1. SMI Stakeholder Event, 7 th March, 2013 SMI Education and Training start and finish group: SMI workforce development: Service innovation and transformation. Prof Graham Turpin National Advisor IAPT: Education and Training

2. Aims of presentation Describe rationale and importance of workforce development within the IAPT SMI programme Overview of development work to date associated with the demonstration sites and the derivation of the competency frameworks Future work required for an IAPT SMI workforce which is fit for purpose

3. Skills and competencies: Existing service delivery New PTs competency Framework and curricula NICE guidance and the evidence base Existing education and training ProfessionalRegulation? Professionalaccreditation, NOS and QAA Evidence-based,competentpractitioners CompetentWorkforce: Levels & Modalities Importance of competency

4. IAPT Workforce Development Strategy Patient needs and care pathways Service models Scoping the workforce to deliver service models in terms skill mix and competences to deliver NICE evidenced based therapies Workforce capacity of existing services to deliver adequate access to evidence based therapies Workforce capacity of existing services to deliver adequate access to evidence based therapies Specifying education and training to ensure staff are fit for purpose – specifying new curricula, training courses and systems implementation Determine workforce training numbers and commissioning E&T Quality assurance, Training course accreditation & Registration and regulation

5. IAPT SMI Workforce Development Strategy Patient needs and care pathways Service models Scoping the workforce to deliver service models in terms skill mix and competences to deliver NICE evidenced based therapies Workforce capacity of existing services to deliver adequate access to evidence based therapies Workforce capacity of existing services to deliver adequate access to evidence based therapies Specifying education and training to ensure staff are fit for purpose – specifying new curricula, training courses and systems implementation Determine workforce training numbers and commissioning E&T Quality assurance, Training course accreditation & Registration and regulation What’s been achieved What’s to be done New NHS: HEE, LETBs & Professions New NHS: HEE, LETBs & Professions

6. SMI IAPT E&T What it isn’t: Creating a new IAPT workforce within secondary care Traditional workforce modeling and commissioning: estimating trainee numbers and commissioning pre- registration training. Commissioning will be important but this project is about development of the existing workforce.

7. SMI IAPT E&T What it is: It is about workforce redesign, service transformation and innovation to deliver evidence-based NICE psychological therapies for people with SMI. Working collaboratively with current services Many similarities with C&YP SMI

8. SMI IAPT E&T To achieve: That the NHS commissioned workforce working with people with SMI and their carers/ families is fit for purpose and delivers NICE approved psychological therapies and high quality psychologically informed support and information.

9. SMI IAPT E&T To achieve: That people with SMI have appropriate and adequate access to effective evidence- based NICE approved psychological therapies across a range of SMI disorders through staff who have demonstrated competences and have been expertly trained and supervised

10. SMI IAPT E&T To achieve: That the system that delivers treatment and support is accountable through the collection of routine clinical outcomes and adherence to explicit quality standards

11. SMI IAPT E&T The barriers

12. SMI IAPT E&T Present barriers – few SMI services have: A vision of psychologically-informed care Commitment to a range of evidence based interventions and the management expertise to implement them Collection of routine and meaningful clinical outcomes for people with SMI Sufficient psychological therapists trained and accredited to deliver NICE approved therapies across all SMI disorders.

13. SMI IAPT E&T Present barriers – few SMI services have: Access to approved trainers and courses able to deliver the SMI competency frameworks that will underpin trainings in a range of NICE approved therapies. Sufficient highly trained staff to supervise psychological therapists and other SMI staff. The clinical leadership and service implementation skills to bring about the transformation to IAPT SMI services.

