Senior PWP Network 23 January 2018 Andy Wright, IAPT Advisor, - - PowerPoint PPT Presentation

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• Andy Wright, IAPT Advisor, Heather Stonebank, Senior PWP Advisor and Sarah Boul,

Quality Improvement Manager

• andywright1@nhs.net, heather.stonebank@shsc.nhs.uk and sarah.boul@nhs.net
• Twitter: @YHSCN_MHDN #yhmentalhealth
• January 2018

Yorkshire and the Humber Mental Health Network

Senior PWP Network 23 January 2018

www.england.nhs.uk

@YHSCN_MHDN #yhmentalhealth

Housekeeping:

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Yorkshire and the Humber Senior PWP Network

Welcome, Introductions and Apologies

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

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Yorkshire and the Humber Senior PWP Network

Wellbeing Activity

Lottie Hutton and Tyra Sutton, North Yorkshire IAPT

Progressive Muscle Relaxation

www.stresscontrolaudio.com

• When we are anxious and stressed our muscles are

regularly contracting and tensing up which over time can result in aches and pains and a feeling of constantly being on edge

• PMR teaches you to manage this tension and anxiety to

promote your health and wellbeing.

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Yorkshire and the Humber Senior PWP Network

Group Skills Supervision Table Top Discussion

Sally Poyser, Deputy Manager and Psychological Wellbeing

Practitioner, Touchstone- IAPT

Sally Poyser Touchstone (Leeds IAPT)

STRESS CLASS SUPERVISION

My Background

• Worked drugs worker for 5 years
• Trained as Trainee PWP in 2012 at Sheffield Uni whilst

working at Insight in Halifax

• Moved to Touchstone IAPT in Leeds IAPT in 2013
• In 2015 became Deputy Manager for the Touchstone

team

Why have a separate type of supervision for SCC?

• No training on presentation skills in PWP course
• We had no service training on delivering courses
• PWPs would tell us that delivering courses the most anxiety

provoking part of the job

• Helps give PWPs another skill
• Seeing a high number of clients in the classes so we want it to be

good quality!!!

• If people have a good experience then they may not need further

therapy

Aims

• To increase effectiveness of Stress control delivery.
• To support facilitators/teachers in their role.
• To develop the skills of the facilitators/teachers in the

delivery of the class.

• To problem solve difficulties in delivery/content.
• To develop and support facilitators/teachers

knowledge of the content.

Delivery of Supervision

• To meet every 4/5 weeks for 2 hrs
• Facilitators attend supervision prior to running a class.
• To then attend where possible each month, with a

minimum of one every 2 months.

• Each participant to create an individual learning contract

and identify areas for their development.

Plan for the session

Set Agenda for the session

• PEQ feedback
• Learning/ reflections from last session
• Pre- agreed area of focus
• A presentation skill or section of Class
• Watch PWP video or expert video
• Reflect on own practice
• Make plan for development

Challenges

• Took a long time to shift from discussing practical

issues to move to skills practice

• Service issues about allowing staff time to attend

away from the assessment hub

• Change in staffing of facilitators

Resources

Video Resources

• Video Resources

Breathing: https://www.youtube.com/watch?v=KanWhGY33Hk

• Hissing (darth vador) https://www.youtube.com/watch?v=zdYLXN0CxHA
• Breathing- sshh technique- https://www.youtube.com/watch?v=9WvgWQIn4ZY
• Pacing- story of regan on plane- https://www.youtube.com/watch?v=AWbkAboFsTQ

Pacing:

• Speaking rate: https://www.youtube.com/watch?v=A50rOCPevzc
• Pause after each sentence- https://www.youtube.com/watch?v=-qOU1oFy8wQ
• Taking a pause- https://www.youtube.com/watch?v=AGhEGrzfTRE
• https://www.youtube.com/watch?v=S2nFK_fLhu4
• https://www.youtube.com/watch?v=my2XaSTgq-0

Pitch :

• https://www.youtube.com/watch?v=1nXhAjuICTA

Style of speech:

• How to do a smart sounding talk:

https://www.youtube.com/watch?v=8S0FDjFBj8o&app=desktop

Video Resources

Reinforcing key points: https://www.ted.com/talks/shonda_rhimes_my_year_of_saying_yes_to_everything Moving around

• (walk stop talk) https://www.youtube.com/watch?v=Z3hae6jG1hs

Body language- fake it until you make it!

• https://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are?referrer

=playlist-the_most_popular_talks_of_all (best part of the video from 10:30)

• https://www.youtube.com/watch?v=cFLjudWTuGQ

Handing over in the session:

• https://www.youtube.com/watch?v=f6Xa1fq-oPo

Visualising success:

• https://www.youtube.com/watch?v=26intm7aNaI

Plan for your fears:

• https://www.youtube.com/watch?v=SqrxJpYEHkM

Body language- fake it until you make it!

