CBRT™– a case for NHS Adoption

Providing patients with structured relaxation support sessions

CBRT is a new innovation in mental healthcareNHS Change and transformation

CBRT (Colour Breathing Relaxation Technique) is a UK innovation which

provides users with a simple, yet very effective, mind - body awareness

technique through structured and guided relaxation support sessions.

Mindfulness + Colour + Breathing + Positive Thinking = Calm

The missing piece of the puzzle

• CBRT provides the NHS with a Value for Money (VFM) practical application and unique system for physical health, mental health and wellbeing.

• Market ready and user-friendly, CBRT provides a ‘safe care’ and ‘right care’ solution to the ever growing requirement for increased capacity within integrated care for patients with anxiety, mild to medium depression and long term conditions. This need was highlighted in the report, “How Mental Illness Loses Out in the NHS”, produced by a distinguished team of economists, psychologists, doctors and NHS managers convened by Professor Lord Layardof the LSE Centre for Economic Performance.

• CBRT provides opportunities to build a productive patient care network and strengthen communication skills. CBRT empowers patients.

• CBRT is a high quality yet low cost product per unit.

• A relaxation technique and therapeutic intervention - CBRT is a safe “technology enabler” and is a safe medical device, made of printed matter.

• CBRT is an all inclusive, motivational, non-pharmaceutical, non-invasive, non-denominational and non-tactile intervention for all ages and abilities.

Relaxation supports rehabilitationA positive outlook supports wellbeing

Aligns with IAPT Commissioning goals

An NHS Psychological Commissioning Manager has written the

following about the CBRT™ NHS Training Initiative:

“The principles of building confidence and socialisation are good, as

commissioners we understand how important this is for a patient’s

recovery.”

“The proposal is very good and well presented, with a good evidence “The proposal is very good and well presented, with a good evidence

base and clinical outcomes.”

“On paper, the savings are good, a reduction in primary care

presentations, and this is similar to IAPT where we also know there

are reductions in referrals to secondary care.”

The case for adoption – a talking solution

• CBRT helps people with anxiety learn how to relax naturally. Supporting patients at a ‘grass roots’ level, CBRT provides the benefits of group therapy with a visually appealing and easy to learn mindfulness technique.

• Patients having individual CBRT sessions are encouraged to talk about how the colours make them feel – with the CBRT Initial Response Sheets prior to receiving their relaxation session. Sheets prior to receiving their relaxation session. This has proven to be a very popular activity.

• Patients waiting to join the IAPT Programme can safely be offered some initial support through provision of CBRT Relaxation Support Sessions, either as an individual or within a group setting.

• CBRT sessions can be provided by all staff across multi disciplinary teams nurses, allied healthcare, social care across primary and secondary care, including occupational therapy, physiotherapy, clinics e.g. hypertension, smoking cessation, insomnia, obesity ,addictions, obesity, trauma, bereavement, maternity.

CBRT Intervention Evidence Base

CBRT is an intelligent amalgamation of Evidence Based Interventions”

Here are the key components of CBRT and number of independent studies: NHS EVIDENCE STUDIES:

• Mind-Body Relaxation Technique (74)

• breathing techniques (1,888)

• Mindfulness approach (375)

• positive thinking (7,383)

• self-help and guided self-help (2,935)

• MBSR (Mindfulness –based stress

Another perspective - Patient Boredom.Occupational therapy and specific evidence for boredom in acute mental health is only just emerging - think of the acute ward environment -Why are service users bored?

• External causes i.e. lack of ward facilities and over structured or no routine?

• Internal causes – lacking skills and volition to engage with occupations available?

• Any other reasons? reduction) (24)

• Mind-body interventions (5,418)

• creative visualisation (60)

• Meditation (565)

• group therapy (46,805)

• Anxiety breathing techniques (971)

Those already with NICE approval: CBT,

Guided relaxation, Mindfulness based stress reduction.

The CBRT Initiative actioned with 8 NHS Trusts and CCGs will quickly create c.17,000 independent case studies for NHS Evidence from NHS staff post training case studies.

• Any other reasons?

• Do the reasons overlap?

• Would we be the same as an inpatient?

• Newell (2009) identifies that if an individual believes in their abilities/has high self efficacy they are more likely to engage in activity and therefore less prone to boredom. Flow is likely to increase self efficacy.

