SMI Education and Training start and finish group:
SMI workforce development: Service
innovation and transformation.
Prof Graham Turpin
National Advisor IAPT:
Education and Training
SMI Stakeholder Event, 7th March, 2013
Aims of presentation
• Describe rationale and importance of
workforce development within the IAPT
SMI programme
• Overview of development work to date
associated with the demonstration sites
and the derivation of the competency
frameworks
• Future work required for an IAPT SMI
workforce which is fit for purpose
Importance of competency
Professional
Regulation?
Existing education
and training
Professional
accreditation,
NOS and QAA
NICE guidance and
the evidence base
New PTs
competency
Framework
and curricula
Evidencebased,
competent
practitioners
Skills and competencies:
Existing service delivery
Competent
Workforce:
Levels &
Modalities
IAPT Workforce Development Strategy
Patient needs and care pathways
Service models
Scoping the workforce to deliver service models in terms skill mix and
competences to deliver NICE evidenced based therapies
Workforce capacity of existing services to deliver adequate access to
evidence based therapies
Specifying education and training to ensure staff are fit for purpose –
specifying new curricula, training courses and systems implementation
Determine workforce training numbers and commissioning E&T
Quality assurance, Training course accreditation & Registration and
regulation
IAPT SMI Workforce Development Strategy
What’s
been
achieved
Patient needs and care pathways
Service models
Scoping the workforce to deliver service models in terms skill mix and
competences to deliver NICE evidenced based therapies
Workforce capacity of existing services to deliver adequate access to
evidence based therapies
What’s
to be
Specifying education and training to ensure staff are fit for purpose – done
specifying new curricula, training courses and systems implementation
Determine workforce training numbers and commissioning E&T
Quality assurance, Training course accreditation & Registration and regulation
New NHS:
HEE, LETBs &
Professions
SMI IAPT E&T
What it isn’t:
• Creating a new IAPT workforce within
secondary care
• Traditional workforce modeling and
commissioning: estimating trainee
numbers and commissioning preregistration training.
• Commissioning will be important but this
project is about development of the
existing workforce.
SMI IAPT E&T
What it is:
• It is about workforce redesign, service
transformation and innovation to deliver
evidence-based NICE psychological
therapies for people with SMI.
• Working collaboratively with current
services
• Many similarities with C&YP SMI
SMI IAPT E&T
To achieve:
• That the NHS commissioned workforce
working with people with SMI and their
carers/ families is fit for purpose and
delivers NICE approved psychological
therapies and high quality psychologically
informed support and information.
SMI IAPT E&T
To achieve:
• That people with SMI have appropriate and
adequate access to effective evidencebased NICE approved psychological
therapies across a range of SMI disorders
through staff who have demonstrated
competences and have been expertly
trained and supervised
SMI IAPT E&T
To achieve:
• That the system that delivers treatment
and support is accountable through the
collection of routine clinical outcomes and
adherence to explicit quality standards
SMI IAPT E&T
The barriers
SMI IAPT E&T
Present barriers – few SMI services have:
• A vision of psychologically-informed care
• Commitment to a range of evidence based
interventions and the management expertise
to implement them
• Collection of routine and meaningful clinical
outcomes for people with SMI
• Sufficient psychological therapists trained
and accredited to deliver NICE approved
therapies across all SMI disorders.
SMI IAPT E&T
Present barriers – few SMI services have:
• Access to approved trainers and courses
able to deliver the SMI competency
frameworks that will underpin trainings in a
range of NICE approved therapies.
• Sufficient highly trained staff to supervise
psychological therapists and other SMI staff.
• The clinical leadership and service
implementation skills to bring about the
transformation to IAPT SMI services.
SMI IAPT E&T
Solutions
SMI IAPT E&T
How to bring about the change – up-skilling the current
workforce to deliver the SMI competency framework?
• Psychological awareness training for all
staff
• Psychologically informed and IAPT
principled clinical practice for staff working
with people with SMI on their case loads
(Primary and secondary care).
• SMI informed IAPT staff delivering
therapies for anxiety and depression
Cont/…
SMI IAPT E&T
How to bring about the change – up-skilling the
current workforce:
• Staff trained across a range of NICE
approved specialised therapies to
enable choice for clients with all types of
SMI problems.
• Staff trained to supervise and train other
SMI staff.
• Staff capable of clinical leadership and
enabling service innovation and
transformation
SMI IAPT E&T
What would courses look
like?
SMI IAPT E&T
We would envisage:
• A range of different levels of
engagement with psychological
approaches across the whole workforce
• These would be:
–Introductory,
–Intermediate,
–Specialist,
–IAPT implementation
• Target all staff groups
SMI IAPT E&T
What training would be required - Psychoses:
SMI IAPT E&T
What training would be required - Psychoses:
Specialist CBT
training.
Psychological
Therapists
CBT Diploma or
equivalent (e.g. IAPT HI
Training).