• https://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are?referrer

=playlist-the_most_popular_talks_of_all (best part of the video from 10:30)

• https://www.youtube.com/watch?v=cFLjudWTuGQ

Video Resources

Good speeches: Steve jobs- commencement speech: https://www.youtube.com/watch?v=UF8uR6Z6KLc Cameron Russell: https://www.ted.com/talks/cameron_russell_looks_aren_t_everything_believe_me_i_m_a_mo del Bill gates: https://www.youtube.com/watch?v=ZLkbWUNQbgk Michael Pritchard: https://www.youtube.com/watch?v=rXepkIWPhFQ Brene Brown: https://www.ted.com/talks/brene_brown_on_vulnerability Simon Sinek https://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action?referrer=playlist- the_most_popular_talks_of_all David Blane: https://www.ted.com/talks/david_blaine_how_i_held_my_breath_for_17_min?referrer=playlist- the_most_popular_talks_of_all Kelly Mcgonigal https://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend?referrer=playlis t-the_most_popular_talks_of_all Bryan Stevenson: https://www.ted.com/talks/bryan_stevenson_we_need_to_talk_about_an_injustice

Leeds IAPT

• NHS contract
• Provided by a consortium of 4 partners: Leeds Community Healthcare (NHS),

Touchstone, Northpoint and Community Links.

• Cover the whole Leeds area
• See around 17,000 people a year
• Target for access is 1313 clients a month

Provide the following therapies:

• Stress control class
• Depression recovery class
• Silvercloud (ccbt)
• Guided Self Help
• CBT
• IPT
• EMDR (PTSD and OCD)
• CfD/ DiT

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Yorkshire and the Humber

Senior PWP Network

Time for a break?

15 minutes only please!

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Yorkshire and the Humber Senior PWP Network

Provider Presentation:

Kirklees Improving Access to Psychological Therapies Service

Sarah Mullaney, Kirklees and Calderdale IAPT

Kirklees IAPT Service

Sarah Mullaney – Senior PWP

The Kirklees Area

Most populated borough in England that is not a city 11th largest borough in England Rural and urban areas Population: 434,600 Ethnicity: 79.1 % White 15% South Asian 1.9% Black 2.3% Mixed 1.7% Other

Kirklees IAPT Service

Established 2008 Commissioned by two CCGs: North Kirklees Greater Huddersfield 64 GP practices LTC Pilot site since April 2017 Operates Monday-Friday 8am-8pm

Core IAPT Staff

Team manager x2 CBT Lead Senior PWP x1.80 (1 vacancy) Data analyst (+ assistant) CBT x13 (inc. two trainees) Counsellors x5.5 PWP x12 (inc. five trainees & one assistant + two vacancies)

LTC Staff

Team leader CBT x2.5 PWPs x4 Funding has been secured for another 12 months

Administration

Manager Secretaries x9 (not all full-time) Four answering phones Two on emails Two group admin + one vacancy

Referral Pathways

GP & other healthcare professionals

• Single Point of Access (SPA) form

Self-referral

• Telephone
• Website

Perinatal & Veteran pathways

Step Two

Assessments (Telephone/Face to face) Guided self-help (Telephone/Face to face) Silvercloud computerised CBT Stress control course Wellbeing group Assistant PWP – Assessments & Silvercloud

Step Three:

Counselling for Depression Couple’s Counselling Interpersonal Psychotherapy Cognitive Behaviour Therapy Eye Movement Desensitisation and Reprocessing Groups:

• Introduction to CBT
• Managing difficult emotions
• Building confidence
• Loss/Bereavement

Partnership Working

Employee Healthcare Older People’s Mental Health Services Sahara Women’s Group Kirklees College & University of Huddersfield Employers Recovery College

Increasing Access

BME Organisations Older People Services – Focus Group Rebranding Website development Targeting GP surgeries Waiting area screens

STRENGTHS Fidelity to the IAPT model LTC pilot success Buddy system & supervision Experienced Counsellors & CBT Treatment choice Good links with secondary care Being part of SWYPFT WEAKNESSES Difficult relationship with GPs Lack of clinics Small communications team Inexperienced PWPs Rio and IT OPPORTUNITIES LTC clinics in community/hospitals Partnership working Development of groups Champion roles/staff specialism Bespoke IAPT website PC-MIS (April) THREATS Recruiting qualified PWPs Increasing access target Waiting times for one to one Increasing pressure on secondary care services Being part of SWYPFT

Thank you Any questions?

