IAPT Providers Network 6 February 2019 Andy Wright, IAPT Clinical - - PowerPoint PPT Presentation

www.england.nhs.uk

• Andy Wright, IAPT Clinical Advisor and Sarah Boul, Quality Improvement Manager
• andywright1@nhs.net and sarah.boul@nhs.net
• Twitter: @YHSCN_MHDN #yhmentalhealth
• February 2019

Yorkshire and the Humber Mental Health Network

IAPT Providers Network 6 February 2019

www.england.nhs.uk

@YHSCN_MHDN #yhmentalhealth

Housekeeping:

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Yorkshire and the Humber IAPT Providers Network

Welcome

Andy Wright, IAPT Advisor, Yorkshire and the Humber Clinical Networks

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Yorkshire and the Humber IAPT Providers Network

Minutes from Last Meeting (03.10.18) and Matters Arising

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Actions from Meeting 03.10.18

• No. Action

Owner

1 All attendees to consider questions for older adults and feedback at the next IAPT Provider Network. This will be revisited as there has not been the opportunity to regenerate the questions. All 2 Sarah Boul to enquire of the National IAPT Team if they have further information on how service user involvement facilitated by the National Team would work. Sarah Boul 3 For copies of the competency framework for PWPs email s.kellett@sheffield.ac.uk. All 4 All services who may have staff who have not completed the PWP training course to identify numbers

• f staff affected by the following Survey Monkey link: https://www.surveymonkey.co.uk/r/8HF7JM8

All 5 All attendees to watch the video by Professor West and consider the questions posed around compassionate leadership and feedback any comments or thoughts to sarah.boul@nhs.net. All 6 For copies of research papers on staff wellbeing and staff retention email rebecca.minton@nhs.net All 7 All services to reflect on the wellbeing checklist (included in Becky’s slides) and feedback on this at the next IAPT Providers’ meeting. All

8

All attendees to contact rebecca.minton@nhs.net with any ideas on how to improve staff IT knowledge. All

9

For services developing new and innovative LTC pathways i.e. Parkinson’s please email ujames@nhs.net with further information. All

10

All attendees to contribute to Ursula James’ tweet on the “long term plan” from 29 September 2018. The Tweet can be found at https://twitter.com/sophieshaesam (scroll back to 29 September). All

11

All attendees to sign up for the NICE News, a monthly e-bulletin, via the NICE website: https://www.nice.org.uk/ All

12

All attendees to share stories/information of their IAPT implementation journey, which could be used as shared learning on the NICE website, to rachel.reid@nice.org.uk. All

13

All attendees to check and/or update the IAPT services provided in their local area on nhs.uk - https://www.nhs.uk/service-search/Psychological-therapies-(IAPT)/LocationSearch/10008 by using the “edit” button to make any necessary changes. All

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Yorkshire and the Humber IAPT Providers Network

Senior PWP Network Update

Heather Stonebank, Lead PWP, Sheffield Health and

Social Care NHS Foundation Trust and Lead PWP Advisor, Yorkshire and the Humber Clinical Network

www.england.nhs.uk

SPWP Network Meeting agenda

• Checking in
• Wellbeing activity – managing the energy
• Feedback from IAPT providers Network
• Perinatal mental health and IAPT
• Provider presentation Barnsley IAPT
• Supervision discussion
• Checking out

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• Wellbeing initiatives
• Drawing exercise
• Picture/coaching cards
• Room re-arranged
• Toilet roll exercise used in supervision

Checking in

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How are you feeling today?

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Reflection and raising awareness of your energy:

• What a typical day looks like?
• How you organise your day?
• What kind of energy is required by tasks?
• What zaps your energy?
• What renews your energy?

Managing the energy

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Feedback - what message would you like to send to the SPWP network?

Answers on a Postcard/Post it! 

