Senior PWP Network 26 September 2017 - NHS Senate Yorkshire Health/Senior PWP... · 2017-09-29 ·...

www.england.nhs.uk

• Andy Wright, IAPT Advisor, Heather Stonebank, Senior PWP Advisor and Sarah Boul, Quality Improvement Lead

• [email protected], [email protected] and [email protected]

• Twitter: @YHSCN_MHDN #yhmentalhealth

• September 2017

Yorkshire and the Humber

Mental Health Network

Senior PWP Network

26 September 2017

mailto:[email protected]



www.england.nhs.uk

@YHSCN_MHDN

#yhmentalhealth

Housekeeping:

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Senior PWP Network

Welcome, Introductions and Apologies

Andy Wright, IAPT Advisor, Yorkshire and the Humber Clinical Network

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Senior PWP Network

Reflections and Purpose of Senior PWP Network


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• To provide a network for Senior PWPs in Yorkshire and Humber to share good

practice and innovation

• Create a network to address local, regional and national topics for the Step 2

role

• To come together to reflect and support each other in the Senior PWP role

• An opportunity to develop the Senior PWP role, contribute to improving IAPT

services, Step 2 interventions and improving quality of patient care

Purpose of the Senior PWP Network

www.england.nhs.uk

Aims of the Senior PWP Network

• To understand and address local and regional level topics that link to national IAPT

initiatives relating to the role of the Senior PWP.

• Contribute to research at Step 2.

• Consider regionally identified training needs and areas of development for the Senior PWP

role.

• To link with other regional and national IAPT Networks, including the Senior PWP Network

in the North West and the IAPT Providers Network, to share good practice, exchange

ideas and support local and national training events.

• Linking to the national IAPT KPIs the Network will share ideas, good practice and

innovative ways of working to influence improvements in the service and patient care.

• Acquire knowledge and skills in relation to leadership and develop best practice guidance

on leadership in the Senior PWP role.

• Develop enhanced communication within the Senior PWP Network – including an online

forum, webinars, WebEx etc.

• Reports Network activities up into the Yorkshire and the Humber IAPT Providers Network.

www.england.nhs.uk

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Update

• Wellbeing

• Service presentation

• Improving access - table top discussion

• Self-help materials

• cCBT training proposal

• Psychoeducational training update

• Accreditation update

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Senior PWP Network

Wellbeing Activity

Heather Stonebank, Lead PWP, Sheffield Health and

Social Care NHS Foundation Trust and Lead PWP Advisor,

Yorkshire and the Humber Clinical Network

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Senior PWP Network

National Update and Overview of the

Intensive Support Team

Caroline Coxon, IST Manager, NHS England

Mental Health Intensive Support Team

IAPT Update

Yorkshire and Humber Clinical Network

Provider Meeting

26th September 2017

Caroline Coxon

Intensive Support Manager

Mental Health Intensive Support Team

Collaboration between NHS England and NHS Improvement

A free resource to NHS providers and other NHS-commissioned

organisations

Emphasis on system-wide improvement work with local health

communities that are facing particular challenges in delivery of new

mental health access and waits standards

Starting with Primary Care Psychological Therapies (IAPT) Access,

Recovery and Waiting Times KPIs and other IAPT quality standards

in 2014

In line with the MH Taskforce Report and 5YFV priorities

12

Priorities for 2017-18

In scope:

IAPT

Long Term Conditions (LTC)

Adult Mental Health

Early Intervention Psychosis (EIP)

Out of Area Placements (OAP’s)

Children and Young People (CYP) including Eating Disorder

Mental Health Dataset across all policy areas

13

Mental Health IST Approach

Diagnostic Reviews at the invitation of commissioners and Providers

Focus on delivering patient outcomes, value for money and

productivity

Cascading subject matter and delivery expertise to regional/DCO

teams, clinical networks and external organisations

Improving accuracy and completeness of data reporting

Supporting good practice in waiting list management, capacity and

demand modelling

Focused on the needs of patients at all times

Ongoing support to Regions, commissioners and MH providers as

required

14

IST and Yorkshire and Humber (23 CCG’s)

Diagnostics Reviews x 4 CCG’s completed

Desktops x 6 CCG’s completed

Previous and regular contact / ongoing support with further 8 CCG’s relating to:

Outcomes

Data

Access

Waits

Workshops:

Data (Provider, CCG’s, Region)

Demand and Capacity

Recovery

15

Top Tips

Clinical

• Standardised assessment templates

• Confidence to make decisions to treat based on the assessment

• Accuracy and Completeness of Problem Descriptors at treatment eg: do they reflect what treatment is needed?

