reachreach out educator manual

8/19/2019 ReachReach Out Educator Manual

1/1361© David Richards and Mark Whyte 2009, 2nd edition

Reach OutNational Programme Educator Materials to Supportthe Delivery of Training for Psychological WellbeingPractitioners Delivering Low Intensity Interventions

David Richards and Mark Whyte

2nd edition


2/1362 © David Richards and Mark Whyte 2009, 2nd edition

This publication wascommissioned by theNational IAPT Programme tosupport training courses for

practitioners delivering LIinterventions. It is thereforerecommended for use bythose courses to facilitateconsistent and high qualitystandards across England.

IAPT WORKFORCE TEAM

NATIONAL WORKFORCE PROGRAMME

Further copies of this publicationcan be downloaded fromhttp://www.iapt.nhs.uk/publications/

Preface4

Foreword 6

A note on terminology 6

Reshape: introduction 7 The low-intensity clinical method 9Clinical simulation feedback sheet 12

Recognition: module 1 13Introduction 14Learning outcomes 16Interview 25

Assessment 27

Recovery: module 2 35Introduction 36

Learning outcomes 38Clinical procedures 45Interviews 67

Assessment 73

Respect: module 3 81Introduction 82Learning outcomes 84

Assessment 90

Reflection: module 4 93Introduction 94Learning outcomes 96Clinical procedures 104

Assessment 107

Reinforce: practice outcomes 117

Reference 121

Contents

First published in the UK by Rethink 2008Reprinted by Rethink July 2008

Reprinted by Rethink August 2009, 2nd edition

www.rethink.orgRethink Welcome Team 0845 456 0455Email [email protected] Charity Number 271028

For more information about Rethink publicationsand other products on mental health, please visitwww.mentalhealthshop.org or call 0845 456 0455.

© David Richards and Mark Whyte 2009, 2nd edition

The right of David Richards and Mark Whyteto be identified as the authors of this work hasbeen asserted by them in accordance with theCopyright, Designs and Patent Act, 1988.

All rights reserved. This book has been producedon the condition that it shall not, by way of tradeor otherwise, be lent, sold, hired out or otherwisecirculated in any form binding or cover other than

that in which it is published and without a similarcondition including this condition being imposedon the subsequent reader.

Providing the source is fully acknowledged, allmaterials in this work may be freely copied, butfor teaching and clinical purposes only.



David Richards is Professor of Mental Health Services Research at the Universityof Exeter’s Mood Disorders Centre (http://centres.exeter.ac.uk/mood/index.php).He is one of the prime movers in national and international efforts to improveaccess to treatment for those suffering from common emotional distress. He led thedevelopment of the Improving Access to Psychological Therapies (IAPT) curriculumfor psychological wellbeing practitioners on behalf of the IAPT Workforce Team at

the Department of Health. David is a vocal advocate of improving social inclusionby educating people from within their own communities to deliver low-intensitymental health care. He works closely with Rethink and other mental health advocacyorganisations as well as running a multi-centre research team funded by the Medical

Research Council and the National Institute for Health Research which is examining new models ofdelivering treatment including stepped care, guided self-help and collaborative care. The results of thisresearch programme have been fundamental to the clinical and educational methods pioneered by theIAPT demonstration site in Doncaster and now implemented nationally.

Mark Whyte was a Lecturer in Mental Health at the University of York until his

retirement in 2009. He has extensive experience of the design, development anddelivery of mental health education programmes. He is committed to expanding accessto psychological therapies for people experiencing common mental health problemsand equipping practitioners with the knowledge and skills to deliver patient-centredevidence-based treatments. He taught on the Graduate Primary Care Mental HealthWorker programme and the Short-term CBT course at York and, with David, played akey role in the development of the clinical model, and associated training, at the IAPTNational Demonstration site in Doncaster and several IAPT wave one sites nationally.

AcknowledgementsThe IAPT programme has been a huge collaborative effort with important contributions from very manypeople too numerous to mention. However, we cannot let the occasion pass without acknowledgingProfessor Lord Richard Layard and Professor David Clark for their joint vision and tenacity in ensuringIAPT has come to fruition and James Seward in directing the programme.

We would also like to thank Roslyn Hope and Graham Turpin for commissioning these materials. Thematerials themselves are the culmination of more than 20 years of effort in developing educationprogrammes for people from non mental health backgrounds including practice nurses, employeesof banks, NHS Direct nurse advisors and most recently graduate primary care mental health workers.Sharing the journey, there have been far too many people to list individually save a few: Karina Lovell andBob McDonald who have both been vital spirits and John Rose who has been a firm fellow traveller.

Most importantly of all, however, we must place in the public record the contribution of Isaac Marks.More than 30 years ago, and against vociferous professional objection, Isaac originally implemented thenotion of training people from diverse professional and non-professional backgrounds in the application ofevidenced based psychological therapies. None of the last 20 years would have been possible without hiscourageous leadership and we would like to thank him for his inspiring vision.

We would also like to thank the team at Rethink for their help in producing these materials, not leastChloe Kyle and Lauren Bourque.

Thanks are also due to Della Bailey, Abi Coe, Clare Walker, Sarah Khalid and Gemma Cheney for allowingus to film their work and to Dominic Ennis and Paul Scott for their skilled camera work. We would also liketo thank all those who assisted as actors.

David Richards, Exeter and Mark Whyte, York, August 2009



Reach Out: Preface to the second edition

During 2008 and 2009, the first IAPT low-intensity training courses were commissioned and began to traintheir first workers. The first edition of these Reach Out materials was quickly snapped up. During 2008-2009 the IAPT national team, clinical services and education providers all learnt a lot through the roll out ofIAPT to 35 new sites. In 2009-2010 over 100 mental health provider organisations will come on stream anda number of new courses will begin. The opportunity arose to revise and reprint these materials in time forthe next cohort of trainees.

Feedback from educators and students was extremely positive about the quality and content of thematerials. Many people also made very helpful suggestions as to ways in which they could be amended.

As a consequence we have edited the materials to take account of these suggestions.

The main difference is in the name. Few people were happy with the term, ‘Low-intensity Worker’ and theIAPT Board agreed the new name of ‘Psychological Wellbeing Practitioner’. We have incorporated thischange throughout the materials. We also found that students were downloading the educators’ manual toaccess the module details and competency assessment guidelines and rating sheets. Educators were alsousing competency assessment rating sheets in their feedback on student clinical simulation role plays.Therefore, the student manual now contains an appendix with module details and all the assessmentmaterials. Each module description is also accompanied by a list of the suggested reading and resourcesspecifically related to the learning needs of the module, as some students found it difficult to distinguishwhich references they should use from the amalgamated list at the back of the student guide.

The reference section of the teachers’ guide has been replaced by more recent work, specifically the

job descriptions for both trainee and qualified Psychological Wellbeing Practitioners. Following feedbackfrom the first round of courses, the competency assessment for module 4 (A7) has been rewritten togive a better balance of percentage marks across the various competency domains. Reference to theelusive publication, ‘Richards and Whyte, 2008’ has been withdrawn and in its place we have insertedits replacement, due to be published by Oxford University Press in May 2010: ‘The Oxford Guide to LowIntensity CBT Interventions’, edited by James Bennett-Levy, David Richards, Paul Farrand and colleagues;a multi-author, international textbook for practitioners delivering low-intensity interventions.

We would also like to draw readers’ attention to the work on the ‘Ten Essential Shared Capabilities: Aframework for the whole of the mental health workforce’. This was developed and published in 2004, withpeople who use mental health services and their carers, to identify what would make a real difference tothem in their experience of care. This was in response to their enduring call to be listened to, empoweredand valued for their experience of dealing with their own distress. Respecting Diversity, ChallengingInequality, Promoting Recovery, Promoting Safety and Positive Risk Taking are some of the SharedCapabilities, as is Making a Difference, which highlights the importance of evidence and values basedpractice. All professional bodies, employers and training courses were asked to implement the 10ESC,which has happened to a variable degree. Learning materials were developed and evaluated and these arenow available on a DVD, together with other relevant values based materials. This is an important source oflearning to support module 3. These can be obtained from [email protected] or on the websiteof the Centre for Clinical & Academic Workforce Innovation (CCAWI) http://www.lincoln.ac.uk/ccawi/ publications/Ten%20Essential%20Shared%20Capabilities.pdf . For further reading consult: Stickley &

Bassett, (2008). Learning about Mental Health Practice, Wiley.