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Yorkshire and the Humber

Senior PWP Network

Time for some lunch?

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Yorkshire and the Humber Senior PWP Network

Low Intensity Competency Project Presentation and Q&A

Rachael Matharoo, IAPT PWP Tutor, University of Sheffield

Measuring Competency in in Low In Intensity Cognitive Behavioural Therapy

Rachael Matharoo

IAPT PWP Lecturer and Psychological Wellbeing Practitioner University of Sheffield &

Stephen Kellett

Consultant Clinical Psychologist, Psychotherapist and IAPT Programme Director

Aims & aspirations

• To develop and test assessment and treatment

competency measures (and manuals) for use in clinical services

• To learn the lessons from the poor testing

completed on previous measures of high intensity CBT (e.g. tiny studies and no empirically derived cut-offs!)

• To further authenticate and endorse esteem for

the PWP role and method

• To further substantiate training standards for

PWPs

COSMIN checklist

PWP competency measures – why?

• ‘Reachout’ was an adherence measure and was

unvalidated.

• A competency measure is needed as part of the PWP

training and to fit with the needs of the new national curriculum.

• Something that acknowledges the COM-B model.
• Will be used in OSCEs/simulations as a standardised

measure of competence.

• Can be used in the services to support supervision and

audit.

• Adherence relates to the degree of fidelity shown to

the stated treatment procedures/manuals and protocols.

• Competency is an index of the degree to which the

intervention was skilfully delivered.

• Competency can be considered as: “The extent to

which a therapist has the knowledge and skill required to deliver a treatment to the standard needed for it to achieve its expected effects.” (Fairburn & Cooper, 2011

• Effective CBT requires adherence to treatment

procedures being in tandem with intervention competences, so high adherence on its own does not necessarily imply or ensure competence (Barber, Liese and Abrams, 2003).

Competency & adherence

• Competency is a significant factor in the successful
• utcome of therapy (Barber, Sharpless, Klostermann &

McCarthy, 2007; Webb, Derubeis & Barber, 2010; Ginzburg et al. 2012)

• Ensuring patient safety (Fairburn & Cooper, 2011)
• Reducing therapeutic drift (Waller & Turner, 2016)
• Ensuring high clinical standards (Bennett & Parry, 2004)
• Dissemination of evidence based practice (Fairburn &

Cooper, 2011)

• Evaluates the training and supervision of therapists

(Kohrt et al., 2015)

Why do we need competent PWPs?

Products - the PWP competency scales

• Two measures – one for

assessment and one for treatment

• Each scores 6 core competencies
• Scales used in conjunction with

the detailed manuals - these will help with scoring accurately.

Scaling - industry standard!

For a PWP to be graded as competent in a assessment session, the session has to score ≥18 overall (range 0-36) and the PWP must score 3 or more in each of the six sections (half-point scoring accepted). The competency-rating tool is designed to be appropriate for assessment sessions lasting 30-45 minutes. **The summary rating of each section is NOT the average of the ratings given on specific aspects and is not cumulative.**

LI CBT Assessment Competencies

Introduction

• Role
• Confidentiality
• Purpose
• Time

Incompetent

Expert 6 Information Gathering

• Questioning skills
• Risk Assessment
• IAPT-MDS
• Problem specific info

Incompetent Expert 6

LI CBT Treatment competencies

Focussing the Session

• Agree

appropriate agenda

• Adhere to

agenda

Incompetent Expert 6

Information gathering specific change

• Questioning skills
• Risk Assessment
• Progress Review-

Goals, MDS

• Homework review

Incompetent Expert 6

Recruitment from September 2015 to July 2017

**OSCE- Observed Structured Clinical Examination

Study 1 (rating of an assessment and a treatment session)

• Experts (PWP trainers

day)

• Qualified (conference)
• Novice (PWP trainees)

Study 2

Trainees’ OSCEs

• Three cohorts from Sheffield
• Mock OSCE and real OSCE (x2)

data collected (and the patients completing measures of helpfulness, the alliance and the FFT)

• Other HEI PWP Course providers

Participants & data collection

Content Validity

Content Validity Index Six experts (3 trainers and 3 PWPs) determined the relevance for each item. Complete agreement for each item and each competency. Apart from one item which was removed from the scale.

• Experts, Qualified and Novice

groups all showed excellent inter-rater reliability for both assessment and treatment measures.

• The three groups also are

significantly different from each

• ther on each measure (novice

raters over rate competency!)

• This test also demonstrated

that there was excellent inter- reliability between each of the items

6 12 18 24 30 Expert Qualified Novice

Total competency scores PWP groups

Study 1 - inter-rater reliability

Assessment = Treatment =

• The study group scales results also

yielded a good internal consistency for the assessment (α= .91) and treatment (α= .92).