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• SPWPs doing a great job!
• How can managers support transition from PWP to

SPWP

• Shaping the role - What does good look like – can we

create a checklist of things which would be helpful for you to support the Senior PWP role? – development and consistency

Key messages

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Yorkshire and the Humber Senior PWP Network

Perinatal Mental Health (PMH) and IAPT

Anna Sebine, Quality Improvement Lead, PMH Clinical Network

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Yorkshire and the Humber Senior PWP Network

Provider Presentation: Barnsley IAPT

Rachel Ambler and Rhyann Morley, Senior PWPs, Barnsley IAPT

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Yorkshire and the Humber Senior PWP Network

Supervision Discussion

Sheryl Horton and Jenny Hall, East Riding Emotional Wellbeing Service / All

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• Emoji exercise
• Managing the energy
• Linking with Perinatal mental health service
• Maintaining change
• Long term plan
• PWP preceptorship

Checking out

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• Ideas into actions
• Integrating learning and ideas back into services
• Connecting with wider context
• Developing the SPWP role
• Sharing best practice
• Supporting wellbeing
• Supporting PWP workforce
• Connecting and networking

Themes

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Yorkshire and the Humber Senior PWP Network

Thank you for listening!

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Yorkshire and the Humber IAPT Providers Network

Training Update and Research Initiatives

Steve Kellett, IAPT Programme Director, University of Sheffield

University of Sheffield 20

Update on the training programmes and relapse following IAPT interventions; results from three interlinked studies

Stephen Kellett, Jaime Delgadillo, Andy Sainty, Nick Firth, Ben Lorimer & Caroline Wojnarowsk Clinical Psychology Unit University of Sheffield

University of Sheffield 21

What I am covering today

 Update on numbers, composition and also

future plans for PWP and CBT training

 Meta analysis of relapse following CBT  Defining the rate of replase following an IAPT

intervention and a machine learning analysis

 A network analysis of relapse following an

IAPT intervention – bit of an educational session on network theory!

 Plans for action based on the results

University of Sheffield 22

Feb 2019 PWP trainees

Total: 40 Non-qualified PWP: 7 (17.5%)

University of Sheffield 23

Feb 2019 HIPI trainees

Total: 22 PWP: 76% Nursing: 9.5% Social work: 9.5% Counselling: 5%

University of Sheffield 24

HIPI Trainee Selection Changes: Role Play

Role play Candidate reflection Mini supervision

Also, better support for applicants from a background that is not PWP.

University of Sheffield 25

Upcoming events

 IAPT Supervisor event: programme outline and

updates 22nd March 2019 – both PWP & HIPI

 KSA workshop for future candidates

Summer 2019 (TBC)

University of Sheffield 26

Successful BABCP re-accreditation visit; Jan 2019

 Mature, well-taught course; good fidelity  Well supported trainees  The best IAPT course nationally for

contributions to the evidence base and integrating research into teaching

 Tighten one aspect of the KSA process  Big site collaboration

University of Sheffield 27

Projected numbers

 Take a deep breath people

University of Sheffield 28

Projected number of training places ‘needed’ by CCG

PWP trainees 2019/20 PWP trainees 2020/21 Total PWP trainees needed 2019-21 HIT trainees 2019/20 HIT trainees 2020/20 21 Total HIT trainees needed 2019-21 78 65 143 166 148 314

University of Sheffield 29

Study One

 A review of relapse following CBT  A meta analysis of the correlation

between relapse and key predictive variables (e.g. if I have had a depressive episode before, what is the likelihood of relapsing after CBT?)

University of Sheffield 30

Definitions in terms of the example of depression

Relapse and Recurrence are terms commonly used to describe a return of depressive symptoms. ... Relapse is defined as a full return of depressive symptoms once remission has occurred - but before recovery has taken hold. Recurrence refers to another depressive episode after recovery has been attained

University of Sheffield 31

So ….

University of Sheffield 32

The data

 13 studies (4 longitudinal cohort studies

and 9 trials)

 Length of follow up averaged 18 months

and mostly quarterly assessments

 Primary outcome = diagnostic interview  Rates varied across studies and risk of

bias was low

University of Sheffield 33

Results

 Relapse rates ranged from 18.5% to

46.5 % with an average of 33.4%.