In the course of the twelvemonths from the publicationof the first edition of thesematerials IAPT has publisheda considerable amount ofguidance on its website.Foremost among these areThe National Plan, Curricula forHigh and Low intensity TherapyTraining, Commissioningfor the Whole Community,

The IAPT Equality Impact Assessment, Special InterestGroup Good Practice Guides,The Supervision Good PracticeGuide and materials from aconference on self-help inFebruary 2009. These importantdocuments can all be accessedon http://www.iapt.nhs.uk/ publications/ .

Finally, we would like to thank Roslyn Hope and Graham Turpin for their continued support and ourappreciation goes to all the people who made suggestions for improvement. We hope we have addressedpeople’s ideas and that this edition of the materials represents an enhancement to the first edition.

David Richards, Exeter and Mark Whyte, York August 2009



Forewordby Ann Bowling, Patient Advisor to the IAPT programme

As one of the Patient Advisors to Improving Access to Psychological Therapies (IAPT), I have beencontinuously involved with its planning, implementation and growth. My initial input was with the pilotproject in Doncaster and then subsequently expanded to include the national picture.

The appointment and training of the Case Managers, now known as Psychological Wellbeing Practitioners,is obviously of paramount importance. They require a broad base of low-intensity clinical knowledge toadd to their existing life skills and previous experience to enhance their professionalism and confidence.They will be faced with an extremely wide variety of challenges as they offer relevant advice andinterventions to their patients, and it is imperative that the training they receive fully reflects this need.

The evidence of this that I have so far witnessed has been both impressive and inspiring. The materialbeing made available here bears full testament to all that has been available to them along the steeplearning curve.

I am particularly happy that this is a collaboration between Rethink and a number of universities. I firmlybelieve that academia, advocacy organisations and the patients themselves should always have an equalvoice when deciding the way current and future needs are met.

I write this as someone who has personal experience of the dark world of depression and whose own careand interventions, although superb, were plagued by interminable waiting lists – so difficult to cope withwhen you already feel that your life has been placed on hold. So much to lose and such an awful wasteof precious time. Imagine then how delighted and impressed I am by the wonderful service that is nowavailable to more and more of those who are unfortunate to find themselves in similar circumstances.

With the quality of training described and illustrated here, there is every reason to believe that theachievement and success of a far brighter mental health future will very soon be evident nationwide.

Choosing the correct term to describe peoplereceiving mental health care is a contested area.The term ‘patient’ has been criticised by some as alabel, and one which implies a passive relationshipwith health care providers. As a consequence,psychological therapists often use the term ‘client’,whereas specialist mental health services andadvocacy groups prefer the term ‘service user’.

However, when interviewed, most peopleexperiencing depression and anxiety do in factprefer the term ‘patient’. This term is consistentwith people’s experiences of seeking help for

physical health complaints from primary care.The use of the term ‘patient’ helps to normalise theexperience of mental distress and de-stigmatisemental health problems. Further, many peoplewith these conditions may consult health servicesinfrequently and do not regard themselves asregular ‘service users’. We have therefore chosento use the term ‘patient’ in these materials.However, educators and workers alike shouldalways remember that those suffering from mentalhealth difficulties are firstly always people, and onlyvery secondly are they patients.

A note on terminology



r e

s h a p e

Introduction



Low-intensity psychological treatments place agreater emphasis on patient self-management andare less burdensome than traditional psychologicaltreatments. Examples include guided self-helpand computerised CBT. Support is specificallydesigned to enable patients to optimise their useof self-management recovery information and maybe delivered through face-to-face, telephone, emailor other contact methods. Psychological wellbeingpractitioners delivering low intensity interventionsare expected to operate in a stepped-care, high-

volume environment carrying as many as 45 activecases at any one time, with workers completingtreatment of between 175 and 250 patients peryear. Psychological wellbeing practitioners alsoprovide information on common pharmacologicaltreatments and support patients in decisions whichoptimise their use of such treatments.

Psychological wellbeing practitioners will operatewithin the Improving Access to PsychologicalTherapies (IAPT) service delivery model defined inthe IAPT business plan agreed by the UK TreasuryComprehensive Spending Review settlementin 2007. This delivery model requires workersto collect, as a matter of routine, clinical, socialand employment outcomes at each treatmentsession, as part of a national outcome system.The performance of workers will, therefore,be measured through their clinical, social andemployment outcomes. Likewise, the performanceof courses implementing this curriculum will be

judged on the ability of their graduates to achievethese outcomes in practice.

Psychological wellbeing practitioners delivering low intensity interventions assessand support patients with common mental health problems (principally anxietyand depression) in the self-management of their recovery. Treatment programmesare designed to aid clinical improvement and social inclusion – including returnto work or other meaningful activity. Psychological wellbeing practitioners do thisthrough the provision of information and support for evidence-based low-intensitypsychological treatments, mainly involving cognitive behavioural therapy (CBT).

Introduction

The curriculum is based on four modules deliveredover 45 days in total. Although each module hasa specific set of foci and learning outcomes, theclinical competences build module upon moduleand courses will be expected to focus the majorityof their classroom activity on clinical competencydevelopment through clinical simulation / roleplay. All modules will be assessed on participants’practical demonstration of competences,according to pass / fail criteria. Participantswill not necessarily possess previous clinical or

professional expertise in mental health, and will beable to undertake academic assessments at eitherundergraduate or postgraduate level, dependingon their prior academic attainment. Skills basedcompetency assessments will be independent ofacademic level and must be achieved according toa pass / fail criterion.

Recognition: Module 1

Engagement and assessmentof patients with common mentalhealth problems

Recovery: Module 2

Evidence-based low-intensity treatmentfor common mental health disorders

Respect: Module 3

Values, policy, culture and diversity

Reflection: Module 4

Working within an employment,social and healthcare context

Reshape



The low-intensityclinical methodLow-intensity clinical work requires skilledinformation gathering, information giving andshared decision-making. A fourth critical activity isreporting and supervision. Information gathering,information giving and shared decision-makingrequire a mix of ‘common’ and ‘specific’ factorsskills. Any clinical encounter between patients andworkers requires the gathering of information in apatient-centred manner, the giving of informationin a way which is congruent with the beliefs andprior knowledge of patients and the identification

of a shared decision between patient and workerwhich is arrived at in as collaborative a manner aspossible. This three-phase organisation of clinicalencounters runs throughout all the modules. The term ‘low-intensity’ is a catch-all phrase whichdescribes several dimensions of treatment. Low-intensity treatment is less burdensome to patients,can be seen as a ‘lower dose’ of specific treatmenttechniques, often represents less support froma mental health worker in terms of duration or

frequency of contact, and is often delivered innon-traditional ways such as by telephone orusing the internet. Much behaviour exhibitedby psychological wellbeing practitioners and bypatients in treatment is similar to those utilised inhigh-intensity therapy. However, low-intensity workis qualitatively different to high-intensity therapy,requiring different competences (Holford, 2008;Roth and Pilling, 2007). Low-intensity treatmentis part of the stepped care system recommendedfor depression and most anxiety disorders (NICE,2007a; 2007b).

Cognitive behavioural therapy is the theoreticalunderpinning of the low-intensity psychologicaltherapies used in this curriculum. The evidencefor specific factors in psychological therapypoints to the greater effectiveness of cognitivebehaviour therapy when delivered in a low-intensityformat (Gellatly et al, 2007; Hirai and Clum, 2006)compared to other types of treatment.