• Confidence in Clustering

• Knowledge of service and individual level recovery rates for PWP’s

• Supervision – caseload and management

16

NHS-Digital Data – May 2017.

17

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% Mixed Anxiety & Depression at first recorded treatment

Mixed Anxiety & Depression Problem Descriptor Completeness

Top Tips

Leadership

• Direct and regular involvement in the Clinical / Operational

Leadership of your service?

• To be heard and to be able to influence change

19

Top Tips

Continuous Professional Development (CPD)

• Induction programmes for new starters

• Reminders re: recovery cut offs

• Opportunities to specialise or access further training eg: LTC / Older People

• Innovation - room and space to do so

20

Top Tips

Data

• Routinely looking at and using local and national data to inform service changes

• Using the data for audits:

– To identify and understand unrecovered patients

– High attrition rates

21

Caroline Coxon

Intensive Support Manager

Mental Health Team

Operations and Information

NHS England

[email protected]

Tele: 07917 597153 @MH_ISTNetwork


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Yorkshire and the Humber Senior PWP Network

Time for a break?

15 minutes only please!

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Senior PWP Network

Provider Presentation:

Emotional Wellbeing Service

Sheryl Horton and Jennifer Wilde, Humber NHS

Foundation Trust

Humber NHS Foundation Trust

Emotional Wellbeing Service

EAST RIDING

Aims and objectives

• To give an overview of our service • To give an overview of how we have tried to implement wellbeing in the work

place. • Our role as a Senior PWP

• To understand the differences of the A&B services • What is any qualified provider? • How does this fit with our service • To have an understanding of the barriers we have come across in implementing

wellbeing.

Current service at a glance

Moved from Block Contract to Any Qualified Provider Tariff on the 1st April 2014 Population size of just over 333,000 Geographical patch just under 10002 miles - mainly rural The service consist of: Service Manager 3 team leaders 21 CBT therapist 4 counsellors 2 Senior PWP 9 PWP’s 4 Trainee PWP’s Going out to advert for 4 Employment advisors

Assessment and Brokerage Service

Assessment: • Block contracted for the commissioned area which is the East Riding of Yorkshire. • Includes assessing patients that have self-referred via the online

portal/telephone/GP and other referrals. • Referrals are triaged by band 5`s and 6`s. Currently triage can be immediately

followed with an assessment. • Assessments mainly provided by PWP’s. We have face to face assessments by

CBT therapist for complex referrals. • Satellite bases. • After the assessment if the patient is suitable for IAPT interventions then the

patient is offered choice of Any Qualified Provider (AQP).

Brokerage

Brokerage is to the following services 1 service spec for all providers/capacity sheet • Emotional Wellbeing Service ; Ccbt, guided self-help, CBT, EMDR, IPT and CFD. • Insight Health Care- CBT, EMDR and CFD • Relate- CFD, relationship counselling • IESO – online CBT • MIND- groups • City Health Care Partnership – CFD, groups/stress control

Service Delivery

• NICE Stepped Care Model - fully compliant with IAPT model • Currently 60/40 split between 3rd Party and Self Referrals but Self Referrals

increasing monthly

• Satellite venues across East Riding + Group Venues- Therapy Centre (main hub)

• Mode of Delivery - Face to Face/Telephone/Online- No home visits

How is our service different? • Other services might have waiting lists into treatment, maybe lengthy due to

demand and historical waiting lists. • Some services offer groups to bridge the gap into treatment. • Our service went 99% telephone for two years – completely eradicated waiting

lists. • Our current model means that we can now bring people straight into treatment

as the patient has a choice of providers which means the waiting lists have reduced .

• 15% prevalence now increased to 25%. (NHS England, 2014) The EWS is on target to achieve this.