Up to 2 years
(P/T).
PGDip or
equivalent
Linked to CBT for
Anxiety and
Depression
Competence
Framework
Examples???
PG Dip
Specific CBTp
interventions and
metacompetences
Could IAPT HI and
CBTp be combined
into a single
course?
To be
supervised by
CBTp skilled
practitioner.
Specialist CBTp
Training
Specialist Family
interventions
training*.
Psychological
Therapists –
already trained in
CBT – see above.
Care Coordinators
and Psychological
Therapists
Specialist CBTp
Either in house training
or access to externally
provided programmes of
specialist FI Training
5 – 10 days
(6 months of
supervised
clinical
practice by
specialist
CBTp
practitioner )
5 days +
(At least 6
months of
specialist FI
supervision)
Examples???
In house
or external
accreditation.
Specific interventions
and metacompetences
Maybe limits due to
intellectual property
rights and external
ownership of
curricula?
How would
curricula based on
Competency
Framework
compare to outside
bodies?
Examples???
SMI IAPT E&T
What training would be required - Psychoses:
SMI IAPT E&T
What training would be required – Bipolar disorder:
SMI IAPT E&T
What training would be required – Bipolar disorder:
Group information
sessions offered to
service users and
relatives.
Enhanced Relapse
Prevention
All staff working
within BD
services with
sufficient
experience to
undertake
Intermediate training for
staff to undertake
education groups with
BD clients and their
relatives based on the
competency framework.
.
Standardised materials
could be used to
structure sessions
nationally, and staff also
trained in basic group
management skills
All staff working
within BD
services with
sufficient
experience to
undertake
A manualised approach
to train frontline care
staff already exists and
has been evaluated.
Currently being
evaluated in online
format
.
A further 2
days, if done
with the
above
courses
Course
credits?
Links to competences
described above, plus
generic therapeutic
competencies and
assessment.
Competences around
group work?
2 days
Course
credits?
Relapse Prevention
skills
Co-facilitated by service
users
A more comprehensive
approach to
psychoeducation
groups for which an
evidence-base exists
would require more
highly trained staff,
together with service
users, plus a
supervision structure for
staff since these groups
can be very
challenging.
Examples????
SMI IAPT E&T
What training would be required – Bipolar disorder:
Specialist
psychological
therapies training:
Group Psycho education,
CBT
Family Focused
Therapy
Interpersonal and
Social Rhythm
Therapy
All staff eligible to
undertake the
training. Will
depend on entry
requirements for
each therapeutic
approach?
Either in house training
or access to externally
provided programmes
of specialist
psychotherapy
trainings.
10 days
Post
graduate
qualifycations or
course
credits.
Specific interventions
and metacompetences
How would curricula
based on Competency
Framework compare to
outside bodies?
In house
or
external
accreditation?
Completed high
intensity IAPT or
BABCP
accredited CBT
therapists?
Maybe limits due to
intellectual property
rights and external
ownership of curricula?
Examples????
IPT therapists?
Mindfulness / ACT
IAPT and Routine
Outcomes
Monitoring (ROM)
All staff delivering
psychological
therapies.
Understand rationale
and practicalities of
routine clinical
outcomes measurement
1 day
Supervision
training
All staff
supervising
psychological
therapists/ or coworking with
service users.
A supervision training
programme building on
IAPT supervision
training and familiarity
(see above), plus
specialist supervision
for specific therapeutic
models and for key
issues arising in BD.
3 days plus?
Generic therapeutic &
Assessment &
Formulation?
Competences within
Adult A&D and C&YP?
Course
credits?
Revised supervision
competences required?
Other trainings may
have specific courses
for supervisors – DBT?
SMI IAPT E&T
What training would be required – Bipolar disorder:
A supervision training
programme building on
IAPT supervision training
and familiarity (see
above), plus specialist
supervision for specific
therapeutic models and
for key issues arising in
BD.
3 days plus?
Course
credits?
Revised supervision competences
required?
Other trainings may have specific
courses for supervisors – DBT?
Course
credits?
Not specified within SMI framework Overlap with C&YP?
but within C&YP?
This would
require an understanding and
responding to the commissioning
environment aspects of quality
assurance,
governance
and
accreditation.
Must include supervision
of service users delivering
interventions.
May need to link external
training providers’
requirements?
Supervision of supervisors
undergoing training?
A
leadership
and 3 – 5 days?
implementation
science
training module to enable
managers and senior
supervisors
within
services to help support,
encourage and direct
service transformation to
enable services to meet
IAPT
BD
Quality
Standards
including
specifics
on
NICE
guidelines, national policy
around BD.
SMI IAPT E&T
What training would be required – Personality disorder:
SMI IAPT E&T
What training would be required – Personality disorder:
Group psychoeducation training.
All staff working
within BD services
with sufficient
experience to
undertake group
psycho-education
approaches. May
also include experts
through experience.
