Early Intervention for Psychosis

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Merry Garrett
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1 Early Intervention for Psychosis Awareness level training for senior clinicians and managers on the key issues around setting up an evidence-based early interventions service for psychosis. This CPD event was part of a wider strategic engagement with Health Boards around the development of new service models. It incorporated a discussion on ways to develop EI services across Scotland, which have been taken up by SGHD. The content of the training itself was very highly rated. 1. Crucial for this kind of strategic training to ensure that key staff are targeted and prioritised for attendance. Communicate with local managers to target training effectively 1. need to have support of local managers, and be in a position to develop future services Given the strategic element of the training there were challenges around ensuring that key local staff attended. All applications were screened by PTTCsand chairs of local psychological therapies planning groups. Challenges around Boards releasing staff to attend training Name: Geraldine Bienkowski Title: Associate Director: Directorate: Contact Details: geraldine.bienkowski@nes.scot.nhs.uk

2 Mindfulness-based Cognitive Therapy 8 Week experiential training course equipping staff with competences to deliver Mindfulness-based CBT groups which reduce likelihood of relapse in depression. 103 staff trained to standard required to deliver Mindfulness Groups All mainland Board areas now have staff trained in the approach 1. Where there is strategic aspect to training-eg aim to cover all Boardslocal liaison is essential. 2. Careful selection procedures are necessary to identify appropriate staff for some psychological therapies. Requires tactful negotiation with service managers 1. Important to reflect on whether you have the time, commitment and lifestyle necessary to function as a mindfulness therapist in the long term. 1. Challenges in recruiting staff from across Scotland. Linking in through local PTTCsnecessary to identify suitable individuals who were in a position to deliver the intervention following the training. 2. Mindfulness requires particular degree of commitment from staff,as ongoing meditation practice is expected. Required careful and diplomatic selection procedure. Name: Geraldine Bienkowski Title: Associate Director-Psychological Therapies Directorate: Contact Details: geraldine.bienkowski@nes.scot.nhs.uk

3 Supervision In line with NES role of providing "quality education for a healthier Scotland, NES Directorate has developed a coherent and inclusive cross professional framework for the delivery of high quality supervision training to support the expansion in access to Psychological Therapies. The scope of the frameworkis to provide supervision training to all appropriately qualified practitioners who, within their professional role, provide supervision to colleagues delivering Psychological Therapies. Delivery of Generic Supervision in Psychological Therapies training to over 400 staff in more than 7 professional groups delivered viaa train the trainers model Within the Uni-professional arena, supervision training has been delivered to in excess of 100 newly qualified supervisors and over 150 experienced supervisors using a blended learning approach 1. Engage with Boards at highest level possible over the perceived need for the training. 2. Ensure managerial sign-off so that staff offered places have supervision as part of their role 1. Discuss application with manager to ensure this in line with job plan 2. Set time aside for reflective practice following training Challenges in persuading some constituencies that the training is necessary, and that general supervision skills are not sufficient for the safe, evidence-based delivery of PTs Challenges for Boards in releasing staff Danger of staff putting themselves forward for training when supervision is not part of their role Name: Geraldine Bienkowski Title: Associate Director-Psychological Therapies Directorate: Contact Details: geraldine.bienkowski@nes.scot.nhs.uk

4 Essential CAMHS Learning Resource The development and early implementation of the Essential CAMHS learning resource. Access to the resource is available from the NES Essential CAMHS webpage. A 5 module online resource was developed for CAMHS workers. During 2012 the resource was evaluated in early implementer sites across 5 health boards. Qualitative and quantitative measures were used to evaluate the resource supervisors/facilitators were involved in early implementation 2. Supervisors worked in the Specialist CAMHS setting staff from specialist CAMHS worked through the resource and gave evaluation feedback during Both inpatient and outpatient staff used the resource At the outset prior to designing the resource, there was a demand for a resource that could be worked through on an individual basis. However, during early implementation, many learners and supervisors actually preferred a group format. The resource and supporting material was adapted for this. Name: Fiona Calder Title: Educational Projects Manager Directorate: Contact Details:

5 Behavioural Activation for Adults with Depression A multidisciplinary group of experienced NHS staff with post-graduate psychological qualifications have been trained as a group of practitioners that would be able to deliver training in Behavioural Activation within the local Health Boards. The training adopts a cascade system whereby a number of therapists are trained as trainers, and subsequently deliver training in local health boards, thus providing a self-sustaining model for ongoing training and service delivery. 74 trainers have been trained across Scotland within 13 Health Boards in Scotland A total of 396 staff in mental health have been trained to deliver Behavioural Activation between Build assessment into the process of accreditation 2. Trainers need time and support to develop their skills 3. Local Board Strategy groups are key to ensuring training is ring fenced 1. Ensure learners set aside time to learn new skills 2. Supervision structures must be in place for learner prior to the training Releasing staff to attend the training Supporting staff to deliver and adhere to a protocol based evidence based intervention Name: Anne Joice Title: Programme Director - PI Team Directorate: Contact Details: Anne.Joice@nes.scot.nhs.uk

6 Acceptance and Commitment Therapy (ACT) for Dementia Caregivers One day training workshop on delivering ACT-based interventions to dementia caregivers to help them deal with stress, depression etc. Aimedat experienced therapists to enable them to utilise a specific approach to their therapeutic interventions which is particularly acceptable to and effective with this population. 18 experienced therapists trained in highly specialist technique Post-workshop evaluation positive, and further training requested 1. For training aimed at senior staff, need to be very clear about level of training and pre-requisite levels of knowledge 1. Need to be clear that these skills will benefit your patient population Plenty of notice required for training targeted at senior staff Clear suitability criteria needs to be in place to ensure that staff who attend have appropriate levels of expertise Name: Geraldine Bienkowski Title: Associate Director: Directorate: Contact Details: geraldine.bienkowski@nes.scot.nhs.uk

7 Cognitive Stimulation Therapy for Dementia 1 day Training for Trainers in delivering Cognitive Stimulation Therapy group for people with dementia. The groups actively stimulate and engage people with dementia, provide an optimal learning environment and the social benefits of a group, and lead to improved cognition and quality of life. Effects are roughly comparable with those of current anti-dementia drugs. Trained 232 staff across health and social care Post workshop and follow up evaluation extremely positive Impact on service delivery demonstrated 1. Encourage staff to join community of practice 2. Crucial to ensure that service managers understand the commitment involved for their staff who take on to run group interventions 1. Need to be clear about time commitment involved, and to identify time to study materials and complete any reflective practice exercises necessary to the training 2. Need to have conversation with manager around releasing time to deliver group interventions Identified need to offer further support to those trained through the establishment of a community of practice Group approaches are not always appropriate for remote and ruralareas where there may not be sufficient demand. Also travel to central point may be difficult. NES is working with researchers to develop a one to one version of the therapy Service managers need to be aware that setting up and running groups is time-consuming. Name: Geraldine Bienkowski Title: Associate Director: Directorate: Contact Details: geraldine.bienkowski@nes.scot.nhs.uk

8 Stress and Distress in Dementia: Training for Trainers 3 day Training for Trainers in The Newcastle Model an evidence based non-coercive response to stress and distress in dementia. Helps staff and carers understand, respond appropriately to, and reduce the occurrence of behaviourperceived as challenging. In advance of training work to set up supervision structures to support staff in learning and embedding new skills in practice Delivered training to 86 trainers across Scotland Training now being cascaded by trainers in local areas 1. With any new therapeutic approach it is necessary to invest time in identifying, upskilling and supporting supervisors before training is rolled out 2. Crucial to ensure that service managers understand the commitments involved for their staff who take on trainer roles, and are clear that staff sent on Training for Trainers have capacity to cascade training within their role 1. Important to appreciate that training is a particular skill, and to seek further input on training skills if you don t already have experience in this area 2. Need to be clear about time commitment involved, and to identify time to study materials and complete any reflective practice exercises necessary to the training 3. Need to have a conversation with manager around releasing time to cascade training in the future Difficulty of identifying staff with experience and time to function as trainers from within a very small staff group who are already supporting NES with other training programmes Some difficulty ensuring that managers send staff who have capacity to deliver training within their current role Identified need to set up Learning Collaborativesto further support staff to embed new skills in practice Name: Geraldine Bienkowski Title: Associate Director: Directorate: Contact Details: geraldine.bienkowski@nes.scot.nhs.uk

