Annual Family Therapy Conference 2014Adelphi 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

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?

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Children and Young People’s Children and Young People’s ProgrammeProgramme

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 People’s Health Outcomes Strategy, – Transfer of project from DH to NHS England in April 2013, – Health Select Committee (HSC) on CAMHS – Mar/Apr 2014

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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.

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CYP-IAPT: Core Implementation Components

Integrated&

Compensatory

Integrated&

Compensatory

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Mentorship & peer support

The CYP IAPT Learning Collaborative

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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 o CBT for anxiety disorders and depression o Parenting training (age 3-10)o Interpersonal Psychotherapy for adolescents (IPT-A) for depression o Competency based curriculum using Roth and Pilling CAMHS

competencieso Systemic Family Practice for conduct disorder (over 10s), depression

and self-harm, and eating disorders

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Systemic Family Practice (SFP) course covers;o Core CYP IAPT curriculum (60 credits)o Systemic Family Practice and basic skills (30 credits)o Module specific pathway;

o Conduct disorder (over 10’s) and depression and self-harm (30 credits)

o Eating disorder pathway (30 credits) –specific entry requirements (hub)o Trainees need to be members of an existing or developing

specialist ED multidisciplinary team in communityo Min of 50 new ED referrals a year o Cover min pop of 500,000o Knowledge and skill required to be held within a team as a

whole

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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. AF

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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.

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Challenges in drawing up the curriculum

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Curriculum consists of

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Who can do the training?• CAMHS workers with1.Prior relevant professional training2.Ability to study at a postgraduate level3.Experience of working in CAMHS4.Some experience of working with families5.Opportunities to carry out required supervised clinical

practice.Some professionals who have already done an intermediate

level training may benefit from the specialist modules. AFT

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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

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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.

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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.

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Specialist Module in Eating DisordersThis 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

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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

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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)

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Some wider reverberations

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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.

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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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