Reshape

How to use these materials

The curriculum and these accompanying materialswill enable teachers to develop courses forpsychological wellbeing practitioners delivering lowintensity interventions, with a particular emphasison clinical skills. The course has been developedas a postgraduate certificate. However, in orderto promote access to students with differentacademic starting points, particularly people whoare non-graduates, courses should be designedso as to allow for a range of entrance requirementsfor accrediting the training of suitably experienced

candidates. Such arrangements will be decidedon a local institutional basis and can use a)advanced standing procedures to allow applicantsto provide the evidence that they can work at agraduate level and could successfully completethe post graduate programme and / or b) thepossibility for course delivery at final year under-graduate as well as post-graduate certificate level.Where more than one level of course delivery is tobe implemented, education providers may needto rewrite some learning outcomes together with

assessment procedures using suitable language toprovide the course at undergraduate level. Pleasesee the IAPT Workforce Team briefing, May 2008for further clarification.

Each learning outcome in the curriculum ispresented separately. Each learning outcomeis also described in more detail and suggestedteaching methods are identified. Each studentshould be given a copy of ‘Reach Out: StudentSupport Materials for PsychologicalWellbeing Practitioners Delivering LowIntensity Interventions’ .

Some learning outcomes also include additionalmaterials. This is particularly true for module 2,where brief descriptions of low-intensity clinicalprocedures are provided. These materials do notreplace more detailed study sources. However,they represent a distillation of much of whatpsychological wellbeing practitioners delivering

low intensity interventions will find themselvesundertaking clinically. Many workers adapt suchmaterials as patient handouts. Each learningoutcome also includes a description of how itshould be assessed. Suggested assessmentsinclude a combination of written and practical



assessments. Finally, each learning outcomeis accompanied by a list of further sources of

information.

Teachers should use the curriculum and thecurriculum materials to plan courses and individuallearning sessions. We have not presented detailedlearning session plans, nor replicated informationwidely available in the source materials listed.Rather, we have provided materials which will allowteachers to construct courses tailored to individualorganisational situations.

Much of the material is practical and skills based.The film clips in particular allow teachers andstudents to observe the required competencesin detail. We have provided materials to assistteachers and students when undertaking practicalskills competences exercises in clinical simulations:interview schedules, planning guides andsupervision guides. We have also provided skillsbased competences assessment sheets for all fourmodule assessments and a model practice-based

skills assessment portfolio.

Suggested teaching methods

Teachers will need to use a variety of teaching andlearning methods to enable students to achievethe learning outcomes within the curriculum. Inorder to achieve competence, students will need tounderstand the nature of the skills employed andthe rationale and theoretical basis for them. Thiscognitive component can be achieved by lectures,guided reading and student presentations, and byobserving the skills being modelled.

The key components of low-intensity interventionsare the ‘common’ and ‘specific’ factor skills whichunderpin them. These need to be broken downinto the associated micro-skills so that studentsunderstand what they are, can identify whenthey are being demonstrated, and can engage in

repeated practising of the skill in order to developtheir own competence. For example, when usingquestioning skills to gather information, studentswould need to be able to distinguish betweengeneral open questions (e.g. “What would you say

is your main problem?”), specific open questions(e.g. “What do you do when you can’t get to

sleep?”) and closed questions to clinch detail (e.g.“Do you drink caffeine before going to bed?”).

Teaching skills are undertakenin the following ways:

Modelling: observing the key skills isa crucial part of developing students’

competence. We hope that the film clips willprovide useful examples of these skills butthey are usefully supplemented by teachersmodelling particular skills in the classroom.

Simulated practice: having learnt whata skill comprises, students need lots ofopportunity to practise before using it inreal life encounters with patients. Teachersshould create scenarios and vignettes tosupport role play and skills practice andprovide clear instruction on what it is thatthe students are expected to demonstrate.

Feedback: when students are engaged insmall group role play and skills practice itis crucial that they are able to develop theskill of giving each other detailed, specificand constructive feedback. It is likely thatteachers will need to model feedback skillsto students which are safe, constructively

critical and non-confrontational. We haveprovided an example of a feedback sheeton page 10 which students and teacherscan use to give specific feedback.

Reflection: all teaching and learningactivities should promote students’ abilityto reflect on their own performance andpersonal development. Learning activitiesand assessments should incorporatereflection by students on what they havedone well and how they could improve theirperformance, linked to an understandingof the rationales for particular skills and anability to accurately identify their use.

Reshape



Written into the Department of Health CurriculumDocument is the expectation that students will

spend one week at the beginning of the course inintensive, classroom based skills practice. In ourexperience, this is critical to make the best of theskills based competency teaching which underpinsthis course. Five consecutive days of intensiveclinical skills simulation practice, with modellingand accurate feedback, is a highly effective way ofensuring both novice and qualified mental healthworkers acquire the critical patient-centred clinicalcompetences required for low-intensity working.This week should be immediately followed upby weekly skills practice days, observation inclinical environments and, as students develop therequired competences, supervised practice withpatients. In our experience, students can beginto see patients under supervision within six to tenweeks of starting a course.

Assessment methods

Each module is assessed by means of an exam,a skills based exercise and a practice basedassessment portfolio. Exams can be a range offormats, for example, multiple choice, short answersor essays. The requirements for examinations differin different institutions and, therefore, we have notincluded an exam in these materials.

We have, however, included skills based exerciseassessment sheets. These delineate the corecompetences included in the curriculum. Studentsshould be able to demonstrate these competencesto the satisfaction of examiners. The mosteffective way of examining the attainment of thepatient-centred competences in modules 1, 2and 4 is through filming and recording students’performance in clinical simulation sessionswith actors. Module 3 is best assessed througha case presentation. Although it is possibleto give students a percentage mark for theseassessments, they are marked as pass / fail

since these types of competences are essentiallyattained or not. Students should pass all therequired sections of the assessment indicated ineach module’s assessment sheet.

Suggested reading

Gellatly, J. et al., 2007. What makes self-helpinterventions effective in the management ofdepressive symptoms? Meta-analysis and meta-regression. Psychological Medicine, 37, p.1217-1228.

Hirai, M. & Clum, G., 2006. A meta-analytic studyof self-help interventions for anxiety problems.Behavior Therapy, 37 (2), p.99-111.

Holford, E., 2008. Improving access topsychological therapy: the Doncaster demonstrationsite organisational model – commentary. ClinicalPsychology Forum, 181, p.22-24.

National Institute for Clinical Excellence, 2007a. Anxiety (amended): management of anxiety(panic disorder, with or without agoraphobia, andgeneralised anxiety disorder) in adults in primary,secondary and community care. London: NationalInstitute for Clinical Excellence.

National Institute for Clinical Excellence, 2009.Depression in Adults (update), Depression: thetreatment and management of depression inadults. London: National Institute for ClinicalExcellence.

Richards, D. & Suckling, R. 2008. Improvingaccess to psychological therapy: The Doncasterdemonstration site organisational model. ClinicalPsychology Forum, 181, p.9-16.

Roth, A. & Pilling, S., 2007. The competencesrequired to deliver effective cognitive and behaviouraltherapy for people with depression and with anxietydisorders. London: Department of Health.

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Module 1engagement and assessment of patients

with common mental health problems



Learning outcomes

1. Demonstrate knowledge, understanding andcritical awareness of concepts of mental healthand mental illness, diagnostic category systems inmental health and a range of social, medical andpsychological explanatory models.

2. Demonstrate knowledge of and competence inusing ‘common factors’ to engage patients, gatherinformation, build therapeutic alliances, managethe emotional content of sessions and grasp thepatient’s perspective or world view.

3. Demonstrate knowledge of and competence inpatient-centred information gathering to arrive at asuccinct and collaborative definition of the patient’smain mental health difficulties and the impact thesehave on their daily living.

4. Demonstrate knowledge of and competence inrecognising patterns of symptoms consistentwith diagnostic categories of mental disorder froma patient-centred interview.

Aims of module

Psychological wellbeing practitioners delivering low intensity interventions assess and support people

with common mental health problems in the self-management of their recovery. To do so, they mustbe able to undertake a patient-centred interview which identifies both the person’s main difficultiesand areas where the person wishes to see change and / or recovery, and which makes an accurateassessment of the risk the person poses to self or others. Psychological wellbeing practitioners needto be able to engage patients and establish a therapeutic alliance while gathering information tobegin assisting the patient to choose and plan a collaborative treatment programme. They must haveknowledge of mental health disorders and the evidence-based therapeutic options available, andbe able to communicate this knowledge in a clear and unambiguous way so that people can makeinformed treatment choices. This module will, therefore, equip workers with a good understandingof the incidence, prevalence and presentation of common mental health problems, and of evidence-based treatment choices.