9 An Introduction to CBT for anxiety disorder The overall aim of this training project is to provide multi-disciplinary groups of staff with a critical understanding of cognitive behavioural therapy for people with anxiety disorders. It will critically explore the clinical presentation of a range of anxiety disorders and the main components of a cognitive behavioural approach. Participants will develop a critical understanding of a cognitive behavioural assessment and working with unhelpful behaviours and thoughts. 382 multidisciplinary staff working in mental health have undertaken the training An e-learning module to support the delivery of training has been developed 1. Training needs to be delivered in a format that allows staff to develop skills in the workplace 1. need to set aside time to enable them to implement new skills 2. need to have clear supervision arrangements in place prior to training. Staff are not released to attend the training Staff have difficulty accessing supervision to support developing skills in clinical practice Name: Anne Joice Title: Programme Director PI Team Directorate: Contact Details: Anne.Joice@nes.scot.nhs.uk

10 Living Life to the Full Classes: Facilitator Training Two day workshops for multidisciplinary staff working with olderpeople to train as facilitators of Living Life to the Full (LLTTF) Classes were held in October 2011 and March LLTTF classes are eight session courses designed to teach cognitive behavioural life skills for those experiencing depression and anxiety. The LLTTF classes and materials have been modified for use with older people and evaluated as an effective low intensity intervention. 51 multi-disciplinary practitioners working with older adults across 11 Health Boards have attended NES commissioned LLTTF facilitator training since 2011 Recent ring-fenced funding has been available to equip local services with materials required to roll-out classes on a pilot basis 1. LLTTF training is well developed and high in quality 2. LLTTF classes can be delivered by a wide range of practitioners with this training, although experience in running groups required 1. Those attending have the knowledge and skills to run LLTTF classes with immediate effect 2. should secure local supervision and agree on plans for local roll-out Release of staff time from services to attend a two day training workshop not all suitable staff can therefore be trained There is an attached ongoing cost for licences and materials for NHS Health Boards, requiring consideration for support Name: Donna Gilroy Title: Educational Projects Manager Older Adults Directorate: Contact Details: Donna.Gilroy@nes.scot.nhs.uk

11 2nd Scottish Winter School on Motivational Interviewing Aberdeen and Glasgow A two day training event to enhance Motivational Interviewing skills was offered to practitioners working with people experiencing problems with alcohol and drug use. The training included an emphasis on small group practice of MI skills and updating knowledge of MI based on the newest developments in the field. 95 participants in skills development event for Motivational Interviewing. 16 coaches receiving additional experience and peer feedback on their coaching practice. 1. Skills development training is possible with large numbers with the use of small practice groups led by experienced coaches. 2. It is important to provide participants with enough time to participate in reflective practice and assess their own skills. 1. There has been a shift in the definition and practice of MI over the years. 2. In order to develop skills in MI, coaching and feedback are essential in the learning process. Skills development courses for a large numbers of participants need to be carefully planned due to the range of expertise and experience. The learning experience within small practice groups can be very powerful. Name: Laura Freeman, Ph.D. Title: Educational Projects Manager Directorate: Contact Details: Laura.Freeman@nes.scot.nhs.uk

12 Paediatric The paediatric team provide Regional training to multidisciplinary staff across Scotland. This is a two day skill-based training event which aims to develop core skills in psychosocial approaches in working with children and young people relating to Adherence/Concordance, Self-Management and Adjustment to Paediatric Physical Health Conditions. They also train and support local trainers to develop, deliver and sustain local training on psychosocial care. 160 multidisciplinary staff trained through regional training 7 additional local trainers identified and over 400 local training places offered 22 people attended level 3/4 ACT training 1. It is important to provide central support for the network of trainers 1. prefer blended learning approaches Arranging for staff to be released from acute sectors to attend training can be problematic Name: Terri Carney Title: Programme Director Paediatric Directorate: Contact Details: terri.carney@nes.scot.nhs.uk

13 Paediatric The paediatric team provide Regional training to multidisciplinary staff across Scotland. This is a two day skill-based training event which aims to develop core skills in psychosocial approaches in working with children and young people relating to Adherence/Concordance, Self-Management and Adjustment to Paediatric Physical Health Conditions. They also train and support local trainers to develop, deliver and sustain local training on psychosocial care. 160 multidisciplinary staff trained through regional training 7 additional local trainers identified and over 400 local training places offered 22 people attended level 3/4 ACT training 1. It is important to provide central support for the network of trainers 1. prefer blended learning approaches Arranging for staff to be released from acute sectors to attend training can be problematic Name: Terri Carney Title: Programme Director Paediatric Directorate: Contact Details: terri.carney@nes.scot.nhs.uk

