Cumbria Partnership - The Evaluation of Training for

The Evaluation of Training for
IAPT therapists in Cumbria
Professor Dave Dagnan
Consultant Clinical Psychologist
Using mainstream services.
• There is increased emphasis on meeting
the physical and mental health needs of
individuals with learning disabilities
within mainstream healthcare services,
recognising that they should have access
to the same services as the general
• Attitudes and skills are often identified
as key barriers to the use of services.
Themes for training
• Review of 13 high
quality papers
reporting outcomes of
training needs
analyses for non
specialist staff who
may work with people
with LD
Supporting adjustments in IAPT
• Training for staff specific to their roles and the
types of intervention supported by their part of
the pathway.
• Pathway adaptation, based on lower ability:
• Easy read medication and self-help guides
• Allowing extra time for reading core questionnaires
• Emphasising less cognitively demanding techniques
• Emphasising smaller set of techniques
• Enabling supporters in therapy
• The 32 Primary Wellbeing
Practitioners (6 men and
26 women) received one
day of training consisting
of 4 modules and the 36
High Intensity
Practitioners (6 men and
30 women) received 2
days of training
consisting of 8 modules.
Training Curriculum
• The training was structured in a modular format such that
the training consisted of 4 or 8 modules depending on
the duration of the training.
• 1. Introduction to intellectual disability, epidemiology
and impact of literacy and numeracy difficulties in the
general population.
- 2. Stigma and its impact on therapy relationships
- 3. Introduction to assessment of people with
intellectual disabilities
4. Advanced assessment of people with intellectual disabilities
5. Overview of adaptation of therapeutic techniques
6. Specific examples of adaptation; thought diaries
7. Therapy approaches and formulation
8. Overview of local services and discussion of
communication and support systems
1. The therapy confidence scale delivered
pre-training, immediately post training
and 3 months post training.
2. Five questions measuring general therapy selfefficacy and five questions measuring attitudes to
the treatment of people with LD in mainstream
Qualitative Data
• In order to add to the understanding of the
effect of training and to gain insights from
therapists when they had had a chance to
reflect on the training in more detail, we
interviewed six Primary Wellbeing practitioners
and six High Intensity Practitioners at three
months follow-up. The interviews were carried
out face to face and were recorded and
• Significant difference
in confidence
between HI and
• Significant increase
in confidence for
both groups
maintained at 3
• Significant positive
change in attitude
to mainstream
treatment for both
groups, maintained
at 3 months
• Significant difference
in therapy selfefficacy between PWP
and HI groups
• Significant increase in
general therapy selfefficacy in both
groups, maintained at
3 months.
• All interviewees were able to identify new skills and
approaches they had applied since the training. The
Primary Wellbeing Practitioners tended to identify
specific adaptations that they had made subsequent to
the training.
• …..things like the questionnaire we fill in with the
people, things like the PHQ and GAD, before I would
give them to people and get them to fill them in and
bring them back or give them to people and fill them
in session, last time because I think I’m now more
aware of that people may struggle with that, I always
now say to people do you want to fill that in or do you
want to go through it together and give them the
option rather than embarrassing them by shoving it
onto them. …..
The High Intensity Practitioners tended to reflect
on more generalisable understanding of
therapeutic issues.
• I think the most helpful bit of it that stayed with us …..
Is the difference between cognitive deficit as opposed to
cognitive distortion so that was quite helpful, in a typical
population we are dealing with cognitive distortion in
CBT ……it was really helpful I think for my thinking and
working with people, not even learning disabilities
working with people with personality disorder and things
like that and thinking how therapy needs to be adapted
when cognitive functioning or impaired or a guess
different experiences in a person’s background mean
they haven’t developed the skills that a lot of us take for
granted problem solving, regulating negative emotions
and things like that, but that’s the thing that stayed with
us the most.
All interviewees were able to describe case studies of
working with clients with lower ability or learning
disability that reflected many of the issues presented in
the training. For example a Primary Wellbeing
Practitioner described a case
• …..he said he found particularly thinking was
something he struggled with… erm so we took a
problem solving approach which was much more
concrete and thinking out different steps and planning
different steps which ultimately got the same results
which I would of got to with cognitive restructuring in
a way that he can grasp more because it was more
involving and thing about what actually doing than
• …. I could easily start to talk about feelings and
thoughts using abstract examples, but I didn’t do that,
I talked about his reactions to things and was able to
get in that way and then explain to him that
sometimes emotions feel stronger than others and
again I was able to use his example to talk about
when it was worse, when it was better, when it was
happening That’s kind of where it went. If I was
working with without the lower ability it would be a bit
more abstract and then maybe I would talk quicker as
well, with him it was vey much about his emotions and
how they affected him and gave him an idea about
you know what sort of influence that can have upon
• Training seems to be effective in increasing
confidence, increasing positive attitudes to
people with learning disabilities in mainstream
services and possibly in increasing general
therapeutic self-efficacy.
• Three month follow-up found most staff
interviewed could describe ways in which the
training had changed their practice.
• Supported by work on developing clear
pathways and protocols.