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Annual Family Therapy Conference 2014 Adelphi Hotel - Liverpool

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Annual Family Therapy Conference 2014 Adelphi Hotel - Liverpool Child IAPT and Systemic Family Practice Irreverence, Ambivalence and Perseverance in an ... – PowerPoint PPT presentation

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Title: Annual Family Therapy Conference 2014 Adelphi Hotel - Liverpool


1
Annual Family Therapy Conference
2014 Adelphi Hotel - Liverpool Child IAPT and
Systemic Family Practice Irreverence,
Ambivalence and Perseverance in an Evidenced
Based Culture. Where are we now, nine months on?
  • With Grace Heaphy, Hannah Sherbersky, Jacqui
    Sayers, Margaret Dimmock, Tom O' Neill, Gary
    Robinson and Judith Lask

2
Outline
  • Overview of the SFP programme
  • Systemic competencies
  • Overview of the five HEIs, including two short
    films
  • Q and A
  • Sustaining change - what can we do together?

3
Transformation of Mental Health Services for
Children and Young People in England? With
thanks to Anne OHerlihy and Judith Lask for many
of these slides

4
Rationale
  • Courageous plan to use IAPT initiative to
    radically transform CAMHS
  • Drawing on policy context
  • Mental Health Strategy, 2011 ,
  • Commitment to increase access to NICE approved
    best evidenced psychological therapies for
    children and young people,
  • NHS and Social Care Bill, 2011,
  • Children and Young Peoples Health Outcomes
    Strategy,
  • Transfer of project from DH to NHS England in
    April 2013,
  • Health Select Committee (HSC) on CAMHS Mar/Apr
    2014

5
Project assumptions
  • CYP IAPT has learned from Adult IAPT but is
    specific to the needs of children and families
    and the agencies that support them.
  • Key IAPT quality markers
  • Evidence Based Practice
  • Routine Outcome Monitoring
  • Strong supervision
  • Participation in the CYP IAPT project is offered
    to existing CAMHS - not necessarily exclusively
    provided by the NHS.
  • The budget is still modest and will be available
    until the next Comprehensive Spending Review.

6
CYP-IAPT Core Implementation Components
Integrated Compensatory
7
The CYP IAPT Learning Collaborative
Mentorship peer support
8
Service Transformation Programme
  • Began in April 2011 with aims to
  • Improve collaborative practice with children,
    young people and families
  • Embed evidence based practice (EBP) as
    recommended by NICE in
  • CBT for anxiety disorders and depression
  • Parenting training (age 3-10)
  • Interpersonal Psychotherapy for adolescents
    (IPT-A) for depression
  • Competency based curriculum using Roth and
    Pilling CAMHS competencies
  • Systemic Family Practice for conduct disorder
    (over 10s), depression and self-harm, and eating
    disorders

9
Systemic Family Practice (SFP) course covers
  • Core CYP IAPT curriculum (60 credits)
  • Systemic Family Practice and basic skills (30
    credits)
  • Module specific pathway
  • Conduct disorder (over 10s) and depression and
    self-harm (30 credits)
  • Eating disorder pathway (30 credits) specific
    entry requirements (hub)
  • Trainees need to be members of an existing or
    developing specialist ED multidisciplinary team
    in community
  • Min of 50 new ED referrals a year
  • Cover min pop of 500,000
  • Knowledge and skill required to be held within a
    team as a whole

10
Systemic Family Practice and Systemic Family
Therapy
  • SFP is based on the same theoretical and evidence
    base as SFT but denotes an intermediate level of
    training. Systemic Family Therapists will have
    another 2 years of training and be equipped to
    deal with the most challenging work and to move
    more flexibly across age range and presentations.
  • The Systemic Family practice curriculum has been
    designed so that successful candidates should be
    able to enter the final 2 years of family therapy
    training leading to registration with UKCP.

11
SFP Curriculum Group
  • Chaired by Peter Fonagy
  • Membership drawn from researchers and
    practitioners in the field especially those
    connected with the main sources of evidence
  • Eia Asen, Paula Boston, Charlotte Burke, David
    Cotterell, Ivan Eisler, Judith Lask, Barbara
    Mackay, Mark Rivett, Tom Sexton.
  • From the beginning supported by the Association
    for Family Therapy whose aim is to support
    skilled and effective work with families.

