3rd Big Idea

Core and Specific Work

2

Clinical skillsABCD’S Skills (Alphabet skills): These are the

range of skills that clinicians need:AssessmentBehavioural CognitiveDynamic.Systemic

3

AssessmentBehavioural

CognitiveDynamic

Systemic

Advanced

Core

“Traditional” skills pattern

4

Extended skills clinician

5

AssessmentBehavioural

CognitiveDynamic

Systemic

Single modality Core work

6

AssessmentBehavioural

CognitiveDynamic

Systemic

Single modality Core work II

Slide 7

CBT: core vs advanced skillsCore CBT: Core/basic work- explain model, structure sessions, using homework,

reviewing homework

Specific CBT: (using advanced skills)All the above PLUS Socratic questioning/guided discovery Automatic thoughts/assumptions/beliefs Problem specific competencies eg in ERP for OCD

Could you manage a bottleneck to CBT by extending clincal skills to increase capacity at core/core level?

Ref: The competencies required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. Dept of Health 2007.

8

Integrative Core work

9

AssessmentBehavioural

CognitiveDynamic

Systemic

Skill summaryAdvanced Skills are often distinct skills in a single

modality trained to a higher level and delivered a higher intensity

CORE skills are eitherto be competent at that modality = single modalityIntegrative work across modalities at lower fidelity

Slide 10

A Possible Pattern… Effects?

1 2 3 4 5 6 7 8

AdvancedPartial

11

A Possible Pattern… Effects?

1 2 3 4 5 6 7 8

Core

Partial

12

A Possible Pattern… Effects?

1 2 3 4 5 6 7 8

AdvancedCorePartial

13

Work streamsSo now we’ve defined the streams by

skill / intervention intoCoreSpecific

We need to work out how much we can do in THAT stream…

This is a PACKING problem.

Slide 14

Splitting the streamsThe demand and capacity term for

identifying different streams is segmentation

Dividing a group up into smaller groups with similar characteristics

But first lets look at what happens with no segmentation…

Slide 15

No segmentation?

Slide 16

One big fruit crate…

Hard to know quite how much fruit we can get in.

SegmentationSegment the big crate into 4 smaller crates…

Fill 2 of the crates with the SAME sized fruit – apples and oranges… CORE fruit

Now we know how much of averaged sized fruit we can pack in…

Slide 17

Specific FruitWhat if we have bigger fruit like melonsCan put them in another crate…

Again we can calculate how many melons we can fit in

Slide 18

Another fruitWhat if we have some bigger fruit?

A 4th crate could have pumpkinsThey are bigger still…So even less can be packed in

Slide 19