University of Sheffield 34

Random effects meta-analysis: significant moderate correlations between residual depression and relapse/recurrence

University of Sheffield 35

Random effects meta-analysis: significant small correlation between prior depression episodes and relapse

University of Sheffield 36

Random effects meta-analysis: no relationship between cognitive reactivity and relapse

University of Sheffield 37

Conclusions

 Relapse is a common problem (but

these were mainly trials)

 Residual depression symptoms appear

to be a risk factor

University of Sheffield 38

Study Two

 Follow-up is not part of IAPT funding  We found a dataset  We wanted to know what was the

relapse rate – and what predicts this (i.e. learn from the meta) using machine learning

University of Sheffield 39

Patient flow and sampling strategy

University of Sheffield 40

How did we define relapse?

• 1. Both PHQ-9 and GAD-7 at last session

below cut-off

• 2. At least one measure above cut-off at

review session

• 3. This measure also had to be a reliable

deterioration

University of Sheffield 41

Demographics

Characteristics Full treatment cohort N = 5921 Primary study sample N = 2899 Demographics Mean age (SD; range) 41.19 (15.44; 16-92) 42.05 (15.87; 17-92) Females (%) 65.7% 65.1% Unemployed (%) 21.8% 12.5% Baseline clinical characteristics PHQ-9 mean (SD) 14.72 (6.17) 12.74 (6.15) GAD-7 mean (SD) 13.70 (4.98) 12.29 (5.15) WSAS mean (SD) 18.63 (9.50) 16.00 (9.06) Prescribed pharmacotherapy (%) 60.2% 55.4% Primary diagnosis Affective disorder 23.6% 22.6% Mixed anxiety and depression 40.0% 36.6% Generalized anxiety disorder 16.2% 19.0% Other 20.2% 21.8% Comorbid LTC 28.4% 27.0%

University of Sheffield 42

The relapse rates

 6-month replase rate of 41.8%  43% at HIT and 39.8% at LIT; a non

significant difference

 HIT more likely to be prescribed meds,

and significantly higher baseline and post treatment measures

University of Sheffield 43

Categorical regression with optimal scaling: elastic net (regularized) coefficients

N = 432 (training sample) Dependent variable = relapse status after acute-phase treatment F(16) = 2.94, p < .001, R Square = .11 Variables B SE Gender (reference = male) .000 .014 Age (decade groups) .097 .070 Unemployed pre-treatment .000 .012 Unemployed post-treatment .033 .043 ADM pre-treatment .000 .016 ADM post-treatment .000 .015 Minority ethnic group (reference = white British) .000 .005 LTC .020 .037 IMD (decile groups) .000 .027 Number of treatment sessions .145 .093 PHQ-9 pre-treatment .011 .036 GAD-7 pre-treatment .000 .023 WSAS pre-treatment .081 .070 PHQ-9 post-treatment .051 .037 GAD-7 post-treatment .000 .031 WSAS post-treatment .002 .048 HIT (ref = LIT) .000 .014 Follow-up period (weeks since last treatment session) .073 .065

University of Sheffield 44

ROC curve analysis: predictive accuracy of a machine learning (ML) model across training and test samples

University of Sheffield 45

So?

 The rate is larger then the meta

analysed average

 Its remarkably similar to the only IAPT

relapse data published (41.7%; Ali et al, 2017)

 Residual symptoms again predicting

relapse

University of Sheffield 46

Study three

 So we know what predicts relapse, but

can we do a more fine grained analysis

• f these residual symptoms?

 The usefulness of network theory and

analysis

University of Sheffield 47

A symptom network of four depression symptoms

University of Sheffield 48

A network of comorbid anxiety and depression

University of Sheffield 49

Phases in the development of anxiety

• r depression

University of Sheffield 50

Connectivity over time

University of Sheffield 51

Quick reminder!

