Karen Rea, Kevin Baker, Lisa Woods, Hazel Flynn Contact: k.rea@ljmu.ac.uk ; kevin.baker@nhs

1. Low intensity psychological interventions for Deaf people in Primary Care:Improving Access to Psychological Therapies in British Sign Language. Karen Rea, Kevin Baker, Lisa Woods, Hazel Flynn Contact: k.rea@ljmu.ac.uk; kevin.baker@nhs.net

2. Improving Access to Psychological Therapies • Context & Rationale for IAPT • Low Intensity (LI) Psychological Interventions • Training Psychological Wellbeing Practitioners (PWPs = LI workers) • Adaptations and Challenges • Outcomes so far

3. Context & Rationale • Common mental health problems of depression & anxiety affect around 6 million adults in UK. • But only 10% receive treatment, mostly medication (Psychiatric Morbidity Survey, 2007). • Costs to economy – around £26 billion year (Sainsbury Centre for Mental Health, 2007) • Costs to Government – around £7 billion year (Layard et al., 2006) • But we know psychological therapies help…

4. Context & Rationale • Social Justice – treatments should be available • Economic argument – it’s cheaper! • IAPT programme 2006 • Making effective psychological therapies available • Increasing number of psychological therapists • Emphasis on quality and outcomes

5. Context & Rationale • 2 national Demonstration sites 2006 • Primary Care MH Treatment to over 5000 adults • 11 Pathfinder sites 2007 • Extending to different areas • Access for different communities • IAPT implementation plan (2008) • Commissioning for the whole community (2008)

6. Context & Rationale • There are 149 PCTs In England providing IAPT services • 18 training providers (HE - Universities) for IAPT PWP • LJMU has experience of specialist training for PWPs • Military Vets • Prison • Deaf/BSL

7. Adult MH services for Deaf people in England, 2011 Manchester Inpatient & Outpatient Newcastle CPN Rotherham CPN Nottingham CPN Birmingham Inpatient & Outpatient Bristol Outpatient London Inpatient & Outpatient

8. AMH &Stepped Care Inpatient Treatment Step Five Out patient Treatment of by MH Specialists Step Four Treatment of moderate disorder in Primary Care CBT / Case management / Counseling / IPT IAPT Step Three Treatment of mild to moderate disorder in Primary Care Facilitated Self Help / Medication support / Signposting IAPT PWPs Step Two Recognition in Primary Care by GPs; Practice Nurses; Health Visitors; District Nurses etc “Watchful waiting” Step One HITS

9. AMH forDeaf people Inpatient Treatment Step Five Out patient Treatment of by MH Specialists Step Four Treatment of moderate disorder in Primary Care CBT / Case management / Counseling / IPT Step Three Treatment of mild to moderate disorder in Primary Care Facilitated Self Help / Medication support / Signposting Step Two Recognition in Primary Care by GPs; Practice Nurses; Health Visitors; District Nurses etc “Watchful waiting” Step One HITS

10. AMH forDeaf people with New IAPT Inpatient Treatment Step Five Out patient Treatment of by MH Specialists Step Four Treatment of moderate disorder in Primary Care CBT / Case management / Counseling / IPT New IAPT Step Three Treatment of mild to moderate disorder in Primary Care Facilitated Self Help / Medication support / Signposting IAPT PWPs Step Two Recognition in Primary Care by GPs; Practice Nurses; Health Visitors; District Nurses etc “Watchful waiting” Step One HITS

11. New IAPTfor Deaf people

12. Manager, hearing, counsellor, BSL fluent • Performance Lead (data collection, support) • High Intensity Therapist/clinical psychologist, Deaf, BSL fluent • 3 hearing BSL PWPs trained first (fast tracked) • 7 Deaf BSL PWPs currently in training

13. IAPT Training • LJMU, programme head and professional lead, experienced PWP trainers • Experienced clinical psychologist/lecturer/trainer, BSL fluent • All training and assessment delivered in BSL

14. 40% University/self learning 40% University/self learning Semester 1 Semester 2 Mod1 – Engagement & Assessment Mod3 – Culture, Diversity & Policy 60% Clinical Placement 60% Clinical Placement Mod2 - Interventions Mod4 – Working in Context IAPT Training: 1 year UG/ PGCE

15. LI Psychological Interventions • Drawn from CBT • LI approach • Brief interventions • Focus on supported self help • Information giving, shared decision making • Regular outcome measures

16. LI Psychological Interventions • 6 Interventions: • Behavioural activation for depression • Exposure for anxiety • Cognitive Restructuring for depression & anxiety • Panic management • Problem-solving • Sleep management + • Medication support

17. LI Psychological Interventions • Parallels with CBT for Deaf people • Communication in BSL/SSE/clear English • Giving information (clearly and visually) • Using narratives and metaphors (e.g. Glickman, 2009; Meichenbaum, 1977)

18. Training PWPs • Nationally agreed curriculum • Subject content, learning outcomes, assessment standards – same all over country • Common factors • Communication skills: empathy, warmth, active listening, shared decision making, collaboration,… • Specific factors • Coaching style: evidence-based information giving, supported self-help materials, motivating patient, … • Brief contacts, short sessions, using email, Skype, SMS, internet…

19. Training PWPs • 40/60 split University/Clinical placement • Information giving • Role plays • clinical experience • reflection • Supervision

20. Adaptations & Challenges • Delivered in BSL • All-Deaf cohort – peers • Adapting materials • IAPT video clips, • Outcome measures • Guided self help materials • Deaf experiences included in teaching and clinical examples • Taking notes while using BSL (eye-contact) • Drawing out an ABC formulation • Alternative ways of delivering support and interventions • Use of video summaries at the end of the teaching day

21. Trainee’s feedback • “Information is clear” • “Role plays are useful” • “Very interesting” • “Discussion is useful” • “Would like more practice with role plays” • “Very visual”

22. Pilot Project Service Outcomes so far • NW have had 49 referrals since service commenced February 2012. Service not yet available in SE. • Female 33, Male 16. The majority (15) have been GP referral which is interesting considering service are heavily promoting self referral, CMHT 12, SSD 9, Self Referral 8, Vol Org 5. • The main referral reason is mild to moderate levels of Depression and the majority of clients have been assessed as having no risk of suicide or self harm which would indicate that the referrals have received so far are appropriate for Step 2.

23. Contacts • Karen Rea – k.rea@ljmu.ac.uk • Dr Kevin Baker – kevin.baker@nhs.net • Hazel Flynn – hflynn@signhealth.org.uk • Dr Sarah Powell – sarah.powell@signhealth.org.uk]