14. SMI IAPT E&T Solutions

15. SMI IAPT E&T How to bring about the change – up-skilling the current workforce to deliver the SMI competency framework? Psychological awareness training for all staff Psychologically informed and IAPT principled clinical practice for staff working with people with SMI on their case loads (Primary and secondary care). SMI informed IAPT staff delivering therapies for anxiety and depression Cont/…

16. SMI IAPT E&T How to bring about the change – up-skilling the current workforce: Staff trained across a range of NICE approved specialised therapies to enable choice for clients with all types of SMI problems. Staff trained to supervise and train other SMI staff. Staff capable of clinical leadership and enabling service innovation and transformation

17. SMI IAPT E&T What would courses look like?

18. SMI IAPT E&T We would envisage: A range of different levels of engagement with psychological approaches across the whole workforce These would be: –Introductory, –Intermediate, –Specialist, –IAPT implementation Target all staff groups

19. SMI IAPT E&T What training would be required - Psychoses:

20. SMI IAPT E&T What training would be required - Psychoses:

21. SMI IAPT E&T What training would be required - Psychoses:

22. SMI IAPT E&T What training would be required – Bipolar disorder:

23. SMI IAPT E&T What training would be required – Bipolar disorder:

24. SMI IAPT E&T What training would be required – Bipolar disorder:

25. SMI IAPT E&T What training would be required – Bipolar disorder:

26. SMI IAPT E&T What training would be required – Personality disorder:

27. SMI IAPT E&T What training would be required – Personality disorder:

28. SMI IAPT E&T What training would be required – Personality disorder:

29. SMI IAPT E&T What training would be required – Personality disorder:

30. SMI IAPT E&T What training would be required – Personality disorder:

31. SMI IAPT E&T How could courses be organised and targeted for different groups within the SMI workforce? Awareness training for all relevant staff delivered by trained SMI staff. Intermediate training for SMI staff to enhance psychologically-informed practice, Relationship to pre-existing IAPT trainings? Specialist psychological therapies training and supervised practice – individually or collectively across SMI disorders. Additional training in IAPT principles, supervision and clinical leadership/implementation. All this requires innovation and newly developed products.

32. SMI IAPT E&T National curricula development, accreditation and quality assurance issues for training providers and services. Next task is to consult and write curricula for SMI (Psychoses, Bipolar and PD). Flexible curriculum to reflect levels of training, different staff groups and different disorders/NICE guidance. Curricula probably organised in similar structure to C&YP curriculum with Generic and Specific therapeutic competences being identified plus: IAPT principles, supervision and clinical leadership skills to be incorporated. All this requires innovation and newly developed products.

33. SMI IAPT E&T Implementation strategy

34. SMI IAPT E&T Implementation strategy Need to be selective at first and work with demonstration sites to develop collaborative partnerships between services and training providers like C&YP. Clear criteria for readiness and participation Focus on clinical leadership and training supervisors and up-skilling existing managers and therapists to lead change. Expanding numbers of existing staff who have been trained in accredited and specialist therapies, together with trained supervisors.

35. SMI IAPT E&T Implementation strategy Train the trainers strategy to help support the roll out and supervision of training in: –psychologically informed clinical practice, –SMI training for IAPT staff (anxiety and depression), –psychological awareness training around SMI for all relevant public sector staff.

36. SMI IAPT E&T Next steps

37. SMI IAPT E&T What needs to happen for 2013/2014 Translate competency frameworks into national curricula for SMI. Translate competency frameworks into workforce capacity tool to assess capability of existing workforce. Survey the competences of the existing workforce and specify the size and extent of the training gap.

38. SMI IAPT E&T What needs to happen for 2013/2014 Identify course structures and existing providers. Alert LETBs to these providers and the existing need for more trained specialists. Identify good practice in E&T within demonstration sites and how these programmes have successfully evolved? Liaise with C&YP clinical leadership and implementation trainings and translate for SMI. Publish commissioning guidance for SMI E&T.

39. SMI IAPT E&T Disseminate to HEE and LETBs – Job well done!

40. Further Information & Contact Details IAPT website: www.iapt.nhs.uk E-mail: g.turpin@sheffield.ac.uk