.
Intermediate training
for staff to undertake
extensive education
groups with PD
clients based on the
competency
framework.
It would also be
equivalent to buying
in packages of
psychoeducation
and skills training
such as Structured
Case Management,
STEPPS and PEPS.
It might also
encompass how to
deliver basic
awareness training
as specified above.
A further 3 - 5 Course
days, if done credits?
with the
above
courses. Use
of supervised
practice and
ongoing
supervision to
be
incorporated
into training.
Links to competences
described above, plus
generic therapeutic
competencies and
assessment.
Competences around
group work?
Co-facilitated by
service us
SMI IAPT E&T
What training would be required – Personality disorder:
Specialist
psychological
therapies training:
CBT?, DBT, CAT,
MBT &
psychodynamic
approaches.
All staff eligible to
undertake the
training. Will depend
on entry
requirements for
each therapeutic
approach?
Either in-house
training or access to
externally provided
programmes of
specialist
psychotherapy
trainings. Other[1]
than MBT, these
tended to last
between 1 and 2
years, involve
around 10 teaching
days a year, and
involve close clinical
supervision of tapes
or clients.
MBT involves 3 days
training with ongoing supervision
within clinical
practice.
Normally 10
days
Post
graduate
qualifycations or
course
credits.
In house
or
external
accreditation?
Specific interventions
and metacompetences
Maybe limits due to
intellectual property
rights and external
ownership of
curricula?
How would curricula
based on Competency
Framework compare
to outside bodies?
Must liase with
external bodies
responsible for CAT
and DBT within UK.
SMI IAPT E&T
What training would be required – Personality disorder:
SMI IAPT E&T
What training would be required – Personality disorder:
Clinical leadership
and
implementation
management
training.
Senior staff within
SMI services
A leadership and
implementation
science training
module to enable
managers and
senior supervisors
within services to
help support,
encourage and
direct service
transformation to
enable services to
meet IAPT PD
Quality Standards
including specifics
on NICE guidelines,
national policy
around PD.
3 – 5 days?
Course
credits?
Not specified within
Overlap with C&YP?
SMI framework but
within C&YP? This
would require an
understanding and
responding to the
commissioning
environment aspects of
quality assurance,
governance and
accreditation.
SMI IAPT E&T
How could courses be organised and targeted for
different groups within the SMI workforce?
• Awareness training for all relevant staff delivered by
trained SMI staff.
• Intermediate training for SMI staff to enhance
psychologically-informed practice,
• Relationship to pre-existing IAPT trainings?
• Specialist psychological therapies training and
supervised practice – individually or collectively across
SMI disorders.
• Additional training in IAPT principles, supervision and
clinical leadership/implementation.
All this requires innovation and newly developed products.
SMI IAPT E&T
National curricula development, accreditation and quality
assurance issues for training providers and services.
• Next task is to consult and write curricula for SMI
(Psychoses, Bipolar and PD).
• Flexible curriculum to reflect levels of training,
different staff groups and different disorders/NICE
guidance.
• Curricula probably organised in similar structure to
C&YP curriculum with Generic and Specific
therapeutic competences being identified plus:
• IAPT principles, supervision and clinical leadership
skills to be incorporated.
All this requires innovation and newly developed products.
SMI IAPT E&T
Implementation strategy
SMI IAPT E&T
•
•
•
•
Implementation strategy
Need to be selective at first and work with
demonstration sites to develop collaborative
partnerships between services and training
providers like C&YP.
Clear criteria for readiness and participation
Focus on clinical leadership and training
supervisors and up-skilling existing managers
and therapists to lead change.
Expanding numbers of existing staff who have
been trained in accredited and specialist
therapies, together with trained supervisors.
SMI IAPT E&T
Implementation strategy
• Train the trainers strategy to help support
the roll out and supervision of training in:
– psychologically informed clinical practice,
– SMI training for IAPT staff (anxiety and
depression),
– psychological awareness training around
SMI for all relevant public sector staff.
SMI IAPT E&T
Next steps
SMI IAPT E&T
What needs to happen for 2013/2014
• Translate competency frameworks into national
curricula for SMI.
• Translate competency frameworks into
workforce capacity tool to assess capability of
existing workforce.
• Survey the competences of the existing
workforce and specify the size and extent of
the training gap.
SMI IAPT E&T
•
•
•
•
What needs to happen for 2013/2014
Identify course structures and existing
providers. Alert LETBs to these providers and
the existing need for more trained specialists.
Identify good practice in E&T within
demonstration sites and how these
programmes have successfully evolved?
Liaise with C&YP clinical leadership and
implementation trainings and translate for SMI.
Publish commissioning guidance for SMI E&T.
SMI IAPT E&T
Disseminate to HEE and LETBs –
Job well done!
Further Information & Contact Details
• IAPT website: www.iapt.nhs.uk
• E-mail: g.turpin@sheffield.ac.uk