• 50% national recovery (NHS England, 2014)– EWS on track • Access standards- - assessment within 10 days. - Into treatment within 6 weeks.

How is our service different cont….? Recent forwarded email from our Manager from NHS England Intensive Support

Team!!! “I have been looking at your data over recent months with interest and have noticed

the increase in Access Rates, alongside good Recovery Rates, low DNA rates, high paired score completeness to name but a few good areas positive outcomes being evidence in NHS D published data. IST are receiving a number of requests for recommendations of good practice re: increase of Access Rates and sustainability. As Commissioner and Lead provider for East Riding CCG do you have any objections to IST passing on your contact details to other CCG / Providers for them to make contact with you to learn the lessons?”

Well done, and it’s great to see acknowledgement of all your hard work from the

very top!

Senior PWP role

• 15 contacts per week • Each have 6-7 PWP to caseload manage • Provide line management supervision • Clinical skills (group) • To supervise 4 employment advisors (new addition) • Complaints- first stages • Sickness- first stages • Sickness clinics • Conflict management • Marketing • Safeguarding links • Chairing business meetings • Recruitment/Interviewing • Organising staff for the general running of the PWP team, ie, triage, groups. • Feedback forms from Heather • Advantages/disadvantages (discuss)

PWP Wellbeing initiative – why now?

• Senior PWP conference/network • Based on research • To reduce sickness, staff turnover and increase team morale. • Table top discussions • Own observations/talks within our own team • Our own wellbeing

PWP Wellbeing initiative • Clinical skills- added wellbeing as an agenda item: humour and positivity-

discussing something nice. IE, what's your claim to fame, what made you happy over the weekend, can you tell a joke, getting to know you.

• Bringing food, drinks into clinical skills, healthy food to create a safer more positive environment.

• Table top yoga. • Occupational health complimentary therapy, ie massages. • Trying to secure funding to go towards the occupational health therapy. • Dinner dates • Walking groups/ running groups within the team. • Allowing staff to go to tai chi, yoga ran through the trust. • Asking staff to email there suggestions, ie lunch time walks. • Changing rooms and hot desking to mix with others. • Encourage to be mindful to eat and spend time with others, take time away from

the desk. • Staff room

PWP Wellbeing initiative Challenges so far:

• Staff not wanting to come back to work after they have had the complimentary therapy.

• Monies- manager/service pot. • Coverage of the service over the lunch time so this could segregate people. • Staff not wanting to change desks as staff are being protective over their desk

space, resources etc.

PWP Wellbeing initiative What has worked:

• Clinical skills agenda- brightens mood. • Staff bringing cakes, fruit to meetings • Staff going out for lunch time walks, eating dinner together away from their desks • Staff meeting after work for dinner dates • Staff walking and running groups • Table top yoga • Some staff emailing about wellbeing initiatives • Positive feedback “Just thought I would let you know as I don't think you give

yourselves enough credit for the small things you do that help in terms of well being”.

PWP Wellbeing initiative

• Unable to compare before an after wellbeing initiative. Moving forward-

• In discussion with service managers regarding evaluating wellbeing • Continue to gather feedback from staff and continue to do the items that are

working.

PWP Wellbeing initiative

• Thank you for your time; Any questions?

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Senior PWP Network

What’s coming next?

PBR, Integrated IAPT etc.


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Time for some lunch?

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Senior PWP Network

Supervision:

Caseload Management and

Clinical Supervision

Heather Stonebank, Lead PWP, Sheffield Health and

Social Care NHS Foundation Trust and Lead PWP Advisor,

Yorkshire and the Humber Clinical Network

www.england.nhs.uk

Supervision

• Topic from feedback

• Service models evolved since 2008, supervision model is based on 1:1 work

• Case Management and Clinical Supervision

• Individual and group supervision

• Supervisory relationship - Support vs Challenge

• Contracts/guidance

• Reflection and evaluation

• Sharing best practice

• Understanding the challenges and what works well

• How can we be consistent and improve

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Why is it important

Patient

• Structured scheduled supervision leads to better outcomes

(Bower et al, 2006)

• Adhering to NICE guidance – right treatment and dose

• Safety and consistency

Supervisee

• Reduced odds of burnout when receiving regular supervision

(Westwood et al 2016)

• Wellbeing and support

• Reflection and development

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Supervision in your service

• Frequency – Case management and Clinical Supervision

• Time

• Who do you take to supervision and how often

• Individual and group supervision

• Who supervisors PWPs and SPWPs

• Contracts/guidance?

