|The effectiveness of a brief Cognitive Behaviour Therapy (CBT)-based ‘Initial Intervention’ for new clients into adult community mental health services delivered by support time recovery workers.|
Mental health services are seeking innovative ways of working effectively with limited resources. With this in mind the Kent and Medway NHS and Social Care Partnership Trust (KMPT) has developed an ‘Initial Intervention’ psychological package for new clients in services designed to be delivered by support time recovery workers and supervised by Psychological therapists. This package is aimed at working age adults requiring secondary care mental health services in the community. This project has been piloted (November 2018 – May 2019) in South Kent Coast Community Mental Health Team’s (CMHT’s) based in Dover and Folkestone and implementation has begun in all CMHT’s across KMPT.
The Initial Interventions pathway has enabled KMPT to define a conceptual service offer of a brief psychological intervention within the first few weeks of being accepted into the service. The intervention supports the service user to understand their difficulties, to learn new coping strategies and come away with a clear recovery plan. For some service users this may lead straight onto referral back to their GP and for others it will be a robust start in their journey onto specialist interventions.
The ‘Initial Intervention’ model was designed by a clinical psychologist drawing on classic Cognitive Behavioural Therapy (CBT) strategies, theorised active mechanisms of change and transdiagnostic research. The package is designed to be a balance between being a manualised and formulation-based brief psychological treatment (Padesky and Mooney, 1990) suitable to be delivered by non-psychologists. This was then co-designed and developed into a full package through a collaborative working group which met fortnightly involving a variety of the trust’s stakeholders, such as people with lived experience, carers, service leads, clinical leads, managers and the project support team.
In addition there has been consultation with and involvement from an extended circle of stakeholders from grassroots through to director level. As part of the engagement work carried out, the trust service user involvement group, clinical care pathways group chaired by the executive director and business teams have all worked collaboratively through each stage of the pilot.
There is a strong evidence base that supports the package, including emerging research into short-term CBT based interventions in NHS services with non-psychologists (supervised by Psychologists) has shown to be effective and positive. The Cost and Outcome of Behavioural Activation [COBRA] trial (Richards et al., 2016) showed that behavioural activation delivered by junior mental health workers was no less effective than CBT delivered by psychological therapists for treating depression. In addition to this, non-psychologists delivering brief CBT interventions improve in their competence and confidence (Armstrong et al., 2017).
The pilot project involved training junior mental health staff (e.g. support workers) working in a community adult mental health service in the package. After training the staff then attended weekly group supervision by a Clinical Psychologist to deliver the intervention to all new clients into service. The pilot, which took place between November 2018 and April 2019, included over 50 clients.
The aims of the Initial Interventions project were:
· To design a transdiagnostic brief psychological intervention which staff in CMHTs can be trained in to deliver.
· To set up a structure in the CMHT which will help support the initial interventions to take place.
· To evaluate the effectiveness of the Initial Interventions.
· To obtain staff and servicer-user feedback.
· To review the pilot, make appropriate revisions and roll out across all CMHTS in KMPT.
The evaluation of the pilot included four categories:
1) data on the service-user flow through the pilot and what their needs were after the intervention,
2) the self-reported clinical outcomes for service users who went through the intervention,
3) the staff outcomes for those that delivered the intervention in terms of their views on their job role, and 4) qualitative feedback from service users and staff.
The results from the evaluation of the pilot have shown that 1) the pilot encouraged flow of service users through the service, with approximately one quarter of completers being discharged back to their GP, 2) reductions in self-reported scores of depression, anxiety, and how their mental health impacts on their living, with an increase in wellbeing, 3) reductions in staff self-reported secondary traumatic stress and burnout and improvements in compassion satisfaction, and 4) positive feedback all round from service users and staff.