Psychosocial Interventions (PSI) Training Dr Helen Lockett Dr Joanna Ward- Brown Lancashire Early Intervention Service Shared Network Learning Name Conference 4 June 2013 EIS Shared Learning Conference
What are Psychosocial Interventions? Psychosocial interventions are activities aimed at improving both psychological wellbeing and social functioning, with a view to improving quality of life. Our PSI training is based on Cognitive Behaviour Therapy (CBT) techniques Good evidence base for individual and family CBT interventions NICE guidance Sound evidence base in psychosis (Wykes et al, 2008) 34 RCT s CBT is safe, acceptable to SU s and cost neutral Basic CBT skills can be incorporated into practice relatively quickly Network EIS Shared Name Learning Conference
What PSI tries to achieve Psycho social interventions... seek to challenge a dominant non-recovery approach to working with psychosis. It supports the vision that an integrated approach to recovery is a basic human right of people with psychosis and their carers. This leads to the premise that the mental health workforce possesses positive attitudes, up to date knowledge and a wide range of skills to help people improve the quality of their lives. Network EIS Shared Name Learning Conference
History of PSI training in Lancashire EIS An EIS worker s guide to psychosocial interventions: CBT-informed case management for psychosis was written in 2008 by Warren Larkin, Joanne Green, Mike Fitzsimmons, Lee Fitzpatrick, Caroline Johnson, Steve Field and Fiona Lobban. PSI training in the EIS also began at this time. The aim was to support EIS case managers and STR workers to think and work psychologically with their clients, so that all clients could access psychologically informed care tailored to their level of need and to ensure a unified approach and understanding among staff. This training is now mandatory for all EIS clinical staff. The training is updated and delivered regularly, led by the Therapy Team and case managers with therapy qualifications.
What does the training look like? Our PSI training consists of the following modules: 1. Engagement and Motivational Interviewing 2. Normalisation 3. Reaching a shared understanding of problem maintenance 4. Prioritising problems 5. Agenda setting and SMART goal setting 6. Activity Scheduling 7. Structure Relapse Prevention 8. Recovery A bio-psycho-social perspective 9. Measuring Specific Outcomes
How does it work in Lancashire EIS? Case managers and STR workers use a PSI approach with their clients (Tier 1). They are supported to do this through Regular clinical supervision Discussions with psychological therapists Formulation groups Referrals can be made for Tier 2 or 3 interventions via a psychological therapist (if appropriate)
North Lancashire Aligned Therapist Central & West Lancashire Aligned Therapist East Lancashire Aligned Therapist Case Discussion and Formulation (Therapist and Case Manager) Core PSI Tier 1 Psychological Assessment including Case Manager Supervision, consultation & ongoing support from Therapist and Team Leader Formal CBT / FI (Tiers 2 and 3) Review Outcome and Effectiveness Review Outcome
A Stepped Approach to Psychological Care Psycho-social interventions Tier 1 Specific PSI Training Supervision/ Consultation Case managers/ ST&R Formal CBT or FI, Discrete Problems Tier 2 Staff with: Formal CBT training or COPE (under supervision) Complex / multiple problems Longer term CBT or FI Tier 3 Cognitive Therapists Clinical Psychologists
Research Evidence -Pilot evaluation: 69 members of clinical staff from the Trust s EI Services: in-service questionnaire -94% of staff completing the programme rated it as good or excellent. -Assessments of knowledge, skills and confidence levels increased after training -Maintained after six months (See figure). -Staff reported implementing psychosocial interventions more frequently following the training and felt supported in using these approaches. Dr Warren Larkin, Clinical Director Children & Families Network Team: Dr Joanne Green; Dr Fiona Lobban; Mr Jeff Warburton
Research Evidence Dr Warren Larkin, Clinical Director Children & Families Network Team: Dr Joanne Green; Dr Fiona Lobban; Mr Jeff Warburton
The future PSI will continue to be monitored and practice assessed All clinical staff Minimum 1 day update every two years (after 2 years) Aiming for City and Guilds accreditation New service user development worker post may possibly lead to increased s.u input to PSI
In-house training group (Multidisciplinary) 1. Establish a multi-disciplinary, multi-spoke In-House Training Group Responsible for co-ordinating all in-house training, including PSI, BFT, REAT and other training needs to be identified Collective ownership within EIS; led initially by Therapy team 2. Monthly half day in-house training open to all staff Clinical skills Ethos/approach to psychosis Research
Any questions?