• What does your service do to support supervision

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Please consider the 4 questions below and capture the

key points from your discussions for feedback to the

wider group:

• What do you value?

• What’s working well?

• What are the challenges?

• What improvements could be made?

Questions to Consider

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What makes you a SUPER-visor?

Sharing Top Tips

• How do we receive feedback as supervisors

• How do we look after ourselves as supervisors

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Time for a break?

15 minutes only please!

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Senior PWP Network

Increased Access Targets and Access

for BAME and Older Adults Discussion

All

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Senior PWP Network

Feedback from PWP Conference

05.09.17

Heather Stonebank, Lead PWP, Sheffield Health and Social Care NHS

Foundation Trust and Lead PWP Advisor, Yorkshire and the Humber Clinical

Network

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PWP Conference Update

• Welcome and Introductions

• ACTivate Your life

• The Role of the PWP in North-East Prisons

• Expanding the development of leadership roles within

the PWP workforce

• Deaf People and Psychological Therapies

• How Durable is the effect of Low Intensity CBT

• Building on the future of the PWP Profession

• Launch of the BABCP LI SIG

• Discussion around PWP training

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Senior PWP Network

Psychoeducational Training

Follow Up Evaluation Update

Sarah Boul, Quality Improvement Lead, Yorkshire and the Humber Clinical

Network

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Aim

• The overall aim of the Psychoeducational Group Training was:

• To increase confidence in the delivery of psychoeducational programmes by Psychological Wellbeing Practitioners (PWPs).

Objectives

• The objectives for the training day were to enable participants to have:

• raised confidence in their ability to present psychoeducational material in group settings,

• increased knowledge of the scientific basis for internal doubt and self-criticism,

• applied the five areas model to performance anxiety,

• learned, practiced and received feedback on key skills for presenting in public,

• prepared a personal action plan for delivering psychoeducational programmes.

•

Aim and Objectives

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• The Psychoeducational Group Training was held on three different dates at

three different locations across the Yorkshire and the Humber region. The

purpose of this was to try and ensure equality of opportunity for participants

from different services to attend.

• In total across the three days 166 people received the training and the Clinical

Network received 129 completed evaluation forms. A breakdown of attendee

numbers of completed evaluation forms is outlined in the table below:

• The evaluation forms from each session requested participant feedback on the

presentations provided by the speakers; how participants experienced the skills

group practice and sought views on the location of the training. Feedback was

sought by both quantitative and qualitative methods

Initial Feedback

Day 1: 15 March 2017, Leeds Total number of attendees 55

Total number of evaluation forms received 38

Day 2: 22 March 2017, Sheffield Total number of attendees 56


Day 3: 5 April 2017, York Total number of attendees 55


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Day 1 Leeds: Feedback

0

2

4

6

8

10

12

14

16

18

20

Introduction to the trainingWhat is Performance

Anxiety?Autonomic nervous system

Applying the five areas

PreparationAcceptance strategies

Presentation skillsDealing with challenges

Action planningReview

Presentation Scores

No Score

Very Poor

Poor

Fair

Good

Excellent

0

2

4

6

8

10

12

14

16

18

20

Skills Group Practice

Skills Group Practice Scores

No Score

Very Poor

Poor

Fair

Good

Excellent

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Day 2 Sheffield: Feedback

0

5

10

15

20

25

30

35

Introduction to trainingWhat is Performance

Anxiety?Autonomic nervous system

Applying the five areas




Presentation Scores

No Score

Very Poor

Poor

Fair

Good

Excellent

0

5

10

15

20

25



No Score

Very Poor

Poor

Fair

Good

Excellent

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Day 3 York: Feedback

0

5

10

15

20

25

30

35

Introduction to trainingWhat is Performance

Anxiety?Autonomic nervous

systemApplying the five areas




Presentation Scores

No Score

Very Poor

Poor

Fair

Good

Excellent

0

5

10

15

20

25

30



No Score

Very Poor

Poor

Fair

Good

Excellent

www.england.nhs.uk

Follow Up Feedback

Following the initial evaluation report of the Step 2 Psychoeducational Group Training, which was delivered

across the Yorkshire and the Humber region in March and April 2017A, it was agreed that the Clinical

Network would:

• Conduct a follow up questionnaire with attendees of the training to gain an understanding of practitioner

confidence levels post-training and changes to the way in group therapies are delivered.