14 Specialist Practice Developing Practice Train the Trainers programme develops delegates psychological assessment and support skills at Level 2 in line with NICE Guidance (2004) AsSETtraining gave participants the opportunity to obtain the knowledge, skills and materials necessary to deliver AsSET spsychological skills training courses. 2 successful Train the Trainers programmes delivered Developing Practice training delivered to 10 delegates AsSET training delivered to 10 delegates 1. Group training for trainers provides a ready made vehicle for peer support and ongoing training networks 1. Management sign off is crucial for trainees to use new skills in practice It looks like it may be possible to combine elements from both of these training programmes in the future Name: Marie Claire Shankland Title: Programme Director Specialist Practice Directorate: Contact Details: marie-claire.shankland@nes.scot.nhs.uk

15 Low Intensity (LI) Psychological Interventions training in Forensic Mental Health Settings NES CPD A 5 day practical skills training programme designed to increasethe psychological mindedness of staff and equip clinicians with the competencies necessary to deliver an agreed suite of low intensity psychological therapy programmes which have been developed by the forensic matrix working group. 27 multi-disciplinary clinicians attended the training across 4 pilot sites (Lanarkshire, TSH, Grampian and Greater Glasgow and Clyde (CG&C). All clinicians were assessed as being competent and LI groups are now being delivered across all pilot sites. Delegates attending the training in GC&C completed the Training Acceptability Rating Scale (TARS) and their responses suggested that the LI training was highly acceptable for clinicians (mean percentage rating of 96.1%) Revisit the psychological principles and concepts underpinning the suite of LI psychological interventions throughout the 5 days. Build in additional role play exercises to allow the confidence of the delegates to develop prior to the final day practical skills assessment 1. Identify who your supervisor will be prior to attending the training. 2. Where possible have your supervisor involved in the initial running of the groups. 3. Session planning is essential and protected time to complete this is a nonnegotiable. Inform delegates that the training is competency-based in advance of the training The importance of liaising with services to ensure that delegates have protected time to prepare/deliver LI interventions and that there are the appropriate supervision structures in place. Maximum of 12 delegates per training event Name: Dr Claire Maclean Title: Education Project Manager-Forensic Directorate: PIT Team Contact Details: claire.maclean1@nhs.net

16 Evidence-based Parenting Programmes The of Parenting Project (PoPP) aims to improve outcomes for 3 and 4 year olds with elevated levels of behaviour problems by increasing workforce capacity around evidence-based parenting programmes, specifically Level 4 Group Triple P and the Pre-School Incredible Years Programme. The PoPPdissemination plan incorporates 3 drivers - staff competence, organisational support and leadership. A Scotland-wide PoPP dissemination plan has been funded by SG In preparation for the national roll-out, 110 multi-agency child care practitioners have undertaken standardised core training and 40 of these have participated in on-going supervision and coaching 8 Community Planning Partnerships have expressed interest in adopting the PoPPImplementation Framework and 3 Wave 1 sites have been selected for Educating staff to deliver evidencebased parenting interventions requires Standardised core training On the job supervision and coaching over a considerable period of time A variety of organisational support mechanisms Improving outcomes for children and families involves on-going commitment to skills development. This is supported through a variety of fidelity-focused learning activities and a selfregulating approach Challenge : Building capacity for evidence-based parenting programmes to be delivered to scale and with fidelity in complex multi-agency environments Lessons learned : Align appropriate educational infrastructure with key policy drivers and disseminate through a systematic plan Name: Brenda Renz/ / Marita Brack Title: PoPPProgramme Directors Directorate: Contact Details: Brenda.Renz@nes.scot.nhs.uk Marita.Brack@nes.scot.nhs.uk

17 Key points of interest Notes / Ideas Questions for Stand Ideas for reusing / links / contacts

NHS EDUCATION FOR SCOTLAND. NES Location

NHS EDUCATION FOR SCOTLAND. NES Location NHS EDUCATION FOR SCOTLAND JOB DESCRIPTION - AGENDA FOR CHANGE 1. JOB DETAILS JOB REFERENCE JOB TITLE DEPARTMENT AND LOCATION JD Reference JD04/767 Educational Projects Manager Infant Mental Health Psychology