Transcript Document

Developing access to psychological
therapies
Dr Kay Macdonald
Director of Therapies
Content
o Background to psychological therapies training plan
o Whole systems design :
governance structure through to training plan and delivery
o Training plan :
specific examples of roll-out (CBT and Personality Disorders
Training)
o Discussion:
problems and pitfalls
MAP
MAP OF
OF SUSSEX
SUSSEX
Rusper
Crawley
East Grinstead
Crawley Down
Hartfield
Turners Hill
Forest Row
Rudgwick Warnham
Pease Pottage
Wadhurst
Broadbridge Heath
Loxwood
Balcombe
Crowborough
Horsham
Plaistow
Slinfold
Handcross
Ardingly
Ticehurst
Fernhurst
Itchingfield
Wisborough Green
Nutley
Lindfield
Southwater
Cuckfield
Five Ashes
Maresfield
Burwash
Ewhurst Green
Billingshurst
Haywards Heath
Rogate
Bolney
Fletching
Peasmarsh
Robertsbridge
Stedham
Cowfold
Petworth
Newick
Uckfield
Heathfield
Midhurst
Wivelsfield
Rye
Brede
South Harting
Pulborough
Burgess Hill
Fittleworth
Chailey
Winchelsea
East
East Sussex
Sussex
West Chiltington
Sedlescombe
Isfield
Hurstpierpoint
Coldwaltham
Henfield
East Hoathly
Ashington
East Chiltington
Battle
Hassocks Ditchling
Chiddingly
Storrington
Herstmonceux
Singleton
Amberley
Crowhurst
Washington
Ringmer
Stoughton
Ninfield
Hastings
Steyning
Hellingly
West
West Sussex
Sussex
Lewes
Hailsham
Bexhill
Stanmer
Wartling
Findon
Glynde
Kingston
Funtington
Slindon
St. Leonards
Tangmere
Arundel Clapham
Selmeston
Moulsecoomb
Southbourne
Polegate
Eastergate Lyminster
Sompting
Shoreham-by-Sea
Chichester
Woodingdean
Berwick
Pevensey
Barnham
Bosham
Brighton
Angmering
Ford
Hove
Fishbourne Oving
Lancing
Alfriston
Yapton
Littlehampton
Willingdon
Saltdean
Newhaven
Felpham
West Itchenor
Worthing
Rustington
Peacehaven
Eastbourne
Brighton
Brighton &
& Hove
Hove UA
UA
Middleton-on-Sea
Seaford
West Wittering
Bognor Regis
East Dean
Pagham
Aldwick
Linchmere
Selsey
Jennifer Cox- IM, Sussex HIS - Sept. 2005
Source: Autoroute
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!!
Context (Training)
o
Need to develop basic therapeutic awareness in clinical staff
o
Develop capacity within staff to offer psychological interventions as part of
treatment packages
- in eclectic therapies
- in specialist interventions
o
….and capacity for supervision
o
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
o
Make sure that funding is based on service need / equitable
o
Review relationships with HEI’s to ensure relevance of training offered
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
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
Psychological Web-Pages
Benchmark Survey - June 2006
Benchmark Nine
The most effective services will be those that: Have a clear and defined
leadership structure
1 - Not Present
13%
13%
17%
2 - Minimal Evidence
30%
40%
40%
3 - Significant Progress
30%
4 - Present to Notable Degree
5 - Beacon Status
17%
0%
Benchmark Five
The most effective services will be those that: Find ways
to involve service users and carers.