Skills teaching will develop workers’ core ‘common factors’ competences of active listening,engagement, alliance building, patient-centred information gathering, information giving and shareddecision making.

5. Demonstrate knowledge of and competence inrecognition and accurate assessment of the riskposed by patients to themselves or others.

6. Demonstrate knowledge of and competencein the use of standardised symptom assessmenttools and other psychometric instruments to aidproblem recognition and definition and subsequentdecision making.

7. Demonstrate knowledge of and competencein giving evidence-based information about treatment

choices and in making shared decisions with patients.

8. Demonstrate understanding of the patient’sattitude to a range of mental health treatments,including prescribed medication and evidence-based psychological treatments.

9. Demonstrate competence in accurate recordingof interviews and questionnaire assessmentsusing paper and electronic record-keeping systems.

Recognition



Learning and teaching strategies

Knowledge

LecturesSeminarsDiscussion groupsGuided readingIndependent study

Skills

Clinical simulation in small supervised groupsSupervised practice through direct patient contact

Assessment strategies

A standardised role-play scenario where workers are required to demonstrate skills in engagement,information gathering, information giving and shared decision making. This will be filmed and assessedby teaching staff using a standardised assessment measure.

Workers must also provide a 1,000-word reflective commentary on their performance.

Both parts must be passed.

An exam to assess module knowledge against the learning outcomes.

Successful completion of the following practice outcomes:

1. Formulating and recording mental health care assessments appropriate to the identified needsof patients.

2. Demonstrating the common factors competences necessary to develop individualised therapeuticalliances that enable patients (and where appropriate their carers) to be purposefully involved in apartnership of care.

Duration

11 weeks, 15 days in total, running parallel with module 2:

• Five days intensive skills practice undertaken in a one-week intensive workshop.

• One day per week for 10 weeks, half the time to be spent in class in theoretical teaching and clinicalsimulation, the other half in the workplace undertaking supervised practice.

M o

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Knowledge assessments are at undergraduate and / or postgraduate level and assessed using percentagecriteria. Skills based competency assessments are independent of academic level and must be achievedaccording to a pass / fail criterion.

Recognition


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Learning outcome

Demonstrate knowledge of and competence in using ‘common factors’ to engage patients, gather

information, build a therapeutic alliance with people with common mental health problems, manage theemotional content of sessions and grasp the client’s perspective or ‘world view’.

Knowledge and skillsThe student should be able to:• demonstrate verbal empathy, summarising,

reflection, clarification, non-verbal and verbalprompts and non-verbal skills such as posture.

• demonstrate warmth and maintain appropriateeye contact while taking notes.

• demonstrate the ability to introduce themselvesto patients in a calm, efficient and reassuringmanner, ensuring they provide the patient witha clear set of expectations regarding sessioncontent and duration.

• manage endings to sessions effectively andefficiently whilst engendering hope in the patient.

AssessmentThis outcome is tested in the exam by assessingknowledge of the theory of alliance buildingwith patients; in the simulation assessment andreflective commentary, where the student shoulddemonstrate, describe and reflect on their commonfactors skills; and in the practice outcome, wherestudents should demonstrate the common factorscompetences necessary to develop individualised

therapeutic alliances that enable patients (and,where appropriate, their carers) to be purposefullyinvolved in a partnership of care.

Learning Outcome 2

Suggested readingBennett-Levy, J., Richards, D.A. & Farrand, P., etal., eds., 2010. The Oxford Guide to Low IntensityCBT Interventions. Oxford: Oxford University Press.Publication forthcoming 2010.

Egan, G., 2001. The skilled helper: a systematic approachto effective helping. 7th ed. California: Brooks / Cole.

Heron, J., 2000. Helping the client: a creative practical

guide. 5th ed. London: Sage.Mead, N. & Bower, P., 2000. Patient-centredness:a conceptual framework and review of the empiricalliterature. Social Science and Medicine, 51, p.1087-1110.

Myles, P. & Rushforth, D., 2007. A complete guide toprimary care mental health. London: Robinson.

Pilgrim, D. & Rogers, A., 2005. Sociology of mentalhealth. 3rd ed. Maidenhead: The Open University Press.

Silverman, J., Kurtz, S. & Draper, J., 2005. Skills forcommunicating with patients. 2nd ed. Oxford:Radcliffe Publishing.

Teaching aids

I Interview I1F Film clips Gathering information 1,

Gathering information 2,and Gathering information 4, whichdemonstrate common factors suchas introductions, empathy, reflection,summarising and endings.

A Assessment A1, A2

Recognition

M o

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Learning outcome

Demonstrate knowledge of and competence in ‘patient-centred’ information gathering to arrive at a

succinct and collaborative definition of the person’s main mental health difficulties and the impact thishas on their daily living.

Knowledge and skillsThe student should be able to:• demonstrate the use of effective information

gathering through non-leading, general open,to specific open and finally specific questionsin a patient-centred funnelling approach togather problem specific detail for all aspects of apatient’s problem(s).

• gather information on the physical, behaviouraland cognitive aspects of a patient’s problem,triggers of the patient’s current difficulties andthe impact of these difficulties.

• ascertain where patients’ problem(s) occur, withwhom they are better or worse and when they occur.

• gather information on onset, duration, previousepisodes, attitudes to and receipt of past andcurrent treatments, alcohol and drug use,expectations of patients, goals for treatmentand other information which patients feel isimportant to divulge.

• gather information on risk.• collaboratively agree a problem statement with

the patient using triggers, physical, behaviouraland cognitive aspects and impact to describethe problem(s) accurately and succinctly.

AssessmentThis outcome is tested in the exam by assessingknowledge of the theory of patient centredinterviewing, in particular the nature of informationgathering in interviews; in the simulationassessment and reflective commentary, where thestudent should demonstrate, describe and reflecton their information gathering skills; and in thepractice outcome, where students should formulateand record mental health care assessmentsappropriate to the identified needs of patients.


Goldberg, D. & Huxley, P., 1992. Common mentaldisorders: a biosocial model. London: Routledge.

Mead, N. & Bower, P., 2002. Patient-centred

consultations and outcomes in primary care: a reviewof the literature. Patient Education and Counseling,48, p.51-61.


Newell, R. & Gournay, K., 2000. Mental health nursing:an evidence-based approach. Oxford: ElsevierHealth Services.

Learning Outcome 3

Teaching aids


Gathering information 2 and ProblemStatement, which demonstratehow to gather information frompatients in a patient-centred andfunnelling manner and how to agree acollaborative problem statement.

A Assessment A1, A2

Recognition



Learning outcome

Demonstrate knowledge of and competence in recognising patterns of symptoms consistent with

diagnostic categories of mental disorder from a patient-centred interview.

Knowledge and skillsThe student should be able to:• demonstrate how to use information gathered

in a patient-centred interview to understandpatterns in the patient’s symptom presentation.These patterns can be understood in terms

of diagnostic systems for common mentalhealth problems.

• differentiate between different anxiety disordersand between anxiety and mood disorders whenpatients present their difficulties.

• use the specific constellation of autonomic,behavioural and cognitive symptoms to helpdistinguish between mild, moderate and severedepression and between obsessive, phobic,traumatic or general anxiety disorders.

AssessmentThis outcome is tested in the exam bypresenting symptom cluster patterns forrecognition; in the simulation assessment andreflective commentary, where the student shoulddescribe the patient’s presentation in terms ofone or more diagnostic systems; and in thepractice outcome, where students should formulate

and record mental health care assessmentsappropriate to the identified needs of patients.

Learning Outcome 4

Suggested reading American Psychiatric Association, 1994. The diagnosticand statistical manual of mental disorders (DSM) IV. 4thed. Washington DC.: American Psychiatric Association.