• Martin (2009) advocates mindfulness techniques; boredom rising from the inability to focus attention mindfully, i.e. paying attention on purpose in the present moment – does this link to a potential educational role for us re flow?

• Illot (2007) Advocates boredom as an OT issue, and is a focus of the Research Centre for Occupation and

Mental Health (2008)

CBRT Training – A New Evidence Base

Evaluation of Training Effectiveness

Before training:

Learner skills and knowledge is assessed

During training: Short tests are conducted at regular intervals – activities and learning

Initial response sheets

Listening Exercise

Working as a group and in pairs

Evaluating feedback - After training :CBRT provides course assessment feedback to the learner

Actual outcomes (see slides 22 – 25 examples)

Follow up:

- Transfer of learning to the workplace

- Patient feedback

- Results and impact on organisationWorking as a group and in pairs

Techniques of evaluation:Observation

Questionnaires

Listening skills

Validating learning

40 question Assessment paper

10 case studies (2 groups of 5 users - twice, 2 individuals – twice.)

- Results and impact on organisation

- Return of investment study

NHS Trust - Business Case for Adoption – QiPPMeeting challenges whilst serving a need

• The purpose of CBRT is to improve quality, safety and value for money in the NHS through establishing the availability and provision of structured and guided relaxation support sessions for patients.

• A ‘cost neutral’ initiative designed to support NHS savings targets.

• An “invest to save” programme.

• Demand for anti-depressants is growing annually including prescription addiction.

• Person centred care is provided though guided group support sessions.

• Two day training for 125 staff

• > 12,000 patients could benefit each year, which a reduction in • An “invest to save” programme.

• An Innovation supporting mental health as a national NHS priority.

• It enhances both Productivity and Prevention programmes..

each year, which a reduction in primary care referrals and secondary care

• “Room for innovation must be allowed.”

• CBRT is a unique innovation and system. Regulation 5 provides for commissioners to award a new contract without a competition where there is only one capable provider.

The Business Case – Improving Patient CareA Best Care Practice project.

• Quality health improvement and modernisation programme through training staff.

• A ‘cost neutral’ initiative. Invest to save.

• A ‘compelling case’ for innovation supporting mental health as an NHS priority. The Health and Care Act highlights the importance of integration.

• Low intensity, practical solution, self care system.

• A non-referral baseline activity. Help to reduce unnecessary admissions and length of stay targets.

“I have no idea why healthcare providers do not offer relaxation classes to Patients suffering from long term conditions. Following an accident, I now live with chronic pain syndrome and bouts of depression...

I am not surprised so many people suffer with depression. Group contact and regular support

• Pre-admission clinics and prevention strategy.

• Improve your local public services and integrated self care programmes.

• A demonstrable improvement in care.

Group contact and regular support is far more important than a packet of tablets.”

Mrs P. NHS Patient, South of England

CBRT Case For Adoption – Staff Skills Training

• The CBRT programme provides a team building opportunity for you and your staff.

• Smaller CCGs can be provided with the two day CBRT Training Programme for 12 - 28 members of staff.

• Advancing Quality Targets. Quality health reform and development.

“Training and education should be an integral part of any proposed service if it is to be

of high quality and sustainable.”NHS Confederation – “Clinical responses to the downturn.”

reform and development.

• CBRT provides Performance Measured Training (PMT) . Upon completion of two day training programme, staff are required to complete an online 40 question Assessment paper and 10 templates for their CBRT user case studies – (3 groups of five people twice and two individuals twice.)

• Upon successful completion and marking of papers, staff receive assessment grade and a certificate is issued (within 8 -10 weeks of training.* Staff are then allowed to provide CBRT Relaxation Support Sessions to patients. (*Based on staff completing paperwork to agreed schedule.)

Measurable outcomes – All CBRT case study templates contain recognised health and wellbeing statements

CBRT Lean Thinking for Service ImprovementBringing Lean to life.

• CBRT is a Lean Methodology Project for your Trust and CCG. CBRT provides a unique • CBRT is a Lean Methodology Project for your Trust and CCG. CBRT provides a unique product, service and results - with measurable outcomes.

• Project as a Value Stream – to quickly provide professional, structured, relaxation support sessions for all patients. A robust, quick diffusion model.

• CBRT supports NHS staff training and resources appropriately in the most serious period of financial constraint ever faced.

