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Developing access to psychological therapies. Dr Kay Macdonald Director of Therapies. Content. Background to psychological therapies training plan Whole systems design : governance structure through to training plan and delivery Training plan :

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Developing access to psychological therapies 1343637

Developing access to psychological therapies

Dr Kay Macdonald

Director of Therapies


  • Background to psychological therapies training plan

  • Whole systems design :

    governance structure through to training plan and delivery

  • Training plan :

    specific examples of roll-out (CBT and Personality Disorders


  • Discussion:

    problems and pitfalls

Context nhs
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/

    (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
Context (Training)

  • Need to develop basic therapeutic awareness in clinical staff

  • Develop capacity within staff to offer psychological interventions as part of treatment packages

    - in eclectic therapies

    - in specialist interventions

  • ….and capacity for supervision

  • 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

  • Make sure that funding is based on service need / equitable

  • Review relationships with HEI’s to ensure relevance of training offered

Context training1
Context ( training)

  • Relate training ( in-house / external) to formal qualification/ accreditation/ professional regulation ( COMPLEX)

  • Engage commissioners / partners in training agenda ( eg.PCT/

  • Provide training in consultation and supervision

  • Engaging service users/ expert pt program/ trainers/Guided self-help

Service redesign access to therapies
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

Benchmark survey june 2006
Benchmark Survey - June 2006

Benchmark Nine

The most effective services will be those that: Have a clear and defined leadership structure

Benchmark Five

The most effective services will be those that: Find ways to involve service users and carers.

Workforce establishing training needs
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
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

Psychological therapies training plan
Psychological therapies training plan

Developed from:

  • National recommendations – e.g NHS Psychotherapy Services in England:review of strategic Policy ( 1996)

  • Local information from questionnaire, focus group, workforce and service plans

  • Informed best practice

  • NICE Guidance

Developing access to psychological therapies 1343637

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

Developing access to psychological therapies 1343637

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.

Developing access to psychological therapies 1343637

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.

Training plan for cbt skills development support and supervision
Training Plan for CBT : skills development, support and supervision

Staff :

specific to

role, prior





Individual learning outcomes

Service related outcomes

Type C

Module 7:

Developing supervision,

training, research and consultation skills

Module 6: Working with complex problems

Type B


Module 5:Practice Development: Utilising skills within teams, understanding research, developing supervision skills


Module 4:CBT applied to specific client group

(psychosis/ ED/ OCD/ trauma etc.)


Module 3:Development of CBT therapeutic skills including assessment, formulation, intervention, discharge and evaluation


Type A

All Staff

Module 2: The development of basic CBTconcepts and skills to enhance work, case discussion, role-play and reflective practice


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.

All New Staff

Definitions of types a b and c cognitive behavioural therapy practitioners
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 practitioners1
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,


  • 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.


  • 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 practitioners2
Definitions of Types A, B and C Therapy Practitioners.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
CBT training rollout Therapy Practitioners.


  • 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
Progress to date Therapy Practitioners.

  • Associate director of psychological therapies training appointed

  • In-house foundation courses started (80+)

  • Some Type B courses started

  • Supervision groups underway

  • Training sessions evaluated

  • Individual learning outcomes recorded

  • Planned audit on service impact - 6mths/ 18mths

  • Link with SHA - CBT training business plan

  • Tender to external HEI’s re: type B training and formal accreditation/ qualification

Personality disorders training
Personality Disorders Therapy Practitioners.Training

The approach has been national / regional and local

Involving all relevant clinical staff (including reception staff)


  • 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 training1
Personality Disorders Therapy Practitioners.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
Personality Disorders Therapy Practitioners.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 Therapy Practitioners.

  • 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
Training forthcoming/ planned Therapy Practitioners.

  • Induction/mandatory module

  • GP Resource manual

  • Non-statutory agencies training

  • Motivational Interviewing

  • STEPPS – New course March 2008