Ideas on how IAPT could run better

This section is for discussion relating to the Layard report, and subsequent schemes like Improving Access to Psychological Therapies where lower intensity inteventions are offered in primary care
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iTeeful
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Ideas on how IAPT could run better

Post by iTeeful »

Hi All!

I would love to start a discussion on how IAPT workers believe their service could run things better, whether that be for PWP's, HI's or Patients

Particularly now with the pandemic, it would be great to hear any innovative ideas on how you believe things in IAPT could improve, are there certain ways which you think certain problems (which you have noticed) could be resolved? this can also be unrelated to the pandemic.

I think particularly for non-senior staff members, we often have a lot of good ideas but often do not speak out because we feel like there is no point, etc. but I would honestly love to hear some of your ideas. Even if they have been ideas which you did speak about and it was implemented, how did this turn out, etc?

I look forward to reading some of your great ideas!
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maven
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Re: Ideas on how IAPT could run better

Post by maven »

Why not start the thread with some of your own? Otherwise people might think you are trying to write an essay or prepare for an interview and want to harvest their ideas!
Maven.

Wise men talk because they have something to say, fools because they have to say something - Plato
The fool thinks himself to be wise, but the wise man knows himself to be a fool - Shakespeare
iTeeful
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Re: Ideas on how IAPT could run better

Post by iTeeful »

That is a very good point, I did not think of this! Thank you.

I think for myself, certain issues have come up for both Clinicians and Clients, particularly interpreter clients.

For clinicians I believe therapist drift is a big issue. I do believe the more experience we have the better therapists we become but we can also start to drift from evidence based interventions or NICE guidelines, especially because the work can also be quite repetitive and demanding. It would be great if therapists were given the time to have a sort of ‘study day’ once in a while where they can refresh their knowledge on what was taught to them and review their practices. I also think it would be great if therapists could share treatment/assessment tapes with one another where we could then rate each other’s tapes (sounds a bit like a nightmare) but I think it would be helpful. Logistically how we might find time to get therapists a ‘study day’ I need to think about more but iapt is usually quite flexible with a lot of staff working for them so maybe having one study day every few months alternating between therapists wouldn’t make such a big difference to contacts.

With interpreters and clients I thought it would be good practice to consider matching clients with interpreters of the same age, gender and ethnicity. I think it would be a good way to give clients extra opportunities to feel comfortable particularly when a 3rd person is involved in their therapy. I have had clients who have been uncomfortable with certain interpreters because of age, gender etc. And have only found out after a session, when it would actually be helpful to find this out before booking an interpreter. Especially because due to the pandemic we are mainly using an interpreter telephone service and get a random interpreter on the phone, which sometimes doesn’t work out so well.

But that is just two of my thoughts. Would be interested to hear other thoughts or even if you have any comments about mine.
hawke
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Re: Ideas on how IAPT could run better

Post by hawke »

Interesting! The main thing I disliked about IAPT was the assessment process - sometimes it felt like we were assessing someone just to find a reason to exclude them from the service. Often this was the classic bouncing between primary/secondary care. I've seen various solutions to this, including practitioners who work at step 3.5 (mostly with trauma/personality difficulties in groups or 1-1), and I think this would be an interesting job if it was offered at a lower caseload and more flexibility than traditional step 3 work. It could be a good band 7 clin psych role, or a good specialism for an experienced CBT therapist.

I also think IAPT could benefit from closer links to a multi-disciplinary team for developing bespoke evidence-based local pathways to expand beyond depression and anxiety. Particularly now it's been established a few years, a lot of services are full of psychology graduates who have been through the PWP route, and I think services will miss the diverse perspectives from nursing, OT, clin psych, social workers etc. I absolutely love how IAPT is leading on adaptations for diverse groups, but I think there's more room to acknowledge the full range of bio-psycho-social interventions.

Day to day, I agree, I think there needs to be a bigger focus on practitioners wellbeing and skills development to stop qualified staff stagnating, drifting, and leaving. What kept me in IAPT for so long was how much I enjoyed working with my colleagues, but I know that team stuff has been pushed out because of caseload pressures.
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Spatch
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Re: Ideas on how IAPT could run better

Post by Spatch »

1) Good leadership, with people being picked out for their ability to manage people rather than out of seniority or being there the longest.
-Probably the most important element.

2) As long as IAPT continues to hire PWPs out of a pool of ambitious, highly motivated psychology graduates with great academic prospects, they will continue to have the leaky bucket problem they have always had of high staff turnover and all the skilled staff leaving for DClinPsys. If they shifted their focus to hiring people with only 2:2s, with really strong local links and no major ambitions and were happy to do routine PWP work for an average UK wage, you would have a far more stable and happy workforce in the longer term. If it continues to be a stepping stone to better things, it's never going to get better.

3) From my conversations with various comissioners and senior teams, they still see IAPT as a disposable workforce that doesn't warrant a full career pathway, salary consideration or associated benefits, which indicates improvement is unlikely to develop from the top down. Realistically the only way the political situation on the ground will change is if IAPT workers strongly unionise, develop professional solidarity and collectively bargain for their rights and working conditions like it's the 1970s.

3) One of the biggest problems is that PWPs/HIAPTs and the IAPT workforce is still percieved as lesser than the more established professions and there has been a failure for the workforce to develop a strong professional identity. I have no empirical evidence for this, but my view is that this has been internalised by the IAPT workforce to some extent. For example people within the IAPT workforce tend to identify more with their core profession ("I am a CPN") when you meet them for the first time in a non work context. Until the perception that IAPT is "proper psychology being done on the cheap with unqualified staff" goes, I think it will continue to have problems around morale and recognition -which makes for a terrible work environment.

It is a pity because it doesn't have to be this way. There could be a more enlightened version of IAPT that moves away from the call centre, sweatshop model to a genuinely more enlighted version with the emphasis on the 'Improving Access' part rather than the 'Psychologial therapies'. That could be greater integration with developments like community psychology, social prescribing, peer support and things like Camerados, which would make it a far nicer place to work. However, if it continues to doggedly pursue the current 'lets pretend it's like traditional therapy' aspiration, they are always going to lose.
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