12
Challenges in drawing up the curriculum
13
Curriculum consists of
14
Who can do the training?
  • CAMHS workers with
  • Prior relevant professional training
  • Ability to study at a postgraduate level
  • Experience of working in CAMHS
  • Some experience of working with families
  • Opportunities to carry out required supervised
    clinical practice.
  • Some professionals who have already done an
    intermediate level training may benefit from the
    specialist modules.

15
What will Students Learn Basic Module
  • Theoretical underpinnings a range of frameworks
    including behavioral, structural,
    trans-generational, communication, narrative.
  • How to maintain effective engagement and
    collaborative therapeutic relationship
  • How to assess and formulate family in relation to
    presenting problem
  • How to work ethically with difference.
  • Planning work and basic interventions
  • Thinking of self in relation to work
  • Family work in context of other interventions.
  • Using formal and informal feedback

16
Specialist Module Depression and Self Harm
  • To make an assessment and formulation
  • Understand developmental issues, risk issues and
    make an effective assessment and formulation.
  • Engage with the family around the young person
  • Help family to create safety around their young
    person
  • Encourage non-blaming explanations
  • Help family understand self harm as a
    communication
  • Help family to engage in discussions around
    emotions
  • Help identify patterns in order to decrease
    likelihood of self harm
  • To use questions and direct interventions in
    family to enhance understanding decrease risk.

17
Specialist Module Conduct disorder
  • Engaging and motivating young people and families
  • Building pro-social, family based behavioural
    skills that fit the family and alleviate the
    presenting problems
  • Generalize treatment and prevent subsequent
    relapse
  • Manage complex clinical situations whilst
    retaining a relational SFT focus
  • Identify the relational processes that maintain
    or precipitate conduct disorders
  • Demonstrate the ability to apply relational
    formulation in conduct disorders
  • Be able to create shared relational treatment
    goals with families
  • Monitor progress to agreed goals collaboratively
  • Demonstrate cultural competence in SFT for
    conduct disorders (including the use of
    interpreters)
  • Use behavioural and structural interventions to
    help families to manage their child.

18
Specialist Module in Eating Disorders
  • This is a double (30 credit) module
  • Applicants must work in a specialist eating
    disorder service or unit and meet particular
    criteria.
  • Includes work with Anorexia and Bulimia , multi
    family groups, running a family meal as well as
    assessment, formulation, engagement, structuring
    treatment etc.
  • Interventions that are most useful in working
    with these groups.
  • Links with wider MDT

19
How will clients benefit
  • Greater expertise in engaging with all family
    members
  • Interventions that take into account different
    perspectives of family members
  • Greater appreciation of family culture,
    aspirations and strengths
  • Enhanced collaboration with family to help
    referred young person.
  • Support and help in making necessary changes
  • Understanding of external and internal
    constraints to making changes.
  • Appreciation of the place of family in wider
    community and network of professionals.
  • Availability of family focused, evidence based
    interventions which have specific applicability
    to presenting problem

20
Supervised practice
  • There is a strong emphasis on well supervised
    practice by supervisors who are ideally
    registered with AFT as systemic supervisors as
    well as completing the CYP-IAPT supervision
    training.
  • Practice will be undertaken with a general
    caseload as well as specialist caseload (a
    minimum of 60 hours of supervised practice)

21
Some wider reverberations
22
Recursive process
  • CYP IAPT developments have influenced AFT in
    revising training standards
  • Systemic Practitioners and therapist are becoming
    more familiar and comfortable with ROMS
  • The flexibility and adaptation which is a
    strength of systemic work is being complemented
    by a greater understanding of the need for more
    specificity when working with particular
    presentations
  • Impact of learning from other modalities, working
    together, supervision, common factors, difference
  • AFT will be involved in the accreditation process
    and Cred is looking to create bridges between SFP
    and Framework in Blue Book Review.

23
The inclusion of Systemic Family Practice will
hopefully bring
  • More understanding of the importance of family
    and wider context
  • Understanding of the importance of a good,
    collaborative therapeutic relationship with
    family
  • Understanding of complex ethical issues in
    working with families
  • More appreciation of culture and working with
    power in relation to marginalized groups
  • Need to adapt interventions to fit with
    presenting families and be able to work in the
    here and now, with perceptions and with history
  • Importance of working with family as a resource
    and identifying and building on strengths.
  • The important connections between beliefs,
    behaviors, emotions and relationships.
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