Item Symptom PHQ9_Q1 Low interest or pleasure PHQ9_Q2 Feeling down, hopeless PHQ9_Q3 Trouble sleeping PHQ9_Q4 Tired or little energy PHQ9_Q5 Poor appetite/overeating PHQ9_Q6 Guilt PHQ9_Q7 Trouble concentrating PHQ9_Q8 Moving slowly/restless PHQ9_Q9 Suicidal thoughts GAD7_Q1 Nervous, anxious or on edge GAD7_Q2 Uncontrollable worry GAD7_Q3 Worry about different things GAD7_Q4 Trouble relaxing GAD7_Q5 Restless GAD7_Q6 Irritable GAD7_Q7 Afraid something awful might happen

University of Sheffield 52

Demographic information of relapse and remission

samples.

Relapse Sample Remission Sample N 93 774 Male 40% 32% Mean Age (SD) 47 (17.2) 44 (16.2) White British 99% 99% Unemployed 17% 11% Treated by CBT 77% 66% Treated by PWP 23% 35%

University of Sheffield 53

Network of first session PHQ-9 and GAD-7 symptoms for a) the relapse sample and b) the remission sample.

University of Sheffield 54

Network of PHQ-9 and GAD-7 symptoms at the final treatment session for a) the relapse sample and b) the remission sample.

University of Sheffield 55

What the important residual symptoms

 Concentration difficulties (a symptom of

depression) highly central in relapse network

 Trouble relaxing was highly central in

the remission sample

University of Sheffield 56

So what do we know?

 Relapse a common problem  Residual symptoms appear important – and

also being make unemployed during treatment and a comorbid LTC

 Granularity – the role of concentration

difficulties in relapse

 We need to better support people – the role

• f low intensity relapse prevention support

that is not overly burdensome or costly for the service; Wellcome grant application.

University of Sheffield 57

I need to go!

 Reflections, questions or comments

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Yorkshire and the Humber IAPT Providers Network

Time for a break?

15 minutes only please!

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Yorkshire and the Humber IAPT Providers Network

Provider Presentation: Barnsley IAPT

Rick Stebbings, Tom Brown and Victoria Greensmith, Barnsley IAPT

BARNSLEY IAPT

Rick Stebbings Tom Brown Victoria Greensmith

• Formed in 2008 (2nd Wave)
• Commissioned to roll out to the World Class Commissioning

practices

• Work from 16+
• Barnsley College
• Perinatal pathway

History of Barnsley IAPT

• December 2016 – Significant increased referrals
• Resulted in service failing waiting time targets
• Long CBT waiting lists/ Not achieving 50% recovery rates
• Commissioner and provider invited IST to review the service

and review waiting lists.

• Contract Performance Notice served 31/8/17
• Notice Tendering of service 21/12/17

History cont.…

• IST identified a number of areas that contributed to the long

waits, from admin processes due to having to input on two electronic systems, skill mix and therapy drift.

• In collaboration with the IST a method of managing the CBT

waiting list was formulated…..

Outcome of IST

• Identify Problem
• Validate list (already done by complete review of CBT

waiting list)

• Understanding Demand and Capacity
• Review/Design Pathway
• Agree communication strategy
• Implement

The Process

• 615 clients awaiting 1-1 therapy
• 80 awaiting Group therapy
• Counselling and PWP waiting lists weren’t an issue so not

included

Problem Identified

• We had already completed a complete review of the waiting

list 3 months prior to the IST visit, whereby all clients had been offered a 1-1 appointment to review their current needs and if needed to remain on the waiting list.

• It was agreed this had validated the list.

Validate List

• Problem – following the IST report, service immediately

issued a Contract Performance Notice. This meant there was a specific time schedule to report outcomes back to the

• CCG. Therefore there was limited time to start the project.
• No time for full demand and capacity
• We identified which staff would work on each pathway, and

this capacity matched the predicted demand

Understand Demand and Capacity

• During the process it was important to have CBT staff

supporting the process

• Regular meetings to discuss the methods and seek ideas

from staff.