A brief follow up survey was circulated to all 166 participants of the psychoeducational training. The survey

asked the following questions:

1. Following the training how much has your confidence to deliver psychoeducational group training

increased?

2. Following the training how much has your anxiety around presenting psychoeducational group training

decreased?

3. Which skills learned at the training (i.e. using joining statements, setting ground rules, relaxation

techniques, debriefing etc.) have you used to enhance your delivery of psychoeducational group

courses?

4. What actions, from the plan you created on the day, have you implemented in your delivery of

psychoeducational group courses?

5. Is your employer/organisation undertaking any activities to support you in your delivery of


6. If yes to question 5 - please provide a few comments to explain what your employer/organisation is

doing to support you to deliver psychoeducational group courses.

The survey received 36 responses and the results are displayed in the following slides.

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Follow Up Feedback: Question 1

1. Following the training how much has your confidence to deliver psychoeducational group training

increased?

Not at all A little Moderately Quite a lot A lot Total

2.78% 1 13.89% 5 36.11% 13 44.44% 16 2.78% 1 36

0

2

4

6

8

10

12

14

16

18

Not at all A little Moderately Quite a lot A lot

Following the training how much has your confidence to deliver psychoeducational group training increased?

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2. Following the training how much has your anxiety around presenting psychoeducational group training

decreased?

Not at all A little Moderately Quite a lot A lot Total

5.56% 2 33.33% 12 38.89% 14 16.67% 6 5.56% 2 36

0

2

4

6

8

10

12

14

16

Not at all A little Moderately Quite a lot A lot

Following the training how much has your anxiety around presenting psychoeducational group training decreased?

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3. Which skills learned at the training (i.e. using joining statements, setting ground rules, relaxation

techniques, debriefing etc.) have you used to enhance your delivery of psychoeducational group courses?

• Joining statements have been very useful

• Relaxation techniques

• Pacing, summarising

• Managing nerves

• Debriefing in particular, as reviewing the session has helped us learn and refine the delivery of future sessions. Also from

now on I allow some time for debriefing with colleagues

• Accepting the anxiety

• Learning I am not on my own feeling nervous

• Patient in pocket, relaxing music on while seating and breaks, breathing and relaxing prior and during presentation.

• Relaxation techniques mainly, help me to stay focused.

• Externalising my behaviours and thoughts rather than internalising everything. This has reduced my anxieties

• Setting ground rules - how normal it is to be anxious. using more examples of own anxiety

• Setting ground rules - being sure to inform the group of the plan such as breaks etc.

• I used these skills prior to the training and already feel they were key skills in delivering groups

• Debriefing and grounding

• Making room for anxiety, using joining statements, setting ground rules, relaxation techniques, debriefing.

• Relaxation techniques and managing my own anxiety

• The importance of meet and great at the start of the course

• Joining statements, asking questions within the dialogue to promote engagement and client thinking and using the 5 areas

to understand my anxiety around delivery.

• Communication tips for engaging with audience as a group conversation

• I do not feel I learned anything more than I already knew

• Not over-preparing

• Joining statements and ground rules

• Setting ground rules.

• Debriefing, joining statements

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• To prepare and know my material, but not to over prepare.

• Setting time to prepare, making sure all equipment is there and working, not cramming before! using relaxation and

grounding techniques

• Ground rules, music

• Most of them thankfully, as my focus was to feel better prepared before presenting which required better planning and time

management, however this is still a work in progress!!

• We always implement ground rules now at the start of a psychoeducational group, as a way of setting boundaries for each

session.

• Preparation of the material and venue.

