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Developing access to psychological therapies

Developing access to psychological therapies. Dr Kay Macdonald Director of Therapies. Content. Background to psychological therapies training plan Whole systems design : governance structure through to training plan and delivery Training plan :

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Developing access to psychological therapies

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  1. Developing access to psychological therapies Dr Kay Macdonald Director of Therapies

  2. Content • Background to psychological therapies training plan • Whole systems design : governance structure through to training plan and delivery • Training plan : specific examples of roll-out (CBT and Personality Disorders Training) • Discussion: problems and pitfalls

  3. Context (NHS) • Large mental health trust ( 1.7 million pop /4,000 staff) • Improving access to therapies work stream - National policy/ agenda / IAPT (access/choice/evidence base/NICE/NSF’s/Layard…) - Trust business plan - Development of specialist services / service redesign/p.care (10 high impact changes/vocational strategy/job centre plus) - Workforce (multiprofessional agenda / CNO review of nursing capacity to deliver on the agenda/A4C/KSF/NWW/Skills for health) - Governance framework - safe and effective practice - Performance indicators as a measure of success!!

  4. Context (Training) • Need to develop basic therapeutic awareness in clinical staff • Develop capacity within staff to offer psychological interventions as part of treatment packages - in eclectic therapies - in specialist interventions • ….and capacity for supervision • Staff need to be more aware about what training options are available and service managers aware of the impact of training on meeting service needs • Make sure that funding is based on service need / equitable • Review relationships with HEI’s to ensure relevance of training offered

  5. Context ( training) • Relate training ( in-house / external) to formal qualification/ accreditation/ professional regulation ( COMPLEX) • Engage commissioners / partners in training agenda ( eg.PCT/vol.org) • Provide training in consultation and supervision • Engaging service users/ expert pt program/ trainers/Guided self-help

  6. Service redesign access to therapies Aim: to embed training into clinical practice Key elements: Increasing profile of psychological therapies - web-pages - governance / management structures Care pathway : - service design: seeing right people at right time - ensuring staff have skills at required appropriate point in care pathway - general approach : stepped model of care Workforce development - skill mix of staff / new ways of working/ new roles - skills development of existing staff - support and supervision networks

  7. Psychological Web-Pages

  8. Benchmark Survey - June 2006 Benchmark Nine The most effective services will be those that: Have a clear and defined leadership structure Benchmark Five The most effective services will be those that: Find ways to involve service users and carers.

  9. Workforce : establishing training needs Three major elements : 1. Psychological therapies Questionnaire all clinical staff • Psychological Therapies being Practiced • Provision of Therapy across the Trust • Skills to practice • Interest in developing skills 2. Stakeholder groups • Focus groups with service users and carers • Staff groups/ teams / across care groups including managerial and admin staff 3. Review of current training • Current in-house training • External training providers/ contracts with HEI’s

  10. The Psychological Therapies Questionnaire Analysis (2006) Therapy types being practiced: • Counselling – 45.5% • Humanistic – 22.8% • Behavioural – 42.8% • Cognitive – 50.3% • Psychodynamic – 23.4% • Systemic – 17.9% Provision of Therapy

  11. Psychological therapies training plan Developed from: • National recommendations – e.g NHS Psychotherapy Services in England:review of strategic Policy ( 1996) • Local information from questionnaire, focus group, workforce and service plans • Informed best practice • NICE Guidance

  12. November 2005 - Draft TYPE A - General psychotherapeutic skills that are provided in primary care, secondary and tertiary care and are part of the basic mental health skills for all practitioners. General psychotherapeutic skills are delivered within a uni-disciplinary care package and would be informed by both generic and formal psychotherapeutic approaches

  13. November 2005 - Draft TYPE B - A complete stand alone psychological treatment intervention informed by a range of different models tailored to individual goals. Service users could be referred for a specific Type B psychological therapy directly or as a component of CPA. Individuals who had undertaken further training in a specific therapy model would provide these therapies.

  14. TYPE C - A complete stand alone delineated psychotherapeutic intervention based upon clear theoretical underpinnings with implications for the use of different interventions to achieve different aims. The provider would be formally trained in approaches such as CBT, CAT, psychoanalytic and/or systemic therapies. Again, service users could be referred directly or as a component of CPA.

