1. Cognitive Behaviour Therapy
Overview of
Positive Step
and
Cognitive Behaviour Therapy
Adrian Dugmore, Clinical lead
Philip Adkins, Service Manager

2. Agenda Who are Positive Step? How do I refer?
Service targets and 25% access rate
What to expect, the patient journey through our service and stepped care
CBT and the various therapies on offer
Resources to use

3. What is Positive Step? NHS Primary Care IAPT Service
Partnership between AWP and Second Step
Work with Common Mental Health issues such as depression and anxiety disorders
Based at the Coast Resource Centre in Worle and work at local surgeries

4. Additional services Long Term Health Conditions (LTHC) pathway
Carers pathway
STEPPS programme (Systems Training for Emotional Predictability and Prevention).

5. Referral pathways Self referral – 0300 300 0834
GP/Health Professional referral via the website
Booking on to courses via the website

6. Referral Statistics
North Somerset Population approximately 167,111 (GP registered adults)
Mental Health Population based on 15%
25,066
15% annual target – 3,760
2015 – 2016, referrals received
3,867 went on to receive treatment

7. Looking Ahead North Somerset Population approximately – 215,000
Access targets for IAPT services nationally will increase to 25% by 2020
Positive Step will need to treat 6,266 to hit target in 2020, an increase of 2,506
Areas to target include year olds, over 65’s and males

8. What to expect and the patient journey through our service

9. Step 1 GP Management
Watchful waiting, Books on Prescription, Internet resources, Self-help material, Signposting to relevant agencies.
Step 2 Receive, process and triage referrals – Book patients on to Psycho-education courses or book initial telephone assessment appointments with Step 2 workers.
  Low Intensity Intervention by Step 2 Worker
Assessment, Books on Prescription, Internet, relevant agencies, Computer CBT, Guided self help, psych-education courses, individual low intensity CBT intervention and reviews.
Step 3 High Intensity Intervention by Step 3 Worker
Assessment, Individual CBT up to 12 sessions, Therapy groups spanning 8 to 16 weeks, EMDR.
Step 4 Secondary Services, Recovery Teams, Early Intervention for Psychosis Team, Intensive Support Team, Consultant Psychiatrist.
Step 5 In-patient services.

10. CBT and the various therapies on offer
Phone Assessments
Various resources and guided self help
Psycho-educational courses
1:1 Cognitive Behaviour Therapy
Step 3 therapy groups
Long term health conditions
Carers Workshops and Individual Sessions
Signpost to other services
Restricted counselling provision

11. Our Psycho-education Courses
Last 4-6 weeks
20 or less participants in the room
Led by a presenter at the front of the room
Education and develop skills and techniques to practice at home through the use of workbooks
Involve informal discussions and activities

12. What courses we offer Low Mood Anxiety/Worry Self-Esteem
Stress and Mood Management
Getting Ready for Change / Weight Management
Carers’ Workshops
Keeping Well

13. Individual Interventions Low Intensity – Single Strand, Up to 6 sessions
Sleep hygiene
Medication review
Cognitive restructuring
Behaviour experiments
Behaviour activation
Graded exposure
Panic management
GAD
Problem solving

14. Individual High Intensity CBT Up to 12 sessions
Formulation incorporating disorder specific protocols
Beckian longitudinal formulation
Therapy incorporating above interventions

15. Different types of anxiety
General Anxiety
Social Anxiety
Panic Disorder
Health Anxiety
Specific phobia
OCD
PTSD
Mild to Moderate Eating Disorder

16. Symptoms of Anxiety Frequent worrying or nervousness
Rapid heartbeat or palpitations
Dizziness / light headed
Nausea / stomach problems
Avoiding people or situations
Difficulty concentrating
Thoughts that you can’t cope
Thoughts that something bad will happen

17. Symptoms of Depression
Feeling sad
Feeling guilty or worthless
Irritable
Less interest in usual activities
Trouble making decisions or concentrating
Focussing on the negative
Tired / loss of energy /difficulty sleeping
Thoughts of death or hopelessness
Withdrawal and isolation
Loss of appetite

18. Resources to Use Helpful CBT Websites
Psychology.tools
Self-help.tools
Northumberland self help
Centre for Clinical Interventions
Living Life to the Full
Mood gym