• These are high scores!

Study 1 – internal reliability

• Principal Axis Factoring (Oblique Rotation)
• Yielded a single factor solution (47.45%

variance explained) for the assessment scale

• Yielded a single factor solution (54.77%

variance explained) for the treatment scale

Study 1 - exploratory factor analysis (EFA)

• Two level model

The factor structure holds when assessing anxiety

• r depression

The factor structure holds when using the different PWP interventions The factor holds when assessing over time

Study 1 - confirmatory factor analysis (CFA) on study 1

Competency Cut-Off Score

• Singh (2006): + / - 2SD from the mean
• Using -2SD from mean (sample of passes)
• Assessment (N=157): M=23.178 (SD:3.0718) cut off:

17.0344

• Treatment (N=135): M=23.97 (SD: 3.471) cut off:

17.028

• Using +2D from mean (sample of fails)
• Assessment (N=17): M=14.176 (SD: 2.7836) cut off:

19.7432

• Treatment (N=10): M=14.35 (SD:1.93) cut off: 18.21

• 4 PWP courses (two raters) assessing

OSCE’s

• Excellent inter-rater reliability within

each course

• Assessment interclass correlation

coefficient = .91 (95% .82 - .96)

• Treatment interclass correlation

coefficient = .85 (95% .70 - .92)

• No differences between courses

Study 2 : inter-rater reliability across courses and differences between

Study 2: test-retest and sensitivity analysis

• No significant difference between the means
• f the formative and summative ratings

(assessment t(63)= .95 p=.35 treatment t(67)=.47 p=.62). The measures are stable.

• There was a significant difference in the

means between the summative and retake ratings (assessment t(27)= 6.37 p=.00 treatment t(27)= 4.33 p=.00) showing that participants results improved from the summative to the retake examinations. The measures are sensitive.

Study 2: what do patients say about the alliance? (i.e. testing construct validity)

• Significant positive correlation

was found between the WAI and PWP competency rating scales for both assessment and treatment sessions.

• The higher ratings of

competence = higher ratings on the WAI.

Study 2: what do patients feel about coming back? (i.e. testing construct validity)

• Significant relationship between assessment

skills and willingness to attend for treatment (χ2 (1, N=130)= 14.59, p= .00).

• 30% of participants who had failed the PWP

competency rating scale receive a no on the FFT, compared to only 5% of participants who had passed.

• For the treatment also showed significance (χ2

(1, N=83)= 5.06, p= .05) – patients want to continue treatment with competent PWPs .

• From those who failed 21% received a no and 4%
• f participants that passed.

Competent

• Empathy:

“It was very easy to talk to her because she seemed interested and acknowledged several times about the difficulties I was having. I felt listened to.”

• Clarity, Collaboration and

structure: “The goal setting discussion was very collaborative and the PWP used things I had said previously to prompt me to set my own goals.”

• Confidence and Knowledge:

“Her explanations of the 5 areas sounded very encouraging that it would be beneficial for me.”

Incompetent

• Lacking confidence/ nervousness:

“… seemed quite nervous.” and “He seemed a little all over the place.”

• Poor timing/pacing :

“I felt rushed and ‘capped off’ at times” and “The start was so quick I felt a little bewildered, jumped into it, could have spent more time in the intro”

• Lack of exploration of 5 areas :

“I felt like some of the areas we discussed were not fully explored.”

• Not being listened to

Comparing the helpful behaviours of competent and incompetent PWPS

Summary

• We have developed valid and reliable

measures of both assessment and treatment skills

• Good liaison between courses
• They are fit for use in clinical services
• Easy to use and supported by detailed

manuals

• They met almost all the COSMIN

standards

• Enhancing post qualification supervision

and continuous personal development within the PWP role.

COSMIN checklist

Future Developments….

• Publishing a paper reviewing these

findings, to disseminate

• Developing further competency tools

(and manuals) to assess telephone work, group work and triage

• Build these developments into the PWP

course material

Special thanks to all the contributors and participants

• f the project
• Jennie Hague, Lucy Hughes, Stephen

Kellett, Emma Limon, Jodie Millington, Mel Simmonds-Buckley, Rachel Siviter and Heather Stonebank

• Sheffield, Uclan, Manchester, Surrey and

Birmingham PWP course providers

Thank you for listening!

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Yorkshire and the Humber

Senior PWP Network

Time for a break?

15 minutes only please!

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Yorkshire and the Humber Senior PWP Network

Reflection: Leadership, Data and the Future

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

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Yorkshire and the Humber Senior PWP Network

Any Other Business

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Yorkshire and the Humber Senior PWP Network

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