1 - Not Present
30%
2 - Minimal Evidence
3%
26%
30%
40%
3 - Significant Progress
40%
27%
4 - Present to Notable Degree
5 - Beacon Status
0%
3%
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
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
90
82.8
80
70
60
42.1
50
%
40
26.9
29
30
14.5
20
10.3
10
0
Prov ision of The rapy
Provides
Therapeutic
Services to
Individuals
Provides
Therapeutic
Services to
Couples
Provides
Therapeutic
Services to
Groups
Provides
Therapeutic
Services to
Families
Provides
Therapeutic
Services to
Organisation/s
Provides No
Therapeutic
Services
Psychological therapies training plan
Developed from:
o National recommendations – e.g NHS Psychotherapy Services in
England:review of strategic Policy ( 1996)
o Local information from questionnaire, focus group, workforce and
service plans
o Informed best practice
o NICE Guidance
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
No’s
Requirement
National and Local Initiative
Development Need
Service
Staff
Priority
Resource
Competence
•Type A Psychological Therapies
skills
•Organising and delivering
psychological therapies
Relationship/
interviewing/
boundaries
Clinical
staff
All clinical staff
should have
competencies in
these skills
Provided in house or
short modular
courses; proof of
competency via
professional training
Competence
•Type A Psychological Therapies
skills
•Organising and delivering
psychological therapies
Key Counselling skills
Clinical
staff
All clinical staff
should have
competencies in
these skills
Provided in house or
short modular
courses; proof of
competency via
professional training
Competence
•Type A Psychological Therapies
•Organising and delivering
psychological therapies
Anti-discriminatory
and empowerment
skills including
Self managed care
Clinical
staff
All clinical staff
should have
competencies in
these skills
Provided in house or
short modular
courses; proof of
competency via
professional training
Competence
•Type A Psychological Therapies
•Organising and delivering
psychological therapies
Key ideas from
therapy (introduction
to CBT, family work,
and psychoanalytic
individual and group
theories)
Clinical
staff
All clinical staff
should have
competencies in
these skills
Provided in house or
short modular
courses; proof of
competency via
professional training
Competence
•Type A Psychological Therapies
•Organising and delivering
psychological therapies
Psychological and
psychosocial
approaches to different
diagnostic groups
(e.g. Eating Disorders,
PTSD, Abuse, OCD,
Self -harm)
Clinical
staff
All clinical staff
should have
competencies in
these skills
Provided in house or
short modular
courses; proof of
competency via
professional training
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.
Service
Staff
No’s
Requirement
National and Local Initiative
Development Need
Priority
Resource
Competence
•Type B Psychological
Therapies
•NICE guidelines
•Care pathways
Core therapeutic
interventions in CBT,
Psychodynamic
perspectives, CAT, IPT,
Integrative approaches
At least X per
team
Provided in house
or short modular
courses
Competence
•Type B Psychological
Therapies
•NICE guidelines
•Care pathways
Core therapeutic
interventions in Family
Work
At least X per
team
Provided in house
or short modular
courses
Competence
•Type B Psychological
Therapies
•NICE guidelines
•Care pathways
Delivering manualised
group treatments for
depression and anxiety
Primary care
mental health
teams CMHT;
Day Hospital
and other
clinical areas as
appropriate
Provided in house
or short modular
courses
Competence
•Type B Psychological
Therapies
•NICE guidelines
•Care pathways
Team approaches to DBT
At least X per
team
Provided in house
or short modular
courses
Competence
•Emerging evidence base
EMDR , mindfulness
At least X per
team
Provided in house
or short modular
courses
Competence
•Type B Psychological
therapies
Training and supervision
skills
Provided in house
or short modular
courses
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.
Requirement
National and Local Initiative
Development Need
Service
Competence
•Type C Psychological
Therapies
Substantive training in a
Therapeutic model
Psychological
Therapies and
Specialist
teams
Competence
•Type C Psychological
Therapies
Training and Supervision
skills
Psychological
Therapies and
Specialist
teams
Staff
No’s
Priority
Resource
UKCP, BAP, BPS
etc. accredited
training; Masters
level practitioner
training in specific
therapy modality
Training Plan for CBT : skills development, support and
supervision
Type C
Staff :
specific to
role, prior
training
Individual
learning
outcomes
Module 7:
Developing
supervision,
training, research and
consultation skills
Module 6: Working with
complex problems
and
Type B
service
requirements
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
All Staff
All New Staff
Type A
Foundation
Module 2: The development of basic CBT concepts 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.
Service
related
outcomes
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.
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.
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.
CBT training rollout
Principles:
o
o
o
o
o
o
o
o
o
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
Progress to date
o Associate director of psychological therapies training
appointed
o In-house foundation courses started (80+)
o Some Type B courses started
o Supervision groups underway
o Training sessions evaluated
o Individual learning outcomes recorded
o Planned audit on service impact - 6mths/ 18mths
o Link with SHA - CBT training business plan
o Tender to external HEI’s re: type B training and formal
accreditation/ qualification
Personality Disorders
Training
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
Personality Disorders
Training
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
Personality Disorders
Training 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
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
Training forthcoming/ planned
•
•
•
•
•
Induction/mandatory module
GP Resource manual
Non-statutory agencies training
Motivational Interviewing
STEPPS – New course March 2008