Bennett-Levy, J., Richards, D.A. & Farrand, P., etal., eds., 2010. The Oxford Guide to Low IntensityCBT Interventions. Oxford: Oxford University Press.Publication forthcoming 2010.


World Health Organization, 1992. ICD-10 Classificationof mental and behavioural disorders: clinicaldescriptions and diagnostic guidelines. Geneva:World Health Organization.

Teaching aids

I Interview I1F Film clips Supervision 1, Supervision

2 and Supervision 3, where

psychological wellbeing practitionersdiscuss their initial assessment ofpatients with their supervisor.

A Assessment A1, A2

Recognition

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Learning outcome

Demonstrate knowledge of and competence in accurate risk assessment and is able to assess and

recognise any risks to self and others posed by patients.

Knowledge and skillsThe student should be able to:• gather information on risk of suicide, self-harm

or neglect to self from the patient.• determine any risks to other people including

family or dependents.• differentiate between thoughts, plans, actions

and preventative factors associated with suicide.• agree a collaborative summary with the patient

on their risk status.• recognise where additional support is needed

for the patient and at what level according to therisk assessment.

AssessmentThis outcome is tested in the exam by seekinganswers to questions on risk, in the simulationassessment and reflective commentary where thestudent should demonstrate, describe and reflecton a risk assessment and in the practice outcomewhere students should formulate and recordmental health care assessments appropriate to theidentified needs of patients.

Learning Outcome 5

Teaching aids


Gathering information 2, Supervision1, Supervision 2 and Supervision3, where psychological wellbeingpractitioners gather information onrisk during a patient centred interviewand discuss their risk assessmentwith their supervisor.

A Assessment A1, A2

Suggested reading American Psychiatric Association, 1994. The diagnosticand statistical manual of mental disorders (DSM) IV. 4thed. Washington DC.: American Psychiatric Association.


Care Services Improvement Partnership, 2006. Primarycare services for depression – a guide to best practice,appendix 4: asking about risk. Hyde: Care ServicesImprovement Partnership.


National Institute for Clinical Excellence, 2009.Depression in Adults (update), Depression: thetreatment and management of depression in adults.London: National Institute for Clinical Excellence.

World Health Organization, 1992. ICD-10 Classificationof mental and behavioural disorders: clinicaldescriptions and diagnostic guidelines. Geneva:World Health Organization.

Recognition



Learning outcome

Demonstrate knowledge of and competence in the use of standardised assessment tools including

symptom and other psychometric instruments to aid problem recognition and definition andsubsequent decision making.

Knowledge and skillsThe student should be able to:• demonstrate knowledge of and the use of a

range of standard ‘off the shelf’ and patient-centred problem scales.

• demonstrate how these measures aresensitively applied, scored, interpreted andfed back to the patient.

• demonstrate the ability to give a sound rationalefor the measures used and a full understandingof their implications together with skill in usingmeasures in clinical and supervision situations.

AssessmentThis outcome is tested in the exam by seekinganswers to questions on measures, their useand structure; in the simulation assessmentand reflective commentary, where the studentshould demonstrate, describe and reflect on theirapplication of measures in a clinical simulation;and in the practice outcome, where studentsshould formulate and record mental health careassessments appropriate to the identified needsof patients.

Learning Outcome 6

Suggested reading American Psychiatric Association, 1994. The diagnostic andstatistical manual of mental disorders (DSM) IV, 4th edition.Washington DC.: American Psychiatric Association.


IAPT minimum data set. www.iapt.nhs.uk/2009/03/ improving-access-to-psychological-therapies-key-performance-indicators-and-technical-guidance-2009/

Gray, P. & Mellor-Clark, J. (eds.), 2007, CORE: A Decadeof Development. CORE IMS: Rugby.

Kroenke, K., Spitzer, R. & Williams, J., 2001. ThePHQ–9: validity of a brief depression severity measure.Journal of General Internal Medicine, 16, p.606–613.


Spitzer, R. et al., 2006. A brief measure for assessing

generalized anxiety disorder: the GAD-7. Archives ofInternal Medicine, 166, p.1092-1097.

World Health Organization, 1992. ICD-10 Classification ofmental and behavioural disorders: clinical descriptions anddiagnostic guidelines. Geneva: World Health Organization.

Teaching aids

I Interview I1F Film clips Gathering information 3

and Supervision 1, where psychologicalwellbeing practitioners use measuresto assess symptoms against patient-centred information and discuss themeasures with their supervisor.

A Assessment A1, A2

Recognition

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Learning outcome

Demonstrate knowledge of and competence in giving evidence-based information about treatment

choices and in making shared decisions with patients.

Knowledge and skillsThe student should be able to:• demonstrate competent and accurate information

giving about problems identified in the patient-centred interview and about evidence-basedtreatment choices for these problems.

• articulate the rationale for a range of CBT basedlow-intensity treatments, including behaviouralactivation, self-help recovery programmes andcomputerised CBT.

• discuss common medicines used to treatanxiety and depression and impart knowledgeon effects and side effects.

• give information about interventions offeredby both the psychological wellbeing practitioner

and other members of health, social careand third sector organisations includingemployment agencies.

• involve patients in informed collaborativedecisions as to choosing treatment.

• demonstrate the competent use of informationproducts such as books, leaflets and CD-ROMSto assist them in their communication of treatmentchoices and the patient’s decision making.

AssessmentThis objective is tested in the exam by seekinganswers to questions on evidence based treatmentoptions; in the simulation assessment andreflective commentary, where the student shoulddemonstrate, describe and reflect on informationgiving and shared decision making at the end ofan initial information gathering session; and in thepractice outcome, where students should formulateand record mental health care assessmentsappropriate to the identified needs of patients.

Learning Outcome 7

Teaching aids

I Interview I1F Film clips Gathering information

1, Gathering information 2 andMedication, where psychologicalwellbeing practitioners demonstrateinformation giving and shareddecision making with patients.

A Assessment A1, A2

Suggested readingBennett-Levy, J., Richards, D.A. & Farrand, P., et al., eds., 2010.The Oxford Guide to Low Intensity CBT Interventions. Oxford:Oxford University Press. Publication forthcoming 2010.

Kennerley, H., 1997. Overcoming anxiety. London: ConstableRobinson.

Lovell, K. & Richards, D., 2008. A recovery programme fordepression. London: Rethink.

Myles, P. & Rushforth, D., 2007. A complete guide to primarycare mental health. London: Robinson.

National Institute for Clinical Excellence, 2007a. Anxiety(amended): management of anxiety (panic disorder, with orwithout agoraphobia, and generalised anxiety disorder) inadults in primary, secondary and community care. London:National Institute for Clinical Excellence.

National Institute for Clinical Excellence, 2009. Depression in Adults (update), Depression: the treatment and managementof depression in adults. London: National Institute for ClinicalExcellence.

Newell, R. & Gournay, K., 2000. Mental health nursing: anevidence-based approach. Oxford: Elsevier Health Services.

Westbrook, D., Kennerley, H. & Kirk, J., 2007. An introduction tocognitive behaviour therapy: skills and applications. Michigan: Sage.

Williams, C., 2003. Overcoming anxiety: a five areas approach.London: Arnold.

Williams, C.J., 2006. Overcoming Depression and low mood: A Five Areas Approach Second Edition. London: Hodder Arnold

Recognition



Learning outcome

Demonstrate competence in understanding the patient’s attitude to a range of mental health

treatments including prescribed medication and evidence-based psychological treatments.

Knowledge and skillsThe student should be able to:• demonstrate the ability to determine the

views of patients on the choices of treatmentand intervention offered as part of theirlow-intensity role.

• demonstrate competence in eliciting patient’sknowledge, attitudes and opinions aboutmedication and about evidence-basedpsychological treatment choices.

• show how they use this information to informtheir own information giving about therapeuticoptions to enable patients to come to acollaborative shared decision.

AssessmentThis outcome is tested in the simulationassessment and reflective commentary, wherethe student should demonstrate, describe andreflect on information gathering and giving aboutpatient’s knowledge, attitudes and opinionstowards pharmacological and psychologicalinterventions; and in the practice outcome, wherestudents should formulate and record mentalhealth care assessments appropriate to theidentified needs of patients.