• Reinforced the importance of being successful

Review/Design of Pathway

• Split waiting list in 2
• Interim Pathway
• New Business as Usual Pathway
• Cut off date identified
• Interim – any referral pre-dating 1 August 2017
• Business as Usual – any referral from 1 August 2017
• Interim – no OCD (no 12 session protocol identified)
• Interim waiting list – 467
• New Business as Usual waiting list – 148

Review/Design Pathway

• Interim Pathway identified:
• 3 x protocols identified that covered the problems for clients
• n the Interim Pathway:
• Behavioural Activation – Depression
• Trans-diagnostic (Barlow Model) – Anxiety
• CPT – Trauma
• All protocols were set up for 12 week programmes
• Treatment Packs copied for staff

Review/Design Pathway cont…

• Staff were asked to count missed sessions in the

total offered.

• Support from CCG around impact on recovery
• This enabled us to predict the numbers of sessions

required with how many clients we had on the list, and give us an end date for the interim pathway.

• It was also agreed with the CCG that clients would

be discharged back to the care of their GP at the end of the 12 session protocol whether they hit recovery or not, which could also impact on recovery figures.

Review/Design Pathway cont…

• Business as Usual pathway Identified:
• 2 face to face formulation sessions
• Reduce 1-1 waiting list by increasing numbers into groups
• Following the Formulation sessions the clients were to be

placed at the top of the 1-1 treatment list, to ensure work completed in the formulation sessions was not lost/wasted,

• r allocated to a therapy group.

Review/Design Pathway cont…

• Time restraints meant that there was no time to complete a

service user focus group

• Service sent letter to the CCG explaining the strategy, so

this could be communicated to all GP’s

• Client’s were informed of their treatment package at their

initial appointment and contracts were agreed with clients.

Communications Strategy

• The process was commenced November 2017
• Staff split- Interim pathway and Business as Usual pathway

ran alongside each other

• A perfect world would start with all therapists having a clear

diary on the first day

• The world isn’t perfect, staff had on-going clients, so pick up

for the Interim was staggered

Implementation

• Cancellations
• Inequality and complaints
• Ethical
• Impact on Leadership Team’s time.

Implementation Issues

• Administration of the preparation and implementation of the

strategy was crucial.

• In Barnsley we have 2 hubs of admin, screening and

treatment.

• The waiting list was split into the 2 pathways, and admin

were given lists of the staff on each pathway.

Administration

Administration (cont…)

• We telephoned clients whose appointments

would be 1 week or less away to confirm agreement with their appointment.

• We asked staff to plan diaries in order to give

at least 2 weeks notice of an appointment, however this was not always possible.

• We monitored progress of clients at 6 weeks

and at discharge to check the protocols were effective.

• August 2018 – ‘Interim’ pathway cleared leaving 378 on the

new ‘Business as Usual’ pathway (reduced from 615).

• Recovery figures were not negatively effected
• Having staff engaged is key
• Overall determination was required in order to engage

everyone and keep the project on track, but ultimately the process was worth while

Outcomes of Interim Pathway

• Clients engaged well with the two formulation sessions,

however this led to some problems. In practice reduced the numbers going into groups.

• Changed this pathway – 4 week Core CBT skill group

sessions offered to everyone

• Aim to reduce number of one to one sessions, increase

numbers into groups and reduce numbers of group sessions

Business As Usual Outcomes

• Contract Performance Notice removed by CCG Feb 2018
• SWYPFT successful in retaining the contract - much

reduced budget

• Impact
• staff were put at risk and relocated
• 1 staff member made redundant
• Emotional Well-being of the team
• Increased pressures
• Reduced staff numbers

The Tender

• Now signed off by the IST
• Just inputting on one system
• New Website
• Extended Working Hours

Current Position

Current Position (cont…)

• Achieving national targets
• Bid submitted for expansion of LTC – start
• f that journey
• Been a very difficult period but also have

achieved a lot to be proud of

• Additional targets
• Waiting times reduced to 4 and 16 weeks (CCG)
• Aspirational moving to recovery 60% (CCG)
• Clients offered face to face appointment for assessment

within 2 days

• PEQ at every session

Future Challenges

Thank you Any Questions?