• Not had to do a group yet but have attended training and it helped

• All of the following were in my action plan and I have implemented them all; patient in pocket, relaxing music on while

seating and breaks, breathing and relaxing prior and during presentation

• I have lost my plan so not sure.

• Setting an agenda, ground rules, and engagement from people that attend . Also preparing beforehand to reduce anxieties

• To move around more to keep things more interesting

• None so far

• To be confident when presenting

• Joining statements

• Added additional material to presentation

• I allow time for debrief

• Relaxation techniques

• More working examples

• Making people feel at ease on arrival and clear explanation of what will happen in each session/section even though I do

this anyway

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Follow Up Feedback: Question 4 cont.



• Meet and great - looking at venue environment

• Worked on my welcome to the group/ making people feel comfortable. Tried to break up the slides (e.g. with something

more interactive or a question or draw on the board) every 20 minutes or so to keep people's attention. Worked on my

delivery (e.g. more movement, eye contact with different members of the class, pacing, emphasis).

• Familiarised myself further with the material I am delivering

• Use of music at the start of course and break. Meeting and greeting clients as they come into the room - you are the first

people that they see.

• Relaxation and being prepared well in advance

• Questions within dialogue and joining statements

• Using joining statements, and applying the communication tips for engaging with audience as a group conversation

• We have not delivered groups since the presentation day and I will be implementing things in October.

• Become more familiar with the material I am presenting

• Being mindful of using the anxiety to help me deliver groups rather than allowing to take over and making me feel self

conscious

• Thinking that the purpose of the group is to give information and support people - it's not about how I look so I have made

an effort to remind myself of this before sessions - making me less self-conscious.

• Discussed techniques for relaxation beforehand with my co-facilitator and tried these out together before the session.

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5. Is your employer/organisation undertaking any activities to support you in your delivery of


Answer Choices Responses

Yes 30.56% 11

No 69.44% 25

Yes No

0

5

10

15

20

25

30

Is your employer/organisation undertaking any activities to support you in your delivery of psychoeducational group

courses?

www.england.nhs.uk


6. If yes to question 5 - please provide a few comments to explain what your employer/organisation is doing

to support you to deliver psychoeducational group courses.

Comments included:

• We have a group session in the near future to look at developing our offering of psychoeducational

groups.

• By letting me become involved in more group work with clients, delivering workshops etc.

• Promotion at assessment, music on coming in - more relaxed atmosphere

• We have refresher skills workshop every year for all facilitators. Also we have a steering group which

looks at the content and delivery of sessions and helps with any current issues - they meet every 2

months

• Looking at ways to promote and develop courses

• We have implemented an action plan out of attendees learning points that have been gathered

• Rewriting our course for depression and anxiety

• We have been granted time to develop workshops and make them more effective (but we struggle to find

the time to take it).

• Supervision

• Stress control class group skills practice.

• Clinical skills groups

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Conclusion and Recommendations

Overall the follow up evaluation has indicated that delegates continue to find the learning from the training

very useful.

It is clear that the majority of respondents have made use of techniques learned on the course, such as

joining statements, relaxation techniques and setting ground rules.

It is also clear that the majority of respondents have implemented some or all of their action plans, including

setting time aside for preparation and relaxation and including time at the end of sessions to undertake a

thorough debrief.

With regards to employer/organisation support only 30% of respondents indicated that they are receiving

support to deliver psychoeducational groups. Those that are receiving support advised that this is through a

variety of means including protected time, discussions in supervision and group skills practice. However,

70% of respondents are not receiving any employer/organisation support to deliver group therapies.

Considering the output of the evaluation with regards to employer/organisation support it is recommended

that the Clinical Network highlights the outcomes of this follow up evaluation at the IAPT Providers’ Network

and Senior PWP Network to encourage services to work with staff to provide meaningful support in the

delivery of psychoeducational groups.

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Senior PWP Network

Any Other Business

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Senior PWP Network

Thank you for Attending!

Please remember to fill out your

evaluation forms!

Senior PWP Network 26 September 2017 - NHS Senate Yorkshire Health/Senior PWP... · 2017-09-29 ·...

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Transcript of Senior PWP Network 26 September 2017 - NHS Senate Yorkshire Health/Senior PWP... · 2017-09-29 ·...