a provisional plan:
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Continue treatment
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Gather more information
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Onward referral
Additional Requirements:
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Check employment support fields
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Update mandatory fields in Clinical Contacts
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Reassure the patient about confidentiality
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Explain duty of care and limits of confidentiality
Logging the Appointment Type
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Self-referrals: Log as Assessment and complete an assessment letter
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Service referrals: Log as Treatment
Always check Site Protocols if unsure.
Video Appointments – Key Steps
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Enter the Therapy Room via IAPTUS
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Message the patient to confirm session start
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Click Start Session
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Select Connect to video
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End the video call
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Click End Session to restore notifications
After the First Session
If Mindler is appropriate:
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Develop a collaborative formulation or problem statement
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Record a provisional diagnosis and treatment plan in clinical notes
Mandatory Actions (within 48 hours):
✔ End the session
✔ Book the next appointment
✔ Add presenting complaint (Problem/Medication tab)
✔ Complete Clinical Contact and Clinical Notes
✔ Complete Assessment Letter (if required)
✔ Raise Step 2 case management task (PWPs only)
Clinical Notes – Key Expectations
Clinical notes are legal documents and may be shared with other services.
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They must:
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Be completed within 48 hours
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Use the standard IAPTUS clinical notes template
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Clearly distinguish:
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Clinical facts
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Patient-reported information
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Clinical opinion
Notes Must Include:
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Agenda
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Treatment plan and protocol
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Change mechanism (Step 3 / 3+)
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Progress and engagement
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Homework and feedback
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Risk review (every session)
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Do not include personal reflections or supervision-related uncertainty.
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Deciding and Recording the Step
If a Step has not already been assigned, decide after assessment:
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Indicative thresholds:
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Step 2: PHQ-9 0–14 | GAD-7 0–15
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Step 3: PHQ-9 15–19 | GAD-7 16–21
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Step 3+: PHQ-9 20–27 or severe/complex presentations (CBT only)
Any Step Change:
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Must be discussed in supervision
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Requires a supervision task
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Must be clearly justified in clinical notes
Stepping down from Step 3 to Step 2 is not permitted.
When Suitability Is Unclear
If concerns arise (severity, modality mismatch, risk, engagement):
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Raise a supervision task
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Discuss suitability for Mindler, Talking Therapies, or secondary care
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Follow referral guidance and Site Protocols