Improving Access to Psychological Therapies

Working for Improving Access to Psychological Therapy Services

Clinical psychologists, Counselling psychologists, Nurse therapists, Primary Care counsellors and other qualified Mental Health professionals are eligible to train in delivering High Intensity therapy (AfC Bands 6 and 7)

To become a High Intensity trainee, you will need to have had considerable experience and training in providing psychological therapies. Some of the staff who would be considered might currently be working as nurses, occupational therapists & social workers, counsellors, experienced graduate workers, psychotherapists or newly qualified clinical psychologists.

People from a wide range of backgrounds with a special interest in therapy are eligible to train in delivering Low Intensity therapy (AfC Band 4)

For the Low Intensity trainees, we would be looking for people, who have preferably worked in local mental health services or local communities, who can demonstrate that they can meet the academic levels in the training programme and are interested to work with this client group. These can be graduates or non graduates.

Advertisements and recruitment will begin April 2009 in every Strategic Health Authority area . Search the latest vacancies www.jobs.nhs.uk Keyword - IAPT

Job Descriptions

• Low Intensity Worker Band 5 Job Description (Word, 60K) and AfC Profile Matching (Word, 60K)
• Low Intensity Trainee Band 4 Job Description (Word, 60K) and AfC Profile Matching (Word, 60K

• High Intensity Trainee Band 6 Job Description(Word, 60K) and AfC Profile Matching (Word, 60K)
• High Intenisty Trainee Band 7 Job Description and AFC Profile available shortly

How can you apply for IAPT jobs/trainee posts?

More than 700 people commenced new training posts in Autumn 2008 , recruitment took place in summer 2008.

Some IAPT services advertising roles for qualified staff; these can be found on NHS Jobs , http://www.jobs.nhs.uk/ search with the keyword : IAPT

It is likely that there will be posts advertised for staff, who have already trained and have the level of skills and competency required and can start working in IAPT services, as well as for trainees.

NHS and other psychological therapy providers setting up and expanding the capacity of psychological therapies services should consider:

• How many of what types of staff are required to deliver the service
• How we can ensure they are competent to do so
• How we can recruit and retain staff

Service commissioners benefit from a clear understanding of these workforce issues because they affect the deliverability, cost and quality of the service more than any other element of the project.

Key factors

IAPT Workforce Planning

The IAPT Programme has made some assumptions about the required workforce in:

• Improving Access to Psychological Therapies (IAPT) implementation plan: national guidelines for regional delivery
• Improving Access to Psychological Therapies ( IAPT ) Commissioning Toolkit

These include nationally defined need, demand, interventions required and the mix of staff that could deliver these services within a stepped care psychological therapy services model.

The IAPT Workforce Capacity Tool accompanied by Frequently Asked Questions can help commissioners work through IAPT workforce planning step-by-step this is current under review .

Further useful guidance on assessing demand and staffing can be found in Neglected Majority -Sainsbury Centre for Mental Health 2005.

Staffing IAPT Services

Large numbers of staff - including nurses, clinical and counselling psychologists, counsellors and psychotherapists, working in the NHS or the private and voluntary sectors, are likely to be able to contribute to the new IAPT services.

Commissioners and providers can use the IAPT Worker Registration Form to assess the levels of skills and training in the existing workforce and establish a workforce profile that will support their recruitment effort.

Two types of psychological therapy workers provide interventions in an IAPT service:

• low intensity therapy workers and
• high intensity psychological therapists

Trainee and qualified staff posts exist for both roles and training curricula have been developed.

Low Intensity Therapy Workers

Qualified low intensity therapy workers employed at AfC-Band 5, provide high volume, low intensity cognitive behaviourally-based interventions at Step 2 including guided self help.

Trainee low intensity therapy workers, employed at AfC-Band 4, will attend a one year low intensity training programme including one day a week training. They will provide supervised IAPT services four days a week. When they graduate at post graduate certificate level, they will be eligible to apply for Low Intensity Therapy Worker posts at AfC-Band 5.