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Yorkshire and the Humber IAPT Providers Network

Yorkshire and the Humber PPN

Paul Boyden, Yorkshire and the Humber PPN

The Yorkshire & Humber Psychological Professions Network

Dr Paul Boyden Development Lead & Senior Clinical Psychologist Sheffield Health and Social Care NHS Foundation Trust P.Boyden@Sheffield.ac.uk

The context

Expansion in psychological workforce in the past decade (e.g. IAPT, Physical health care, maternity) Increased diversity of roles within the psychological professions workforce (e.g. PWP as a workforce) Psychologically informed practice in some areas of health and social care Popularity of psychology at undergraduate level provides a good supply of entrants Integration into teams alongside mental/physical health services and social care

Background

Lack of a joined up career path Lack of a shared identity Lack of a coherent voice in workforce planning No coordinated national voice

Opportunity

The Five Year Forward View workforce expansion requirements Potential to expand existing roles Potential in new psychological roles Multi-professional voice of psychological professions can be stronger Service user and other stakeholder promotion of psychological approaches and workforce Collaboration with other practitioners with training in psychological approaches Need for psychologically informed practice across the whole of health and social care

Who are the other Stakeholders?

Experts by experience Arms Length Bodies

Professional Bodies

PPN North (NW/NE) NHS funded Services PPN KSS Universities

The Public Local Communities The Members Commissioners

Free membership network for all

psychological practitioners in NHS services / Universities and associated stakeholders

Provides workshops / events linked to a

strategic NHS agenda

Communicates with members about news

and relevant issues

Supports workforce planning, development

and commissioning

What is the PPN?

A professional body A network that represents any specific

professional group above others

A body that represents individual practitioners A body led entirely by the agenda/interests of

its members

A network representing mental health more

broadly (e.g. nurses, OT, support workers)

What it isn’t

Our mission

We join together to inform both the strategic stakeholders and our members around key areas. We seek to enable our members to engage with each other and relevant partners in supporting collaboration and promotion of evidence based practice across the whole health service. We seek to influence policy, practice and organisations to ensure that psychological approaches are embedded within health and social care for all.

Animation

https://youtu.be/osRe6fim7jM

Structure

Workforce Board/Steering Group Terms of Reference Communications, Twitter, Newsletter + Blog Website Membership Stakeholder event – Spring 2018 Conference

Yorkshire and Humber

P.Boyden@sheffield.ac.uk www.nwppn.nhs.uk @YH_PPN

Contact Us

www.england.nhs.uk

Time for some lunch?

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Yorkshire and the Humber IAPT Providers Network

Compassionate Leadership Continued

Andy Wright, IAPT Advisor, Yorkshire and the Humber Clinical Networks and Lindsay Jones, TEWV

Compassionate leadership

Cultivating compassion in mental health services

Lindsay Jones Andy Wright

Aims for our presentation

What's Happening In IAPT Locally

So it was about climate (cultural) change

What is compassion?

‘a sensitivity to the suffering of self and

• thers with a deep wish and commitment to

relieve the suffering and prevent the causes

• f suffering’

Two key psychologies:

ENGAGING WITH and APPROACHING suffering COMMITTING TO ALLEVIATING and RELIEVING suffering “I feel for you (affective), I understand you (cognitive), I want to help you (motivational)” (Hangartner, 2011)

Compassion involves:

• Attending to the other and noticing their suffering
• Understanding through appraising the cause of

the distress

• Empathising with the other’s distress
• Helping by taking intelligent (thoughtful and

appropriate) action

The key attributes of compassion

WARMTH WARMTH WARMTH WARMTH

Adapted from Gilbert (2009)

Compassion

Sensitivity Sympathy Care for well- being Distress tolerance Empathy Non-Judgment

A compassionate mind approach can:

