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IAPT for People with Dementia and their Carers

IAPT for People with Dementia and their Carers. 14 th June 2012 Faculty of the Psychology of Older People CPD Event. Contributors. Ian Andrew James Georgina Charlesworth Sally Robbins Gwynn Higginson Candy Stone Susan Hill Karim Saad Sandra Evans Rachel Marshallsay Don Brechin

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IAPT for People with Dementia and their Carers

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  1. IAPT for People with Dementia and their Carers 14th June 2012 Faculty of the Psychology of Older People CPD Event

  2. Contributors • Ian Andrew James • Georgina Charlesworth • Sally Robbins • Gwynn Higginson • Candy Stone • Susan Hill • KarimSaad • Sandra Evans • Rachel Marshallsay • Don Brechin • and others...

  3. What is IAPT for PwD and their Carers? Dementia • Depression/Anxiety • Adjustment • Role changes/Meaningful occupation • Challenging behaviour Focus of IAPT work is on Depression/Anxiety for PwD and Carers Parallel work on other areas (e.g. stepped care model for challenging behaviour)

  4. National Context Need to place this work in the context of: • IAPT Roll Out Programme • National Dementia Strategy (England) • National Strategy for Carers • NICE guidance (SIGN guidance)

  5. Carers Workstream • Family carers of people with dementia experience high levels of distress(Dementia UK) • Support and counselling for carers improves QoL and reduces placement in care (NDS) • Support for carers is deficient (National Audit Office, 2007) • IAPT needs to be expanded to include carers (National Strategy for Carers, 2010 update)

  6. Identification • Carers have a right to an assessment of their needs (Carer’s Act) • The assessment should include an assessment of psychological need (NICE, 2006) • “Any carer who is experiencing depression or anxiety disorder – whether as a result of their caring or not – can access National Institute for Health and Clinical Excellence (NICE) approved treatment from local services set up under the Improving Access to Psychological Therapies (IAPT) programme. (Next steps for carers strategy 2010, p.27 para 4.6)

  7. Intervention

  8. Intervention • NICE indicates that carer support is not just about therapy (e.g. advice, practical support, etc) therefore the support to carers needs to be linked in to other services • Interventions recommended by NICE • Psychoeducation • Peer-support groups with other carers • Support and information by telephone/internet • Training courses about dementia, services and benefits, and communication • Problem solving in the care of people with dementia

  9. Interventions But formal psychological therapy is also required “Offer psychological therapy (including cognitive behavioural therapy) with a specialist practitioner to carers who experience psychological distress and negative psychological impact” (CG42: Quick Reference Guide, p.21)

  10. Carers and PwD live in a Dynamic System Thoughts/understanding of situation Emotion Physiology, including pain PWD BEHAVIOUR INTERACTION BEHAVIOUR Emotion Physiology Carer Thoughts/understanding of situation

  11. Carers and PwD live in Dynamic Systems Thoughts/understanding of situation Emotion Physiology, including pain PWD BEHAVIOUR INTERACTION

  12. Adaptations for Working with OP Need to consider relevant adaptations; e.g. • Stirling Moorey’s work (managing realistic negative automatic thoughts) • Third wave therapies (e.g. Compassion focused approaches) GH • Other?

  13. How do we organise this work? • Put this interventions into a stepped care framework • Delivered in the context of local service provision (e.g. Memory Clinics, Admiral Nurses, Dementia Advisors, Alzheimer’s Society (& other voluntary organisations)

  14. The Evidence-Based Interventions

  15. How are they delivered?

  16. Dementia Workstream Commissioning guidance is less advanced than the carers workstream Issues as to where this work will sit: • ?IAPT only for those with early cognitive impairment • ?Memory services (etc) for those with dementia

  17. People with Dementia are Entitled to Psychological Intervention People with Dementia • Psychosocial interventions for comorbid depression and/or anxiety • Consider cognitive behavioural therapy (possibly involving carers) (NICE Clinical Guideline 42: Quick Reference Guide, p.19)

  18. Can we do Psychological Therapy with People with Dementia

  19. Dementia Workstream Plenty of good work going on • Gwynn Higginson • Susan Hill • Astrid Scheper and colleagues Need to provide a framework within which to organise this work that fits with IAPT/Memory Services

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