One of the underlying principles of this role is that there should be a diversity of backgrounds to match local communities, included in the guidance on access to Low Intensity Training for Non Graduates.
At present there is no system to accredit LI courses in the same way HI courses will be accredited by BABCP. A group of experts are meeting in an Oversight Group Accreditation for IAPT training (OGAIT) to decide the best way forward for monitoring and accredit high and low intensity courses and other evidence based training as they are agreed. Recommendations will be forthcoming from this group

Training materials for low intensity staff have been developed by Professor David Richard and Mark Whyte , these are available to download

Job Descriptions

• Low Intensity Worker Band 5 Job Description (Word, 60K) and AfC Profile Matching (Word, 60K)
• Low Intensity Trainee Band 4 Job Description (Word, 60K) and AfC Profile Matching (Word, 60K)

High Intensity Therapy Workers

Qualified High Intensity Psychological Therapists provide a course of cognitive behavioural therapy (CBT) at Step 3. These roles are likely to be delivered by a mix of professions including CBT therapists, clinical psychologists , counsellors, nurses, occupational therapists, and psychotherapists. However they are required to be an accredited/accreditable BABCP practitioner or able to demonstrate equivalence.

Trainee High Intensity Psychological Therapists, employed at AfC-Band 6 or 7 & will attend a one year training programme two days a week, undertaking supervised practice in IAPT services for three days a week. When they graduate with a post-graduate diploma for BABCP accreditation, they will be eligible to apply for High Intensity Psychological Therapy Posts at AfC-Band 7. Guidance on KSA for entry into High Intensity Training without a core profession is available .

IAPT practitioners also need access to staff with expertise in employment support, benefits and housing who can offer sound advice and information to the people accessing IAPT services and those who support them.

Job Descriptions

• High Intensity Therapist Band 7 Job Description (Word, 60K) and AfC Profile Matching (Word, 60K)
• Provisional Band 7 Trainee Job Description and IAPT A4C Report
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• High Intensity Trainee Band 6 Job Description(Word, 60K) and AfC Profile Matching (Word, 60K)

Working in IAPT services

Training and job opportunities for IAPT services are advertised via NHS Jobs search “IAPT” , Primary Care Trusts providing IAPT services can be found at on our Regions pages

Supervision, Management and Leadership

IAPT supervisors should be trained in supervision and able to supervise five trainee therapists or therapy workers.

IAPT services are expected to link into existing services. In some areas, some staff from other services may deliver some aspects of the IAPT service, such as supervision. Training courses for IAPT staff who want to become supervisors are being developed.

All High Intensity Psychological Therapists will have the opportunity to progress their careers to AfC Bands 8a , 8b , 8d and 9, depending on the expansion of their capabilities and competence.

IAPT senior staff are expected to demonstrate competence in clinical leadership, training delivery, governance, audit, evaluation, service design and improvement. They are also expected to commit themselves to the ongoing clinical supervision and case management essential to setting up and managing stepped care systems.

The service lead is a senior member of staff carrying overall accountability. This level of responsiblity and supervision will have a bearing on the amount of clinical work they can carry out.

Job Description Service Lead Band 8b Job Description (Word, 60K) and AfC Profile Matching (Word, 60K)

Further guidance can be found in Delivering the Government’s Mental Health Policies: Services, staffing and costs (SCMH,2007).

Competences

Different skill mixes can result in different cost effectiveness so, rather than prescribing the exact workforce numbers and types of staff, IAPT workforce guidance emphasises the functions/competences and levels of work of staff in IAPT services.

Resources developed to assist services in this are:

• Competences for low intensity practitioners have been defined and incorporated into the job description and low intensity curriculum
• A competence framework for the delivery of cognitive behavioural therapy is accompanied by practitioner and patient guidance
• A competence framework for psychological therapy supervision provides a basis for training supervisors in the IAPT programme

Future competence resources will include:

• An audit tool to help individual practitioners asses their own levels of competence and develop individual personal development plan. This is now available Self Assessment Tool (.xls) and Guidance Self Assessment Tool use and information (pdf)
• Competences for two more psychological modalities are being developed. These are family/ systemic, person-centred humanistic psychological therapies available by the end of 2009. Further information is available at Skills for Health

This work will inform how the skill mix should develop in future years as the programme develops.

Clinical Supervision Principles and Guidance

Supervision is a key activity, which will determine the success of the IAPT programme. We are in the process of supporting the commissioning of training for all IAPT supervisors throughout the SHA regions based on a supervision framework specifically developed for IAPT (http://www.iapt.nhs.uk/2008/02/supervision-comptences-framework/ )

We recognise that as most services and training courses are about go live in October 2008, a summary of principles of IAPT supervision is required for Clinical and Course Directors.