  15. Training Plan for CBT : skills development, support and supervision Staff : specific to role, prior training and service requirements Individual learning outcomes Service related outcomes Type C Module 7: Developing supervision, training, research and consultation skills Module 6: Working with complex problems Type B Intermediate Module 5:Practice Development: Utilising skills within teams, understanding research, developing supervision skills Intermediate Module 4:CBT applied to specific client group (psychosis/ ED/ OCD/ trauma etc.) Intermediate Module 3:Development of CBT therapeutic skills including assessment, formulation, intervention, discharge and evaluation Foundation Type A All Staff Module 2: The development of basic CBTconcepts and skills to enhance work, case discussion, role-play and reflective practice Foundation Module 1: Application of CBT theory: appreciation of the relationship between thinking and emotion and how this informs understanding of mental health problems and their treatment. All New Staff

  16. Definitions of Types A, B and C Cognitive Behavioural Therapy Practitioners. The definitions are for guidance. On occasion a practitioner may not fit neatly into this system of classification. In these instances factor such as length and breath of supervised experience should be taken into account in determining practitioner type Type A practitioner • Has a basic understanding of the CBT model and its value in working with emotional problems. Able to use some CBT ideas in order to enhance work with clients, but not able to practice CBT.

  17. Definitions of Types A, B and C Cognitive Behavioural Therapy Practitioners. Type B practitioner • Either, works wholly or predominantly within a CBT model and is in the process of gaining experience and undergoing development leading to type C practitioner recognition, Or • Works eclectically, drawing on two or more therapeutic models for the conceptualisation and treatment of a range of problems. The depth of knowledge and breath of experience of CBT will normally be less than that of a level C practitioner. Or • Lacks a recognised formal training in CBT but has undergone some training in the application of CBT to specific problem types or client groups under the supervision of an experienced CBT practitioner. Depth and breath of CBT may be narrow.

  18. Definitions of Types A, B and C Cognitive Behavioural Therapy Practitioners. Type C practitioner. • Works wholly or predominantly within a CBT model. Uses the CBT model for the conceptualisation, treatment and evaluation of complex problems and /or client groups. Has developed and regularly uses a high level of supervision and consultancy skills with other staff. Maintains regular continuing professional development activities and has either undergone further formal advanced CBT practitioner training or has a substantial amount of experience working within the model (at least three years). Will normally be BABCP accredited or eligible for BABCP accreditation.

  19. CBT training rollout Principles: • Fit with service models and care pathways and NICE guidelines • Not dependant on professional training – multiprofessional • Capacity to provide supervision - local accessible / group format • Service managers on board/ Trust ownership • CBT not the only solution – part of assessment and overall care • Opportunities to progress in skill development • Formal recognition of training / link with PDR • Capture individual and service outcomes • Provision of training in-house and external

  20. Progress to date • Associate director of psychological therapies training appointed • In-house foundation courses started (80+) • Some Type B courses started • Supervision groups underway • Training sessions evaluated • Individual learning outcomes recorded • Planned audit on service impact - 6mths/ 18mths • Link with SHA - CBT training business plan • Tender to external HEI’s re: type B training and formal accreditation/ qualification

  21. Personality DisordersTraining The approach has been national / regional and local Involving all relevant clinical staff (including reception staff) National/Regional • National pilot monies enabled set-up of Surrey-Sussex course: ‘Personality:Disorder or Challenge?’ • First course 2005, 40 Participants across Surrey & Sussex • Second Course 2006/7

  22. Personality DisordersTraining West Sussex • Draft training proposal completed • Training course directory in preparation • Register of training done • A-B-C model (in line with Psychological Therapies) • Training for all professional groups (including admin, management, reception) • Across care groups and agencies

  23. Personality DisordersTraining done (to Dec 07) • 2-day Awareness (HOST) (250 trained) • 10 day course (HOST) (21) • Attitude change workshops (30) • Dialectical Behaviour Therapy Intro (83) • Ward training (Making Positive Connections) • Self Harm workshops • SHO/medics Intro training • Psychology training day • Team presentations (CMHT, Crisis, Forensic, SM) • Basic Awareness module • STEPPS

  24. STEPPS • Skills training for people diagnosed with Borderline Personality Disorder • Collaboration across Trusts • Initial trainings Dec 2006 & Spring 2007 (USA trainer) • Trainer networks and additional training • Connection with Dutch group & USA groups • First group Jan-Jul 2007 • Specialist assessment workshops • Rollout of groups Jan/Feb 2008

  25. Training forthcoming/ planned • Induction/mandatory module • GP Resource manual • Non-statutory agencies training • Motivational Interviewing • STEPPS – New course March 2008

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