Learning Outcome 8

Suggested readingBazire, S., 2003. Psychotropic drug directory2003/2004: the professionals’ pocket handbook andaide memoire. Salisbury: Fivepin Publishing.


BMA & RPS. 2008. British National Formulary. London:British Medical Association and Royal PharmaceuticalSociety of Great Britain.

Mead, N. & Bower, P., 2002. Patient-centred consultationsand outcomes in primary care: a review of the literature.Patient Education and Counseling, 48, p.51-61.


Norfolk and Waveney Mental Health NHS FoundationTrust. NWMHP Pharmacy Medicine Information. http:// www.nmhct.nhs.uk/Pharmacy/.

Teaching aids

I Interview I1F Film clips Gathering information

1, Gathering information 2 andMedication, where psychologicalwellbeing practitioners demonstrateinformation gathering about patient’sknowledge, attitudes and opinions onpharmacological and psychologicaltreatments to inform their owninformation giving.

A Assessment A1, A2

Recognition

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Learning outcome

Demonstrate competence in accurate recording of interviews and questionnaire assessments using

paper and electronic record keeping systems.

Knowledge and skillsThe student should be able to:• demonstrate accurate record keeping in the

form of clinical notes and other records suchas clinical outcome measures. These should bein the format used in the service within whichthe student is working but include a recordof the patient-centred assessment, problemstatements, goals, risk, treatment plan andcontinuation notes.

• demonstrate competence in the electronicentry of the minimum data set required bythe Improving Access to PsychologicalTherapies programme.

• demonstrate competence in the operation of

one of the approved or recommended datamanagement systems (such as PC-MIS).

AssessmentThis outcome is tested in the practice-basedevidence approved by clinical supervisors,where students should formulate and recordmental health care assessments appropriateto the identified needs of patients.

Learning Outcome 9

Teaching aids

I Interview I1F Film clips Supervision 1,

Supervision 2 and Supervision3, where psychological wellbeingpractitioners demonstrate thediscussion of notes and clinicalmeasures with a supervisor.

A Practice-based evidence


IAPT minimum data set. www.iapt.nhs.uk/2009/03/

improving-access-to-psychological-therapies-key-performance-indicators-and-technical-guidance-2009/


Pullen, I. & Loudon, J., 2006. Improving standardsin clinical record-keeping. Advances in PsychiatricTreatment, 12, p.280–286.

Recognition



Initial information gathering

I1 Example interview schedule

IntroductionEach interview in a low-intensity programme takesthe form of three sections: information gathering,information giving and shared decision making.The following interview schedule is used togather information at the first contact between apsychological wellbeing practitioner and a patient.

Objectives of the interview

The objectives of the interview are to:

• elicit the main difficulties beingexperienced by a patient.

• assess the patient’s level of risk.

• determine the patient’s attitudesto his / her difficulties.

• come to a shared understanding

of their problem.

The interview uses a well tried question schedule.It is important that this schedule is used in a non-dogmatic, patient-centred and flexible manner. Thekey skill is to ensure that information is gatheredusing a funnelling technique whereby general openquestions are followed by specific open and thenclosed questions. This process of funnelling willbe used many times in an information gatheringinterview as patients divulge information about their

problems. In contrast, checklist-driven interviewsare the antithesis of patient-centredness.

Empathy dots Along the right hand border of the schedule are‘empathy dots’. Many therapists and workersuse these as memory joggers to remind them touse verbal empathic statements at regular times inthe interview.

Options for

low-intensity treatmentFollowing successful information gathering,psychological wellbeing practitioners will generallycomplete the interview by agreeing a problemstatement, identifying some patient-centred goalsand giving information about treatment options.These options are dependent on the problemidentified and on available resources locally.They may include:

• recovery programmes for depressionand / or anxiety.

• medication support.

• exercise.

• step ups to cognitive behaviour therapy.

• computerised cognitive behaviour therapy.

• support groups.

• signposting to other services including

employment programmes.

Although shared decisions can be made at theinitial contact, many patients will prefer to readwritten information about these choices beforemaking a decision.

The main focus of the next contact then becomessupporting patients to decide which approachsuits them best in attempting to overcome theirdifficulties through a process of collaborative,informed, shared decision making.

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I1 Example interview schedule

Empathy dots

4 ‘Ws’

• What is the problem?• Where does the problem occur?• With whom is the problem better or worse?• When does the problem happen?

•

•

•

•

•

•

•

Triggers (antecedents)• Specific examples of situations and other stimuli that trigger the problem

in the here and now• Past examples of triggers

Autonomic (physiological) aspects of the problem

Behavioural aspects of the problem

Cognitive aspects of the problem

Impact (consequence) of the problem• Work, home management, social leisure, private leisure, family life

and intimate relationships

Assessment of risk• Intent: suicidal thoughts• Plans: specific action plans• Actions: current / past; access to the means• Prevention: social network, services• Risk to others• Neglect of self or others

Routine outcome measures

• IAPT minimum data set including at least PHQ9 and GAD7

Other important issues• Onset and maintenance• Modifying factors• Why does the patient want help now• Patient expectations and goals• Past episodes and treatments• Drugs and alcohol• Current medication and attitude to this

• Other treatment being provided• Anything else that has not been covered in the assessment that is relevant

from both perspectives



A1 Patient-centred assessment

How to use this assessment sheet

The four sections are weighted: 10% for theintroduction section, 30% for interpersonal skills,40% for information gathering and 20% forinformation giving and shared decision making.Each section is rated from 0 – 10 and multipliedby the relevant weighting to give a final score.The assessment is marked as an overall pass /fail exercise.

The middle two sections MUST be passedindependently – students cannot fail the

interpersonal skills section and make up markson the other three sections. The same applies tothe information gathering section. A missing riskassessment leads to an automatic fail. The sectionratings given should reflect the amalgamated ticksgiven in each cell, the majority of which wouldneed to be in the left-hand or middle columnsto constitute a pass. As competence ratingsare dependent on multiple criteria, the overallpercentage ratings are indicative only and usedto give students feedback rather than indicate

concrete competence performance differencesbetween students.

It is best to use this assessment sheet on filmedclinical simulation interviews using actors withclear instructions on how to role play patients.This allows the scenarios being assessed to beconsistent between students. Filming also allowsdouble blind marking, external examiner scrutinyand an audit trail. Finally, filming allows studentsto observe their interview in order to write areflective commentary on their own performance.The reflective commentary is subject to theexamination regulations of the awarding bodyand is assessed accordingly.

This assessment sheet is dividedinto four sections: 1. Introduction

2. Interpersonal skills

3. Information gathering

4. Information giving and shareddecision making

Each section includes a number of competenceswhich are specific and central to these four aspectsof an initial patient-centred interview.

Each component of the assessment sheet isdivided into three columns. Assessors should rateeach competence according to observations made

of the student’s interview.

The right-hand column represents an aspect of theinterview which was not conducted sufficientlywell to be regarded as competent. The middlecolumn should be ticked when students displayedthe behaviours necessary but could have donemore. The left-hand column is reserved forstudents who are fully competent in the relevantskill. Guidelines are given in each cell of theassessment sheet to assist assessors in making

an objective judgement of competence.

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Participant Number: Date:

Introduction to the Session – WEIGHTING 10%


Clear evidencedemonstrated

(The worker fullydemonstrated thecriteria)

Some evidencedemonstrated

(The workerdemonstrates part ofthe skill or limited skill)

Not demonstrated

(Not demonstrated)

Introduces self

by name

(Clearly states own

full name)

(States first name only) (Does not introduce

or just uses role e.g.“I am a case manager”)

Elicits patient’sfull name

(Finds out patient’s fullname / preferred name)

(Finds out part of namee.g. first name)

(Fails to discover nameor ascertains laterduring interview)

Role of the workermade clear

(“I am a mental healthworker, my job is….”)

