Network Name EIS Shared Learning Conference

Psychosocial Interventions (PSI) Training

Dr Helen Lockett Dr Joanna Ward-

Brown

Lancashire Early Intervention Service Shared Learning Conference – 4 June 2013

Network Name 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 Name EIS Shared 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.”

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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.

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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

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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)

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North Lancashire East

Lancashire

Central & West Lancashire

Aligned Therapist Aligned Therapist

Aligned Therapist

Case Discussion and Formulation (Therapist and Case Manager)

Core PSI Tier 1

Formal CBT / FI (Tiers 2 and 3)

Supervision, consultation & ongoing support from

Therapist and Team Leader

Review Outcome and Effectiveness

Psychological Assessment including Case

Manager

Review Outcome

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A ‘Stepped’ Approach to Psychological Care

Psycho-social interventions

Case

managers/

ST&R

Tier 2

Tier 3

Formal CBT or FI, Discrete Problems

Staff with:

Formal CBT training or COPE (under supervision)

Complex / multiple problems Longer term CBT or FI

Tier 1 Specific PSI

Training Supervision/ Consultation

Cognitive Therapists

Clinical Psychologists

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Research Evidence

Dr Warren Larkin, Clinical Director Children & Families Network Team: Dr Joanne Green; Dr Fiona Lobban; Mr Jeff Warburton

-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.

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Research Evidence

Dr Warren Larkin, Clinical Director Children & Families Network Team: Dr Joanne Green; Dr Fiona Lobban; Mr Jeff Warburton

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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

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In-house training group (Multi-disciplinary)

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

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Any questions?