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Fiona Johnstone and Andrew Smithsimmons - Cognitive Behavioural Therapists

Behavioural Activation (BA) for Depression

Behavioural Activation is an evidence-based therapy that attempts to help depressed people re-engage in their lives through focused activation strategies. It is recommended within national clinical guidelines for the treatment of depression.

Within Argyll & Bute, the local Psychological Therapies Management Committee (PTMC) identified Behavioural Activation as a therapy that can be delivered by multi-professional groups of staff and supported its development as a means of increasing access to psychological therapies in Argyll and Bute.

Argyll and Bute has a population of 63,606 people living in three geographical areas, each covered by one mental health team. Centrally there is a small inpatient facility with 24 beds based in Lochgilphead.

In November 2012 we applied for and completed NHS Education for Scotland’s (NES) Training for Trainers in Behavioural Activation for Depression. 

We had also completed the NES course, Training in Generic Supervision Competences for Psychological Therapies and attended the Master class in Behavioural Activation as well as the Training for Trainers: Foundations of Education training for educators held in May 2013.

Training Plan

We developed a plan to deliver training in all three areas within Argyll & Bute in 2013 with additional training for Primary Care Mental Health Workers (PCMHW) who were identified as a target group of staff. We sent out a flyer to Team Leaders and PTMC members with dates identified in each locality. Staff who applied received support from Line Managers to attend; and the importance of supervision and use of the model after training was emphasised. The MAPS department took responsibility for training materials, venue bookings and participant bookings. Information about the training was given on application and line manager approval verified.

Our first training for three PCMHW’s went well and convinced us of the transferability of the model to staff and gave us more confidence in our ability as teachers. Seventeen staff attended the training over the year including nine nurses, two occupational therapists, one mental health physiotherapist, three primary care mental health workers, one support coordinator and one assistant psychologist.

Feedback was very positive with a Training Acceptability rating of 88% which indicates an extremely good participant reaction. Comments from participants included: ‘I have an improved understanding of BA and the structure is very useful. The principles and protocol are very helpful’ and ‘I found the discussion that reflected on how one might implement this approach to treatment very helpful’.

Supervision Groups

Two supervision groups have developed which we facilitate.  These are held on a monthly and fortnightly basis respectively.

BA Communication Meeting

Following the national trainers update meeting at NES headquarters this year, a communication meeting was held locally in Argyll & Bute for BA trainers to share information from the national meeting and update on new developments. VC facilities were used and agenda items requested in advance in order to make the best use of the time available. 

The next communication meeting is scheduled to follow the BA Group Training where attendees will share their skills and knowledge post training. The group intends to continue to hold the BA communication meeting on a regular basis.

The Future

We plan to offer new training in each locality in 2014.  One more BA trained member of staff has completed the NES Supervision training and is a valued addition to the BA supervision resource.

We also approached the Practice Education Facilitator for Inpatient Service in Lochgilphead and there is now a training plan in place for Inpatient staff to complete BA Inpatient training when it becomes available in the coming year.

We are also in discussion about how to develop a one-off, half-day, training event for the Guided Self-Help Workers, one in each locality, focusing on the self-help BA resource, Overcoming Depression One Step at a Time (Addis & Martell, 2004).

Summary

From our original NES training as trainers in Behavioural Activation for Depression, we have actively embraced and enjoyed the technical challenge of rolling out the protocol to appropriate staff groups across Argyll & Bute Community Health Partnership (CHP).  Given the size of the staff base in our CHP, the scale of the uptake of the initial 2013 round of BA training should be viewed positively.  It has highlighted key issues for us to continue working on.  These include the differentiation of protocol-based and principle-based applications of BA according to context and client group and the challenge of effectively matching supervision resources to increasing demand from a growing team of practitioners delivering BA. During our 2014 round of training we intend to train an estimated 15 new Outpatient BA therapists and will be working closely with the previous cohort to identify further individuals to bolster supervision resources.