Increasing Efficiency without Compromising Quality - Workshop

Developing training to demonstrate efficiency, quality and demonstrated competence Dr Donna Gilroy Dr Laura Freeman Educational Project Managers NES Psychological Interventions Team 23 October, 2013 Quality Education for a Healthier Scotland

Psychology

Opening Discussion Question

What are your expectations of this session? • 5 minutes for discussion in small groups • Nominate one person to feedback from your group

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Psychology

Developing a programme of training Psychology

• • • • • • • • •

Determine level of intensity of intervention. Evidence-base for the intervention. Evidence-base for training in this intervention (inc. supervision) Plans for training roll-out and sustaining this over time. Method of selection of trainers - what skills do they need? Selection method and criteria for appropriate ‘trainees’. How you will measure competence as a result of training? How will you monitor continued competence over time? How do you demonstrate skills are used in actual practice and make a difference to individuals? • How do you build continued development of these skills into ongoing training? Quality Education for a Healthier Scotland

CBT

CAT C-BASP

Psychodynamic Psychotherapy

ACT

Motivational Interviewing

So many modalities; so Behavioural Activation many different IPT ways of training! MBSR

Psychology

C-BIT

EMDR

Problem Solving Therapy

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Common core components of high quality skills-based training programmes

Psychology

1) Fact-based information about the PI 2) Demonstration of PI 3) Participant skills based practice within a training environment e.g., skills role play exercises and feedback 4) Method of demonstration of competence in PI in practice 5) Required level of supervision (variable across modalities)

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In reality….. Psychology

Following post registration/qualification: Training in the mode of ‘Train, Run and Hope’: standalone events with no follow-up Variation in training content, quality and length between areas Training in a PI may not reflect the level of training received by clinicians delivering the same PI in clinical trials Supervision provision and requirements are more clearly defined for certain PIs than others – a particular issue in LI

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Example A: PST Trainer Development Process Psychology

Problem Solving Therapy (PST) is Matrix-referenced LI treatment of late life depression in both primary and secondary care settings National consultation highlighted need for behaviourally oriented interventions Challenge: with no clearly identified UK PST trainer experts or specific materials in UK – how to develop PI training for efficiency, quality and delivery at a consistent standard of competency?

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PST: Developing a programme which is efficient without compromising quality Psychology

Efficiency: • As a stand-alone intervention can be provided in 4 – 12 sessions • Intervention itself is flexible and can be provided in context of other roles Quality: • Formal consultation and commission of PST experts and leads on clinical trials • Identified training process and materials utilised in the training of clinical trial therapists, tested with multi-disciplinary staff with (mild) modifications for NHS • Identification of suitable trainers in board, who complete training in PST protocol and are required to demonstrate competence as a clinician and rater • Core content of training can be delivered flexibly, in vivo and remotely Demonstrating Competency: • Skills based practice exercises using structured case role play a core element of PST training • Use of standardised measure of adherence in PST: PST- AC in rating clinical sessions in-vivo

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Overview of PST Trainer Development Process Trainer Selection

Stage 2

4 Monthly Group VC calls : Calibrate PST-AC ratings of practice samples

Trainer Case Practice Sample rating by Expert PST Trainer

Certified PST-OA Trainer Eligible to train clinicians and trainers Full access to all PST Training Materials

PST-OA Trainer Network (Scotland)

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Implementation Guidance

Stage 1: Trainer Workshop with PST Expert Trainer

Psychology

Overview of PST Clinician Development Process Psychology

Implementation Guidance Quality Education for a Healthier Scotland

Example B: Motivational Interviewing Psychology

• The question is how to develop an integrated programme of training which:
Enhances the quality of Motivational Interviewing delivered
Addresses issues of efficiency – need a model of training which has been shown to lead to changes in practice
Demonstrates consistent and competent practice delivered in the workplace

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Developing a Programme of MI Training • Strong evidence base for use in enhancing motivation for behavioural change. • Research into effective training of MI and other skills (Miller et al., 2006) • Three stages proposed in learning a new skill:
Preparatory information,
Monitored practice with feedback, and
Ongoing Supervision Quality Education for a Healthier Scotland

Psychology

Three Stage Training Model from Miller et. al. Preparatory Information Introduction to knowledge and principles needed

Monitored Practice with Feedback Coaching and monitored practice with feedback with the goal of developing consistent competency

Ongoing Supervision and Coaching With a specific focus on maintaining consistency of competence and fidelity Quality Education for a Healthier Scotland

Psychology

Preparatory Information Psychology

• May be traditional introductory workshops or e-learning. • Aim is introduction as first step in a programme of training • E-learning can be time effective, completed in workplace without travel, video examples of practice, and objective assessment of knowledge. • Limitations (at this point), include lack of consistent appropriate and updated technology, frustration of users, no practice element and no peer discussion/feedback element • Risk of assumed competence. Must be followed with coaching and assessment of actual practice to ensure fidelity

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Monitored Practice with Feedback Psychology

• National MI Coach Group (NMICG) established to provide a collective of experienced MI practitioners to provide coaching and feedback to enhance development of skills-based practice • Local coaching groups • Scottish MI Winter School Programme • MIA rating scale system which can be used as a structured system to provide feedback on practice and to set a standard of consistent demonstrated competence Quality Education for a Healthier Scotland

Ongoing Supervision and Coaching

Psychology

• Need to consider supervision and ongoing coaching with the goal to support consistent maintenance of demonstrated competence of MI skills. • Ongoing use of MIA rating scales to monitor own practice. • Ongoing use of peers and coaching groups to compare and receive feedback.

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Reflection: Challenges and Facilitators Challenges • Time • Prioritisation issues • Roles and job descriptions • Staff availability, all stages • Data protection – clinical practice samples • Different service designs

Psychology

Facilitators • Go to evidence base • Identify thresholds & standards • Implementation framework • Process flexible enough to fit most service provision Quality Education for a Healthier Scotland

Discussion Psychology

• Think about an intervention and the skills-based training that is needed to implement it (e.g. Current or proposed). • What are the challenges in implementing this training? • How can you creatively work around these challenges to enhance efficiency, maintain quality and demonstrate competence?

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Final thoughts..... Psychology

• There are no easy answers • The challenge is how to develop training programmes that are efficient, promote quality and lead to demonstrated competence. • Consider implementation plan from outset. • Two day, time-limited courses have not been found to be an efficient use of time and money. • One of the challenges is how to blend and facilitate training, workplace practice and supervision. Quality Education for a Healthier Scotland

As you leave.....

Psychology

• Please take a copy of the reference list of useful articles • Please sign the sheet at the door if you want us to send you the compiled notes from the final discussion session.

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