2. 2

3. Clinical skills ABCD’S Skills (Alphabet skills): These are the range of skills that clinicians need: Assessment Behavioural Cognitive Dynamic. Systemic 3

4. “Traditional” skills pattern 4

5. Extended skills clinician 5

6. Single modality Core work 6

7. Single modality Core work II Slide 7

8. CBT: core vs advanced skills Core 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

9. Integrative Core work 9

10. Skill summary Advanced Skills are often distinct skills in a single modality trained to a higher level and delivered a higher intensity CORE skills are either to be competent at that modality = single modality Integrative work across modalities at lower fidelity Slide 10

11. A Possible Pattern… Effects? 11

12. A Possible Pattern… Effects? 12

13. A Possible Pattern… Effects? 13

14. Work streams So now we’ve defined the streams by skill / intervention into Core Specific We need to work out how much we can do in THAT stream… This is a PACKING problem. Slide 14

15. Splitting the streams The 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

16. No segmentation? Slide 16 One big fruit crate… Hard to know quite how much fruit we can get in.

17. Segmentation Segment 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

18. Specific Fruit What if we have bigger fruit like melons Can put them in another crate… Again we can calculate how many melons we can fit in Slide 18

19. Another fruit What if we have some bigger fruit? A 4 th crate could have pumpkins They are bigger still… So even less can be packed in Slide 19

20. Why have separate core and specific work? Segments and so helps flow Segments have different clinical needs and characteristics so that… Many can be helped by core work Extended core skills reduces bottlenecks to specifc work Extended core skills increases clinical flexibility (fewer queues into ‘specific interventions’ streams) Allows us to identify AND PROTECT specific work with advanced skills 20