• Meeting national policies – long term conditions, mental health, health prevention, innovation, QiPP.

• Innovation procurement to meet local strategic needs.

• Embedding Equality, Diversity and Inclusion.

• Extends patient choice prior to IAPT Programme.

• Designed for easy large scale change and adoption.

• Integrated healthcare for “whole patient” and self care pathway. Greater commitment and ownership.

CBRT Lean Thinking for Service Improvement“Any project worth doing is worth doing fast and right.”

CBRT Lean Goals:

• Improve Quality - Patient experience, mental health and wellbeing provision

• Eliminate Waste across and in all areas

• Reduce Lead Time ,through Innovation and practical application of new technology

• Reduce Total Costs – examples include group provision, medication, LOS, GP visits...

CBRT Initiative Project Goals

• Staff professional development –engage and mobilise the right people.

• Staff make shared time with patients “Make Time to Save Time.”

• Enhance Patient Listening and Communication using the visual and accessible CBRT toolkit.

• Length of stay – reducing length of stay. Reduce boredom on the ward.visits...

• Sustainability - Train the Trainer

• Project system = people + process + product + services = relationships.

stay. Reduce boredom on the ward.

• Start CBRT Relaxation Support Sessions as part of Community mental health programmes.

• Improve patient choice. Learn to relax before starting a medication pathway?

• NHS Staff and Trainers to complete training paperwork to agreed time

• Meet RCN and COT performance standards and requirements.

• The NHS Change model includes need for “Rigorous Delivery.” Each member of staff trained to aim to support 10 patients per week.

CBRT Technique is Safe and Supports All

• Individual and groups of patients - of all ages and abilities, including children.

• Correct breathing pattern. Mindfulness, focus, concentration, positive thinking .

• Guided group relaxation sessions found to be supportive; groups of up to 20 patients

• Focused breathing on one colour also effective - in just 5 – 10 mins.

• Most effective sessions last between 30 – 50 mins. A practical, visual tool – easy to use.

• Patients participation in relaxation process empowers them as individuals.

• Patients select their own Affirmation Cards for focus – able to express “how they feel.”

• “CBRT Initial Response Sheets©” - form of ‘talking therapy’ - used with individual patients

Our Patients’ Needs:

The 6 C’s of Nursing are listed as being:

• Care quality/safety

• Compassion

• Commitment

• Communication - understanding

• Courage – change, adopting innovations

• Competency

Patients also need:

• To feel they are being heard

• Feel respected

• Experience calm

• Learn relaxation skills

• Positive thinking

• Develop self – care tendencies• Competency • Develop self – care tendencies

• Feel involved and cared for

• Interconnection.

An Easy to Use, Ongoing Self-Care Programme

• CBRT provides a patients with a non-pharmaceutical intervention choice.

• Patients are able to continue using their Colour Breathing everyday- the CBRT Kit is safe and suitable for home use.

• CBRT encourages patients to be proactive in self-care.

• Each CBRT Kit comprises: full colour book, set of sevenColour Breathing Disks easel set, Audio CD.

• The new 2013 “Daily Observations Diary” will enableusers to record their feelings and moods and whichaffirmations they choose to use each day. This will provideNHS staff with improved communication and regular weekly feedback from patients in a simple format.

Adoption of CBRT = Patient Benefits

• Relaxation and education�

• Mindfulness, focus �

• Inner calm �

• Breathing improvement, awareness �

• Positive thinking �

• Group support �

• Quality time with nursing staff �

• Self-help in action �

• Cardiac and stroke prevention�

• Respiratory �Smoking cessation �

• Long term conditions support �

• Mild – medium depression �

• Anxiety, Insomnia toolkit� �

• Mild dementia , easy to use technique�

• Antenatal, Postnatal skills� �

• Rehabilitation pathway tool �• Self-help in action �

• Group participation �

• Rehabilitation pathway tool �

• Medication reduction support�

The Colour Breathing book is very easy to read and printed in full colour

How will CBRT help our Staff?CBRT includes Training in Communication Skills

• Quality improvement made simple.

• Engagement to mobilise. Nurses, Allied

• Structured CBRT Relaxation Support Sessions – whether patients experience this as a ‘once-only experience’ or in • Engagement to mobilise. Nurses, Allied

healthcare and Social Care Teams have the opportunity of training together, attending a two day CBRT Training Programme.