• Help us to understand the nature and causes of

suffering and how to reduce / alleviate it

• Help us to understand what helps us flourish

and experience wellbeing

• Focus on the evolution of mind, motives and

functions of emotions

• Highlight the psychology of caring, nurturance

and affiliation

www.compassionatemind.org

The human brain is the product of many millions of years of evolution – a process of conserving, modifying and adapting

Fight, Flight, Sex, Hunt, Territorial Kin caring/affection, alliances, play, social communications Symbolic thought, self- awareness, met cognition mentalizing Frontal C

• ntal Cor
• rte

tex Empa Empathic br thic brain ain - key ey for af

• r affect

ect regula gulation tion

To understand rstand ourse selves, ves, we we must st understand rstand our brains ns- Evoluti ution

• n of strateg

rategies, ies, motives ives and competen petenci cies: es:

www.compassionatemind.org.uk

What overloads the “new brain”?

• Chronic sympathetic arousal
• Rapid shifts of attention
• No time for reflection
• Impulsive
• Fear based arousal
• Self criticism and self-doubt
• Irritable and other blaming

A mind that does not know itself

Our motives organise our minds

Compassion Attention Thinking Reasoning Behaviour Emotions Motivation Imagery Fantasy

Types of affect regulation systems

How might the balance of the systems look?

DRIVE

SOOTHING

THREAT

People’s reactions and behaviours and adaptive to the social environments they grey up / are in, even if they are unhelpful now!

Threat-focused Activating/inhibiting To stay alive, reduce threat, reduce anxiety (protection system) Anxiety, Anger, Disgust

Body/feelings

• Stress response
• Tense
• Heart increase
• Dry mouth
• “Butterflies”
• Afraid, alone
• Anger, irritability

Attention/Thinking

• Narrow-focused
• Danger threat
• Scan – search
• Paranoia / confusion

Behaviour

• Fight / flight
• Passive avoidance
• Active avoidance
• Submissive display
• Dissociate
• Push thoughts /

feelings away

• Attacking

THREAT SYSTEM

When threat dominates...

• Any ideas of what this would look like?
• Fight, flight, freeze
• Capacity to think reduced
• Hyper vigilant / hyper arousal
• World, self, others viewed through threat

based stance

• Safety seeking mode / protection
• Dominated by threat based emotions

Excitement Body/feelings

• Activation
• Heart increase
• Pressure to act
• Disrupt sleep
• Excitement / pleasure
• Dopamine release if

goal achieved

Attention/Thinking

• Narrow-focused
• Acquiring
• Explorative
• Planning
• Solution focused

Behaviour

• Approach
• Engage
• Socialise
• Restless
• Celebrating
• Pursuing / striving

Incentive/ resource-focused Wanting, pursuing, achieving, consuming Activating DRIVE SYSTEM

When drive dominates

• What does this look like?
• Over reliance on achievement
• Perfectionism
• Over working
• Overly critical
• Very high expectations of self
• Driven to avoid failure
• Drug use-’uppers’
• Caffeine, energy drinks

Soothed, connected, safe Body/feelings

• Calm / relaxed
• Slow
• Well-being
• Content
• Endorphins,
• xytocin
• Safe

Attention/Thinking

• Open-focused,

mentalising

• Reflective, flexible,

creative

• Prosocial
• Understanding
• Non-judgmental
• Able to use “new

brain”

Behaviour

• Peaceful
• Gentle
• Prosocial, kind
• Self care and self

support

• Relating to and

bonding with

• thers

Non-wanting/ Affiliative focused Safeness-kindness SOOTHING SYSTEM

A lack of soothe / affiliation

– Feel disconnected from others – Struggle to feel content – Lack of happiness / joy – Struggle to soothe ourselves – Struggle to reassure ourselves – Struggle to regulate threat and drive systems – Difficult to deal with failure, disappointment, difficult emotions – Lack of ability to emphasise –more capable

• f hurting others, causing harm

Introducing blocks

Drive and Achievement

Soothing and Connection Threat and Protection

Compassion as flow

OTHER SELF SELF OTHER SELF SELF

The flow of relating

Society / wider culture Organisation Senior managers Team / colleagues Own mind Service users