(Vague, e.g. “I workhere”)

(Does not state role)

Describes purpose / agenda of interview

(Purpose stated e.g.“I will be asking you totell me what your main

difficulties are, then wewill look at what we cando about this”)

(Vague statementse.g. “I am going tointerview you”)

(No purpose stated)

Defines time scalefor the interview

(Explicitly states time)e.g. “we have 25minutes”)

(Vague statement abouttime scale e.g. “we onlyhave a short time”)

(Time not mentioned)

0 1 2 3 4 5 6 7 8 9 10



Interpersonal skills – WEIGHTING 30%

Clear evidencedemonstrated Some evidencedemonstrated Not demonstrated

Displays empathy byverbal communicationskills e.g.

“I realise that this is verydistressing for you”

(More than oneoccasion)

(One occasion only) (Not demonstrated)

Displays engagementby non verbal cues e.g.eye contact, posture,nods, facial expression

(Displays all / most ofthe time)

(Displays some / part ofthe time)

(Not demonstrated)

Acknowledges theproblem by reflection e.g.

“so you felt that youwere having a heartattack” or “so you feltreally anxious”

(More than oneoccasion)

(One occasion) (Not demonstrated)

Acknowledgesthe problem by

summarising e.g.“you have told meyour difficulties are...is that correct?”

(Two or moreoccasions)

(One occasion only) (Not at all)

Uses patient centredinterviewing and clearinformation gathering

Uses a funnellingprocess to elicit patient

centred problemidentification by:

• General openquestions

• Specific openquestions

• Closed questions• Summarising and

clarification

(Full elements ofprocess demonstratedappropriately)

(Some evidence / notall appropriate use, e.g.general open questionsleading too quicklyto closed questionswithout interveningstage)

(Not demonstrated,e.g. mainly closedquestioning orinterrogative style)

0 1 2 3 4 5 6 7 8 9 10

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Information gathering – WEIGHTING 40%


Uses four W’s tostructure questions:

What is the problem

Where does theproblem occur

With whom is theproblem better or worse

When does theproblem happen

(At least first threeevident)

(Two evident) (Zero or one evident)

Elicits autonomicaspects of the problem

e.g. physiologicalaspects of problem

(Asks specific questionsand follows answersup to gain thoroughunderstanding)

(Asks vaguely and failsto follow cues / or asksspecifically but fails toobtain thorough info)

(Does not obtaininformation)

Elicits behaviouralaspects of the problem

e.g. what is the patientdoing or not doing

(Asks specific questionsand follows answers

up to gain thoroughunderstanding)

(Asks vaguely and failsto follow cues / or asks

specifically but fails toobtain thorough info)


Elicits cognitive aspectsof the problem

e.g. what is the patientthinking – as internalmental scripts orimages

(Asks specificquestions and followsthrough answersto gain thoroughunderstanding)

(Asks vaguely and failsto follow cues / or asksspecifically but fails toobtain thorough info)


Enquires about‘triggers’

e.g. current triggerspecific examples ofpast trigger

NOT THE PRESUMEDHISTORICAL CAUSE

(Specifically asksabout triggers)

(Vague in enquiryor does not followup cues)

(No enquiry made)




Includes assessmentof risk

Intent : suicidalthoughts

Plans : specificaction plans

Actions : current / past;access to the means

Prevention : social

network, services

(Comprehensive riskassessment appropriateto risk level articulatedby patient)

(Risk investigated butlimited in depth) (No risk assessmentundertaken)

AUTOMATICFAIL

Determines theimpact of the problemon lifestyle

(Clearly enquiresincluding domestic,work, social leisure,private leisure andfamily)

(Vaguely orincompletely enquires)

(No enquiry made)

Use of routineoutcome measures

(Uses at least oneclinical outcomemeasure from theminimum dataset and

feeds back result)

(Uses a Likert scale orother means to assessproblem severity ordoes not feed back

result)

(Does not use anymeasures)

Asks about otherimportant issuessuch as modifying factors , onset and maintenance ,why do they wanthelp now , patientexpectations andgoals , past episodes

and treatments ,drugs and alcohol ,current medicationand attitude to this,other treatment ,anything else that hasnot been covered inthe assessment thatis relevant from bothperspectives

(Clearly enquiresincluding follow upof important leadsfrom patient)

(Vaguely orincompletely enquires)

(No enquiry made)

0 1 2 3 4 5 6 7 8 9 10

Information gathering (continued) – WEIGHTING 40%

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Information giving and shared decision making – WEIGHTING 20%


Summarises anddefines problem

Using the framework:Four W’s

ABCTriggersImpact

and in patient’sown words

(All used withappropriate language inpatient’s words)

(Some demonstratedand / or in appropriatelanguage)

(Vague / absent / poorlydemonstrated)

Seeks patient’saffirmation of problemstatement

(Gives opportunity torevise statement)

(Presents statementbut limited opportunityto revise)

(Does not seekpatient’s view)

Agreed ending, whichshould include theinformation givingand the presentationof options for the

appropriate step.For example, theRecovery Programmefor Depression and / or Anxiety; medicationsupport, exercise,CBT, CCBT, supportgroups, signposting toother services.

At the very least,

this should include anagreement on nextsteps in terms of nextcontact arrangements.

- Session summarised

- Next steps agreedcollaborativelywith patient

(Brief ending withno collaborativeaction plan)

(None described)

0 1 2 3 4 5 6 7 8 9 10




(% aspect weightings given in brackets)

Students should receive a copy of the film clip of their clinical simulation assessment in orderto prepare a commentary on their performance. This commentary forms part of the academicassessment for the module. Suggested marking schedules are given below.

Knowledge and understanding (25%)Students should display knowledge and understanding of theories and concepts (relevant to theengagement and assessment of patients with common mental health problems), suitably integrated intotheir commentary.

Structure and organisation (10%)The commentary should be logically and systematically structured. It should be legible, error-free andpresented in accordance with institution’s guidelines.

Application of theory to practice (25%)Discussion of the student’s practice performance should be substantiated with reference to particularskills and techniques, with a rationale for their use.

Critical reflection (30%)The commentary should be balanced, detailing what went well, what was learnt from the film clip, whatwould be done differently next time, and why. The critical reflection should be supported by reference tokey concepts and theories.

Use of source material (10%)The commentary should be informed by reference to relevant source material, suitably acknowledgedutilising the institution’s accepted system of referencing.

A2 Markers’ guidelines for reflective commentaryon patient-centred assessment

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Notes



r e c o v e

r y

Module 2evidence-based low-intensity treatment

for common mental health disorders



Learning outcomes

1. Critically evaluate a range of evidence-basedinterventions and strategies to assist patients tomanage their emotional distress and disturbance.

2. Demonstrate knowledge of and competence indeveloping and maintaining a therapeutic alliancewith patients during their treatment programme,including dealing with issues and events thatthreaten the alliance.

3. Demonstrate competence in planning acollaborative low-intensity psychological and / orpharmacological treatment programme forcommon mental health problems, includingmanaging the ending of contact.

4. Demonstrate in-depth understanding of, andcompetence in the use of, low-intensity, evidence-based psychological interventions for commonmental health problems.

Aims of module

Psychological wellbeing practitioners delivering low intensity interventions aid clinical improvement

through the provision of information and support for evidence-based low-intensity psychologicaltreatments and regularly used pharmacological treatments of common mental health problems. Low-intensity psychological treatments place a greater emphasis on patient self-management and aredesigned to be less burdensome to people undertaking them than traditional psychological treatments.Examples include guided self-help and computerised cognitive behavioural therapy (CCBT).

Support is specifically designed to enable patients to optimise their use of self-management recoveryinformation and pharmacological treatments and may be delivered through face-to-face, telephone,email or other contact methods. Workers must also be able to manage any change in risk status. Thismodule will, therefore, equip workers with a good understanding of the process of therapeutic supportand the management of patients individually or in groups, and also support families, friends and carers.Skills teaching will develop workers’ general and disorder-defined ‘specific factors’ competences in thedelivery of CBT-based low-intensity treatment and in the support of medication concordance.