Principles of supervision for an IAPT service

This guidance applies equally to all staff employed and working therapeutically within an IAPT service including both IAPT trainees and qualified staff, and those delivering high and low intensity interventions. Supervision for all these staff should entail:

Amount of supervision:

• Be provided weekly on a regular basis and consist of a minimum of one hour of individual supervision with an experienced and trained supervisor, and located within the IAPT service.
• In some circumstances, group supervision will be appropriate but will require sessions of a longer duration to be effective.
• Supervision should address the review of all ongoing clinical cases, and routinely be informed by an individual client’s IAPT outcome measures. For low intensity practitioners this will consist of individual supervision provided from a case management perspective.
• The discussion of individual clinical cases during supervision should be prioritised according to clients’ needs and a pre-determined schedule. All cases should have been regularly reviewed within a reasonable period of time (2-4 weeks).

Trainees:

• High Intensity IAPT trainees should also receive during their two-day attendance on the course, additional in depth supervision of training cases, usually in groups of two to three trainees, and lasting for around 1.5 hours per week.
• Low Intensity IAPT trainees should also receive, in addition, to case management supervision, both individual and group supervision aimed at case discussion and skills development. This should normally be around 1 hour per fortnight.

Supervisors:

Supervisors should have a working knowledge and experience of the interventions for which they are providing supervision. Where there are gaps in experience (e.g. low intensity working), these might be addressed by supervisor training and familiarisation with specific services.

Supervision of trainees will be shared between supervisors who might be university-based and provide specific input into training cases, and supervisors providing routine clinical supervision within the service. Clinical directors and course directors should ensure that appropriate governance arrangements exist for all supervision provided and where appropriate university-base supervisors have honorary contracts etc.

IAPT is commissioning short training courses (5 days) for supervisors within IAPT services, although these are not currently available in all SHA regions. It is expected that most IAPT supervisors will eventually be trained around the specifics of supervising within an IAPT service by attending one of these courses. Courses will address IAPT requirements for supervision of both high intensity practitioners, together with case management supervision for the low intensity practitioners.

Other considerations:

• Low intensity practitioners should have access to an experienced supervisor to consult on assessment and risk issues. Clinical decisions to either step up treatment to high intensity, discharge or refer on to specialist services will need to be discussed within regular case management supervision.
• Services should consider how they support their supervisors and ensure that they have sufficient time and adjusted caseloads to allow them to provide quality supervision. They should also have access to peer/group support and continuing professional development.
• All staff should access to professional and managerial supervision, as appropriate to their role, which will be in addition the clinical supervision arrangements detailed above.
• It should also be stressed that the number of hours of supervision identified within this document are the minimum recommended for full-time staff. Flexibility should be adopted for staff on part-time contracts or with reduced caseloads arising from other non-clinical responsibilities.
• A named senior therapist should be responsible for overseeing and monitoring the effectiveness of supervision provided within the IAPT service, in conjunction with the Clinical Director and Course Directors concerned.

Future supervision guidance is provided will include the different forms of supervision expected within an IAPT service and the importance of issues such cultural sensitivity and how supervision can be tailored to meet the needs of clients, supervisees and the service.

Download the IAPT Supervision Guidance December 2008

Education, Training and Development

Strategic Health Authorities have commissioned Higher Education Institutions to deliver the training, which will use the low and high intensity curricula. Existing courses for graduate workers and CBT therapists are being reviewed to ensure they fit the IAPT model.

An audit tool for assessing Cognitive Behavioural Therapy courses and the Cognitive Behavioural component in Clinical Psychology Programmes is being developed by BABCP and BPS. It will be available at the end of summer 2008.

IAPT and the Wider Workforce

Person centred values and psychological awareness are being factored into local training strategy and implementation plans to raise the psychological awareness and person-centred values among primary and secondary care staff. The 10 Essential Shared Capabilities is a useful starting place for this work; new guidance on what is required for those who work at Step 1 in primary care and in local communities is also expected.

Accreditation by Professional and Regulatory Bodies

Seven professional bodies are engaged in a significant piece of work preparing a system of accreditation for the IAPT workforce. They are:

• Health Professions Council (HPC)
• British Psychological Society (BPS)
• British Association for Behavioural Cognitive Psychotherapies (BABCP)
• British Association for Counselling and Psychotherapy (BACP)
• United Kingdom Council for Psychotherapy (UKCP)
• British Psychoanalytic Council (BPC)
• British Accreditation Council (BAC)

Further Resources for Workforce Development

Workforce redesign underpins the development of new services and these NIMHE Workforce Programme resources may be useful:

• New Ways of Working for Everyone
• The Creating Capable Teams Approach
• New Ways of Working for Applied Psychologists - Positive Practice Guide NIMHE/BPS