• Through interaction and learning how to use CBRT with both individuals and groups of patients, staff enhance their natural communication skills of listening, focus, timing, patience and awareness.

• Some NHS staff have mentioned being sent on training programmes makes them feel ‘more valued’ by management.

this as a ‘once-only experience’ or in a series of 8 – 10 sessions, provides time and space for positive, uplifting, calming dialogue between staff and patients, contributing to overall staff and patients’ wellbeing.

• An active interface for patient care and compassion.

• In the community, clinics, wards, rest rooms...CBRT is a flexible tool and relaxation intervention.

An NHS Change Model CBRT provides a New Peace and Calm strategy...

CBRT™ Relaxation Support Sessions are an established method ,which require :

• A trained member of staff

• 20 – 45 minutes of uninterrupted time

• A suitable, well ventilated room

• Comfortable seating, with table space, if possible

• Colour Breathing Disks – 1 set per user

• Colour Breathing Affirmation Cards – 1 set per group

• Initial Response Sheets (Individual use only)

Sustainability to reduce NHS Costs further

Each Initiative =

Two days CBRT Training Programme for 28 staff + Two days "Train the Trainer” for 5 staff +100 Training Kits = 128 staff

• The Training Initiative provides ongoing sustainability to every NHS Trust and CCG, allowing flexibility with local training provision and discounted prices on materials..

• Stage 1 is an initial two day CBRT Training Programme for 28 nursing, allied healthcare and social care staff.

• 8 weeks later a two day “Train the Trainer” regional Training Programme is provided for 5 members of staff.

• Stage 2, the NHS Trust / CCG receive their allocation of 100 CBRT Training Programme Kits and additional Colour Breathing Disk sets for staff to provide group CBRT Sessions.

Users Feedback of “CALM Programme”

Participants of the CALM Programme were asked about their views on CBRT and their responses included:

• Meeting new people that they can learn from, both other participants and the

“Colour Breathing Relaxation Therapy is a vital tool that we use within our community to enable relaxation and stress management techniques, which focuses and calms the mind”

Aidan Hamilton – CALM Programme Coordinator, Belfast, N.Ireland

trainer;

• Learning new skills that they can apply and building self-confidence;

• A positive environment to come to and bring them out of their shell where they need to;

• Promoting positive mental health and reducing suicide;

• The way it has been delivered and the interaction between the group;

• The CBRT resources they now have available to them.

85 Users - Overall improvement after 2 CBRT sessionsQuestions - Physical health & Mental Health

85 Users - Overall improvement after 2 CBRT sessions Questions : enjoyment of life and optimism

85 Users - Overall improvement after 2 CBRT sessions Questions : feeling useful and feeling relaxed

85 Users - Overall improvement after 2 CBRT sessions Questions: dealing with problems, thinking clearly

85 Users - Overall improvement after 2 CBRT sessions Questions: Feeling close to other people, able to make up own mind

CBRT Working With NHS Trusts & CCGs

CBRT NHS bespoke versions

All products are printed in full colour and to a high quality,

As CBRT are also a publishing house, there is the flexibility and capacity to create bespoke localised versions of all CBRT products for NHS Trusts and CCGs where requested.

CBRT future products

• CBRT are to create additional sets of boxed Affirmation Cards to provide positive thoughts and a low cost solution to further support and address specific conditions and life such as:

• Hypertension,

• Anxiety, Stress, requested. E.g. The CBRT Book Kit can be produced to include 10 pages of relevant NHS Trust /CCG local information for patients, with the minimum print run being only 3,000 units per product. CBRT can also create CBRT products and information leaflets :

• In different language editions* :

• Braille

• Larger font

• All formats - special needs.

*NHS Leaflets are currently produced in over 20

language editions.

• Anxiety, Stress,

• Insomnia

• Mild to medium depression

• Long term conditions,

• Obesity

• Smoking cessation

• Bereavement

Work with us! CBRT is affordable for all budgets. The CBRT NHS Training Initiative for

Trusts and larger CCGs (125 staff & 5 Trainers) is payable in three stages across a period

of three months. Deposit on booking £5,000, Phase 1 £19,638, Phase 2 £20,489 or

Local training programme for 12-28 staff @ £600 each + National Trainer travel costs,

accommodation allowance + VAT. Support UK innovation nationalhealth@colourbreathing.com