Annual Family Therapy Conference 2014
Adelphi Hotel - Liverpool
“Child IAPT and Systemic Family Practice –
Irreverence, Ambivalence and Perseverance in
an Evidenced Based Culture. Where are we now,
nine months on?”
With Grace Heaphy, Hannah Sherbersky, Jacqui Sayers,
Margaret Dimmock, Tom O' Neill, Gary Robinson and
Judith Lask
• Overview of the SFP programme
• Systemic competencies
• Overview of the five HEIs, including two short
films
• Q and A
• Sustaining change - what can we do together?
AFT Conference 2014 SFP CYP
IAPT
Outline
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Children and Young People’s Programme
Rationale;
Courageous plan to use IAPT initiative to radically transform CAMHS;
– Mental Health Strategy, 2011 ,
– Commitment to increase access to NICE approved best evidenced psychological therapies
for children and young people,
– NHS and Social Care Bill, 2011,
– Children and Young People’s Health Outcomes Strategy,
– Transfer of project from DH to NHS England in April 2013,
– Health Select Committee (HSC) on CAMHS – Mar/Apr 2014
AFT Conference 2014 SFP CYP
IAPT
• Drawing on policy context;
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• CYP IAPT has learned from Adult IAPT but is specific to the needs
of children and families and the agencies that support them.
Key IAPT quality markers:
• Evidence Based Practice
• Routine Outcome Monitoring
• Strong supervision
• Participation in the CYP IAPT project is offered to existing CAMHS
- not necessarily exclusively provided by the NHS.
• The budget is still modest and will be available until the next
Comprehensive Spending Review.
AFT Conference 2014 SFP CYP
IAPT
Project assumptions
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CYP-IAPT: Core Implementation
Components
Identification
of
partnerships
CAPA and
other
collaborative
systems
Integrated
&
Compensatory
Routine
outcomes
monitoring
Workplace
supervision
Training of
therapists
AFT Conference 2014 SFP CYP
IAPT
Leadership and
management
training
Training of
supervisors
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The CYP IAPT Learning Collaborative
HEIs (n=5)
Assure quality
Organise training
AFT Conference 2014 SFP CYP
IAPT
Deliver content in partnership
Mentorship & peer support
Yr3 Partnerships
(n=25; 2013/14)
Yr2 Partnerships
(n=24; 2012/13)
CAMHS-Vol.S/LACommissioners
CAMHS-Vol.S/LACommissioners
Yr1 Partnerships
(n=18; 2011/12)
CAMHS-Vol.S/LACommissioners
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Service Transformation Programme
• Improve collaborative practice with children, young people and
families
• Embed evidence based practice (EBP) as recommended by NICE
in
o CBT for anxiety disorders and depression
o Parenting training (age 3-10)
o Interpersonal Psychotherapy for adolescents (IPT-A) for depression
o Competency based curriculum using Roth and Pilling CAMHS
competencies
o Systemic Family Practice for conduct disorder (over 10s), depression
and self-harm, and eating disorders
AFT Conference 2014 SFP CYP
IAPT
Began in April 2011 with aims to:
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o Core CYP IAPT curriculum (60 credits)
o Systemic Family Practice and basic skills (30 credits)
o Module specific pathway;
o Conduct disorder (over 10’s) and depression and
self-harm (30 credits)
o Eating disorder pathway (30 credits) –specific entry
requirements (hub)
o Trainees need to be members of an existing or developing
specialist ED multidisciplinary team in community
o Min of 50 new ED referrals a year
o Cover min pop of 500,000
o Knowledge and skill required to be held within a team as a
whole
AFT Conference 2014 SFP CYP
IAPT
Systemic Family Practice (SFP) course
covers;
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• SFP is based on the same theoretical and evidence base as
SFT but denotes an intermediate level of training. Systemic
Family Therapists will have another 2 years of training and be
equipped to deal with the most challenging work and to
move more flexibly across age range and presentations.
• The Systemic Family practice curriculum has been designed
so that successful candidates should be able to enter the
final 2 years of family therapy training leading to registration
with UKCP.
AFT Conference 2014 SFP CYP
IAPT
Systemic Family Practice and
Systemic Family Therapy
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SFP Curriculum Group
• Eia Asen, Paula Boston, Charlotte Burke, David Cotterell, Ivan
Eisler, Judith Lask, Barbara Mackay, Mark Rivett, & Tom Sexton.
• From the beginning supported by the Association for Family
Therapy whose aim is to support skilled and effective work
with families.