5. Demonstrate knowledge of and competencein low-intensity basic, intervention-specific,problem-specific and meta-CBT competences

such as behavioural activation, exposure, CBT-based guided self-help, problem solving and theindividualisation of CBT approaches.

6. Critically evaluate the role of case-managementand stepped-care approaches to managingcommon mental health problems in primary care,including ongoing risk management appropriate toservice protocols.

7. Demonstrate knowledge of and competence insupporting people with medication, in particularantidepressant medication, to help them optimisetheir use of pharmacological treatment andminimise any adverse effects.

8. Demonstrate competency in delivering low-intensity interventions using a range of methodsincluding face-to-face, telephone and electroniccommunication.

Recovery


37/136



Learning outcome

Critically evaluate a range of evidence-based interventions and strategies to assist patients to manage

their emotional distress and disturbance.

Knowledge and skillsThe student should be able to:• articulate knowledge of evidence-based

interventions, supported in National Institutefor Clinical Excellence (NICE) Guidelines,Cochrane and other reviews and in the primaryempirical literature.

• use systematic review and primary study sourcesto critically evaluate the strength of the evidenceunderpinning low-intensity treatments.

• critically evaluate the evidence base forinterventions other than those which thepsychological wellbeing practitioners deliver.

• demonstrate knowledge of the range ofempirically supported treatments outside their

own competence.• demonstrate knowledge of psychological andpharmacological interventions.

AssessmentThis outcome is tested in the exam by assessingstudents’ knowledge of the evidence base forempirically supported treatments, as well as thecompletion of the relevant practice outcome.

Suggested readingBennett-Levy, J., Richards, D.A. & Farrand, P., et al., eds.,2010. The Oxford Guide to Low Intensity CBT Interventions.Oxford: Oxford University Press. Publication forthcoming2010.

Centre for Reviews and Dissemination. Database ofabstracts of reviews of effects (DARE). http://www.york.ac.uk/inst/crd/crddatabases.htm#DARE

Chambless, D. L. and Hollon, S. D. 1998. DefiningEmpirically Supported Therapies. Journal of Consultingand Clinical Psychology, 66, 7-18.

Egger, M., Smith, G. & Altman, D., 2001. Systematicreviews in health care: meta analysis in context.London: BMJ Publications.

Hopko D., Lejuez C., Ruggiaro K.& Eifert G., 2003.Contemporary behavioural activation treatments fordepression: procedures, principles and progress. ClinicalPsychology Review, 23, p. 699–717.

Khan, K. et. al. eds., 2001. Undertaking systematic reviewsof research on effectiveness: CRD’s guidance for thosecarrying out or commissioning reviews. Report 4 (2nd ed.),Centre for Reviews and Dissemination, University of York.

Available from http://www.york.ac.uk/inst/crd/repor t4.htm

Martell C., Addis M. & Jacobson N., 2001. Depression inContext. Strategies for Guided Action. Norton: New York.


National Institute for Clinical Excellence, 2007a. Anxiety(amended): management of anxiety (panic disorder, with orwithout agoraphobia, and generalised anxiety disorder) inadults in primary, secondary and community care. London:National Institute for Clinical Excellence.

National Institute for Clinical Excellence, 2009. Depressionin Adults (update), Depression: the treatment andmanagement of depression in adults. London: NationalInstitute for Clinical Excellence.

Salkovskis, P., 2002. Empirically grounded clinicalinterventions: cognitive behavioural therapy progressesthrough a multi-dimensional approach to clinical science.Behavioural and Cognitive Psychotherapy, 30, p.3–9.

The Cochrane Collaboration. http://www.cochrane.org/

Learning Outcome 1 Recovery

Teaching aidsThere are no film clips provided for thislearning outcome. Teachers should consultthe range of policy, clinical and researchliterature to assist students to attain thisobjective. Aside from introductions in class,this objective is best achieved by studentsthrough directed reading.

C Clinical procedures C1-C7



Learning outcome

Demonstrate knowledge of and competence in developing and maintaining a therapeutic alliance with

patients during their treatment programme, including dealing with issues and events that threaten thealliance.

Knowledge and skillsThe student should be able to:• demonstrate common factors skills (verbal

empathy, summarising, reflection, clarification,non-verbal and verbal prompts, non-verbalskills such as posture, warmth, appropriate eyecontact, unobtrusive note taking etc.).

• demonstrate the ability to develop andstrengthen their alliance with patients, includingwhere they need to recognise and manageruptures in the alliance and be responsive topatients’ changing agendas and expectations.

• be able to deal with patients’ responses tosetbacks in treatment which may also threatenthe therapeutic alliance.

AssessmentThis outcome is tested in the exam by assessingstudents’ knowledge of the theory of the therapeuticalliance; in the simulation assessment and reflectivecommentary, where the student should describeand reflect on their development and maintenanceof the therapeutic alliance; and in the practiceoutcomes, where students should demonstrate

the techniques necessary to develop and maintainindividualised therapeutic alliances; as well as thecompletion of the relevant practice outcome.

Learning Outcome 2


Cahill, J. et al., 2006. A review and critical analysis ofstudies assessing the nature and quality of therapist/ patient interactions in treatment of patients with mentalhealth problems. Final report to the National Co-ordinating Centre for Research Methodology. Availableat: http://www.ncchta.org/project/1556.asp


Norcoss, J., 2002. Psychotherapy relationships thatwork: therapist contributions and responsiveness topatients. Oxford: Oxford University Press.

Norfolk, T., Birdi, K. & Walsh, D., 2007. The role ofempathy in establishing rapport in the consultation:a new model. Medical Education, 41, p.690–697.

Pilgrim, D. & Rogers, A., 2005. Sociology of mental health.

3rd edition. Maidenhead: The Open University Press.

Silverman, J., Kurtz, S. & Draper, J., 2005. Skillsfor communicating with patients. 2nd ed. Oxford:Radcliffe Publishing.

Recovery

Teaching aids

I Interviews I 2, I 3F Film clip Behavioural activation 2,

which demonstrates themanagement of setbacks throughacknowledgement, empathy andproblem solving.

A Assessment A3, A4

M o

d u l e

2



Learning outcome

Demonstrate competence in planning a collaborative low-intensity psychological treatment programme

including medicines management issues for common mental health problems, and managing theending of contact.

Learning Outcome 3 Recovery

Knowledge and skillsThe student should be able to:• demonstrate competence in working with

patients to plan treatment based on a patient-centred shared understanding of the patient’sdifficulties. Planning includes discussion ofpatient-identified goals, appropriate choicesfor intervention available, the ‘pros and cons’of these choices and the effort required toundertake the range of interventions available.

• demonstrate the relevant stages of planning anintervention in terms of information giving andthe collaborative use of information sourceswith a patient.

• discuss the use of medication and support

with written information on best practice inmedicines concordance.

AssessmentThis outcome is tested in the exam by testingstudents’ knowledge of the stages of evidence-basedlow-intensity psychological treatments and medicinesconcordance; in the simulation assessment andreflective commentary, where the student shoulddemonstrate ability to engage the patient in planningtreatment; and in the practice outcomes on adaptingcare on the basis of systematic evaluations.

Suggested readingBazire, S., 2003. Psychotropic drug directory 2003/2004:the professionals’ pocket handbook and aide memoire.Salisbury: Fivepin Publishing.

Bennett-Levy, J., Richards, D.A. & Farrand, P., et al., eds., 2010.The Oxford Guide to Low Intensity CBT Interventions. Oxford:Oxford University Press. Publication forthcoming 2010.

Gilbert, P., 2000. Overcoming depression. London:Constable Robinson.

Greenberger, D. & Padesky, C., 1995. Mind over mood:changing how you feel by changing the way you think. NewYork: The Guilford Press.

Hopko D., Lejuez C., Ruggiaro K.& Eifert G., 2003.Contemporary behavioural activation treatments fordepression: procedures, principles and progress. ClinicalPsychology Review, 23, p. 699–717.

Lovell, K. & Richards, D., 2008. A recovery programme fordepression. London: Rethink.

Martell C., Addis M. & Jacobson N., 2001. Depression in

Context. Strategies for Guided Action. Norton: New

reachreach out educator manual

Documents