Impact of main motivations

Competition / threat Affiliative / cooperation Own mind Self focused, avoidance of harm, secrecy Focused on relationships, connection, harmony Team Comparisons with others, critical of others Supportive and inclusive, focus

• n working together and

developing as a team Managers Paranoid about manager’s motivations, fearful of discipline and job loss Feel understood and supported, able to take risks Organisations Fear blame, less loyal Focus on staff, engagement and wellbeing, moving forwards together Society “Dog eat dog” All in it together

Shame doesn’t help

• Blaming and shaming self and others keeps us

locked in threat-based emotions, fueling our problems.

• Function: Tribe mentality, drive and threat

based.

• Shame-based pain/distress foster avoidance.
• “Warming things up” via compassion can help

us feel safe, balance emotions, and approach difficulties rather than avoid them.

Staff experience and clinical outcomes are linked

• Higher staff engagement has been linked

with higher patient satisfaction and lower rates of mortality (West and Dowson, 2011)

• It enhances the intrinsic motivation of staff
• Creates psychological safety so that staff

are able to speak out

• It is an enabling condition for innovation

(Worline and Dutton, 2017)

Developing helpful and caring relationships

Being consistent, predictable and stable:

• Availability and attention
• Compassion
• Empathic validation
• Approval, closeness and warmth
• Attunement, co-regulation and modelling
• Non-shaming / non-judgmental
• Encouragement / support

Compassion must be modelled

• Kindness, genuineness, empathy, concern,

willingness to help

• Courageousness – willingness to directly and

confidently explore difficult material

• Mindfulness and wisdom – facilitate awareness
• f dynamics as they play out
• For example, noting how the dynamic changes

when threat activation occurs, and how different it is when people feel safe.

• 3 aspects of compassionate therapeutic

engagement

Emotionally safe environments

• Developing self-compassion
• Creation of cultural norms that enhance sense of

psychological safety

• Motivation and meaning in our work
• Mutual respect and good team working
• Challenging and supporting each other
• Transparency and honesty
• Recognising good work in others
• Acknowledging when we are wrong

The usefulness of cultivating mindfulness in ourselves

• What do we bring to the work?
• What do we bring to our interactions with service

users, staff we manage, each other?

• Stop and notice our own emotions and

motivations

• We do not have to blame ourselves for having

“bad” thoughts of feelings about people we are working with

• When we are aware of our own thoughts,

feelings and motivations we can choose how to respond in the most helpful way

How to support compassion – Paul Gilbert

• Understand the human brain and the implications
• Supportive, guiding environments
• Make deliberate attempts to understand and cultivate

compassion in organisations

• Build compassion into training and regular working

practices

• Affiliative and cooperative teams (address bullying)
• Facilitating staff’s mental health
• Bottom-up organisation (managers supporting staff to

achieve compassion goals)

• Openness to mistakes
• Ways of spreading good practice through the system
• Compassion needs time for reflection and learning

Resources

www.nhscompassion.org/resources The Compassionate Mind Foundation: www.compassionatemind.co.uk

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Yorkshire and the Humber IAPT Providers Network

Time for a break?

15 minutes only please!

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Yorkshire and the Humber IAPT Providers Network

Compassionate Leadership Discussion

All

Discussions in groups

Given this framework, what are the implications?

• At an individual level
• At a team level
• At an organisational level
• What would facilitate you in being able to implement

compassionate leadership?

• What gets in the way?

Feedback: How can we carry it forwards, how can we

• vercome the barriers, 3 best ideas from each group.

My personal commitment

My motivation is . . . . Why do I want to be like this (goals and values)? What skills can I bring and develop? What will help me to become my compassionate self? What will challenge me? How will I address, accept or overcome these challenges?

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Yorkshire and the Humber IAPT Providers Network

Reflections on the Day and Any Other Business

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Yorkshire and the Humber IAPT Providers Network

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