AFT Conference 2014 SFP CYP
IAPT
• Chaired by Peter Fonagy
• Membership drawn from researchers and practitioners in the
field especially those connected with the main sources of
evidence;
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Challenges in drawing up the
curriculum
Develop
understanding of
ethics and working
with difference
Develop skill level
to work
confidently with
day to day work
Base on
evidence
AFT Conference 2014 SFP CYP
IAPT
To provide a
theoretical
foundation
Integrate with CYP
IAPT principles
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Depression and
Self harm
Basic module
plus
Or
Conduct
disorder
or
Eating Disorders
AFT Conference 2014 SFP CYP
IAPT
Curriculum consists of
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• CAMHS workers with
1. Prior relevant professional training
2. Ability to study at a postgraduate level
3. Experience of working in CAMHS
4. Some experience of working with families
5. Opportunities to carry out required supervised clinical
practice.
Some professionals who have already done an intermediate
level training may benefit from the specialist modules.
AFT Conference 2014 SFP CYP
IAPT
Who can do the training?
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• Theoretical underpinnings – a range of frameworks including
behavioral, structural, trans-generational, communication,
narrative.
• How to maintain effective engagement and collaborative
therapeutic relationship
• How to assess and formulate family in relation to presenting
problem
• How to work ethically with difference.
• Planning work and basic interventions
• Thinking of self in relation to work
• Family work in context of other interventions.
• Using formal and informal feedback
AFT Conference 2014 SFP CYP
IAPT
What will Students Learn: Basic
Module
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• To make an assessment and formulation
• Understand developmental issues, risk issues and make an
effective assessment and formulation.
• Engage with the family around the young person
• Help family to create safety around their young person
• Encourage non-blaming explanations
• Help family understand self harm as a communication
• Help family to engage in discussions around emotions
• Help identify patterns in order to decrease likelihood of self
harm
• To use questions and direct interventions in family to
enhance understanding decrease risk.
AFT Conference 2014 SFP CYP
IAPT
Specialist Module: Depression and
Self Harm
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• Engaging and motivating young people and families
• Building pro-social, family based behavioural skills that fit the
family and alleviate the presenting problems
• Generalize treatment and prevent subsequent relapse
• Manage complex clinical situations whilst retaining a relational
SFT focus
• Identify the relational processes that maintain or precipitate
conduct disorders
• Demonstrate the ability to apply relational formulation in
conduct disorders
• Be able to create shared relational treatment goals with families
• Monitor progress to agreed goals collaboratively
• Demonstrate cultural competence in SFT for conduct disorders
(including the use of interpreters)
• Use behavioural and structural interventions to help families to
manage their child.
AFT Conference 2014 SFP CYP
IAPT
Specialist Module: Conduct
disorder
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This is a double (30 credit) module
• Applicants must work in a specialist eating disorder service
or unit and meet particular criteria.
• Includes work with Anorexia and Bulimia , multi family
groups, running a family meal as well as assessment,
formulation, engagement, structuring treatment etc.
• Interventions that are most useful in working with these
groups.
• Links with wider MDT
AFT Conference 2014 SFP CYP
IAPT
Specialist Module in Eating
Disorders
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• Greater expertise in engaging with all family members
• Interventions that take into account different perspectives of
family members
• Greater appreciation of family culture, aspirations and strengths
• Enhanced collaboration with family to help referred young person.
• Support and help in making necessary changes
• Understanding of external and internal constraints to making
changes.
• Appreciation of the place of family in wider community and
network of professionals.
• Availability of family focused, evidence based interventions which
have specific applicability to presenting problem
AFT Conference 2014 SFP CYP
IAPT
How will clients benefit
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• There is a strong emphasis on well supervised practice by
supervisors who are ideally registered with AFT as systemic
supervisors as well as completing the CYP-IAPT supervision
training.
• Practice will be undertaken with a general caseload as well as
specialist caseload (a minimum of 60 hours of supervised
practice)
AFT Conference 2014 SFP CYP
IAPT
Supervised practice
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AFT Conference 2014 SFP CYP
IAPT
Some wider reverberations
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• CYP IAPT developments have influenced AFT in revising
training standards
• Systemic Practitioners and therapist are becoming more
familiar and comfortable with ROMS
• The flexibility and adaptation which is a strength of systemic
work is being complemented by a greater understanding of
the need for more specificity when working with particular
presentations
• Impact of learning from other modalities, working together,
supervision, common factors, difference
• AFT will be involved in the accreditation process and Cred is
looking to create bridges between SFP and Framework in
Blue Book Review.
AFT Conference 2014 SFP CYP
IAPT
Recursive process
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• More understanding of the importance of family and wider context
• Understanding of the importance of a good, collaborative
therapeutic relationship with family
• Understanding of complex ethical issues in working with families
• More appreciation of culture and working with power in relation to
marginalized groups
• Need to adapt interventions to fit with presenting families and be
able to work in the here and now, with perceptions and with
history
• Importance of working with family as a resource and identifying
and building on strengths.
• The important connections between beliefs, behaviors, emotions
and relationships.
AFT Conference 2014 SFP CYP
IAPT
The inclusion of Systemic Family
Practice will hopefully bring;
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