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Psychology

Psychological Interventions and Physical Health

NES Psychology directorate has been developing a programme of work aimed at addressing the training needs of the NHS Scotland workforce in relation to psychological interventions in physical health care. The objective has been to encourage a stepped care model of delivery, a key plank of which has been to deliver Train the Trainers packages to applied psychologist working in physical health settings, alongside the provision of e-learning modules directly to non-psychologists. In addition the team is undertaking projects in relation to patient safety and reducing harm in health care.

Trainer Network

The Trainer Network was set up following an early consultation meeting with applied psychologists from across Scotland. Psychologists have been recruited into the Network as they have undertaken NES training (such as the train the trainers sessions in AsSET and Developing Practice packages) , but also through existing psychology networks and by word of mouth. As a result around 70 trainers working in physical health settings form the network.  The network meets 2-3 times per annum to support delivery of training in clinical settings, review training materials and collate data on training outcomes.  Trainers in the network can also access materials which support training through a Moodle page.

Details of the Network and future Train the Trainer events are available from leeanne.nicklas@nes.scot.nhs.uk or mairi.albiston@nes.scot.nhs.uk

Emotion Matters – e-learning module

Emotion Matters was developed by the Physical Health Team in the Psychology Directorate at NHS Education for Scotland (NES).  The team worked closely with the NMAHP NES Self Management team who requested training following feedback, from practitioners, that they did not feel skilled in addressing emotional issues when working with people living with long-term conditions.

Emotion Matters aims to:-

  • increase understanding and awareness of the psycho-social aspects of living with a long term condition
  • provide skills that will enable more holistic, collaborative and person centred care

The team also worked closely with the Alliance and the Scottish Government self management unit. The Alliance’s document:  “Emotional Support Matters 2011”, was published in response to people with long-term conditions wanting a more holistic approach taken by health care practitioners to their care. This report formed the policy bedrock upon which Emotion Matters was built.

‘People with long term conditions want holistic support that includes emotional and psychological support as part of an integrated service and not just as an add on.’

A Competence Framework for Psychological Interventions with People with Persistent Physical Health Problems

Officially launched in Scotland in March 2016, this competence framework was commissioned by NHS Education for Scotland and the Improving Access to Psychological Therapies (IAPT) programme in England. The project team was headed by Anthony Roth and Stephen Pilling from University College London (UCL).

The competence framework describes the method for identifying competences for staff working with people with persistent physical health conditions. It organises the competences into seven domains, with an overarching domain that identifies the ‘therapeutic stance, values and assumptions’ for work in this area. The domains are organised into a ‘map’ which shows how all the competences fit together and inter-relate.

Please see the below link to access further information on the framework, including background on its development and the various competencies outlined. The link also contains details regarding the implementation of the competence framework, and considers some of the organisational issues around its application.

https://www.ucl.ac.uk/pals/research/cehp/research-groups/core/competence-frameworks/Psychological_Interventions_with_People_with_Persistent_Physical_Health_Problems

The Matrix (2015) A Guide to Delivering Evidence-Based Psychological Therapies in Scotland; Persistent Physical Symptoms

The Psychological Therapies 'Matrix' is a guide to planning and delivering evidence-based Psychological Therapies within NHS Boards in Scotland. The Matrix is published by NES, in partnership with the Scottish Government. It provides a summary of the information on the current evidence base for various therapeutic approaches, guidance on well functioning psychological therapies services and advice on important governance issues. The sub-section relating to the psychological management of persistent physical symptoms was updated in 2015. Persistent Physical Symptoms refers to health problems that last a year or longer, impact on a person’s life, and may require ongoing care and support. The definition does not relate to any one condition, care group or age category. Common examples include diabetes, heart disease, chronic pain, arthritis, inflammatory bowel disease, asthma and chronic obstructive pulmonary disease (COPD).

The evidence tables for persistent physical symptoms can be found and downloaded in the link below: /media/3500010/matrix_-_persisent_physical_symptomstablesfinal_1.pdf

Economic Paper

Psychological Interventions in Physical Health Care: The need and the Economic Case

Written in 2015, the evidence reviewed suggests that psychological problems account for a considerable proportion of the disease burden of both long term conditions and medically unexplained physical symptoms. The additional costs are associated in the main with increased medical treatment, length of stay in hospital, additional medical consultations and pharmacological costs. This is independent of costs associated with treating any psychological problems. Worryingly co morbid psychological problems impede people’s ability to self-manage their conditions and is associated with increased mortality.

Psychological interventions have been shown to improve co morbid anxiety and depression particularly where such treatments can be integrated into the overall treatment for the LTC/ MUS. Such treatments have been shown to have true economic benefits for both threshold and sub threshold psychological problems.

Taken together, the evidence for positive clinical outcomes and economic benefits of treatment suggest that addressing psychological problems should be a core, and where possible integrated part of the treatment of both Long Term Conditions and Medically Unexplained Symptoms.

For further details, please see the entire report which is available here.

 

DCP-S Review article

A summary of the work conducted by the NES Psychology Directorate in the area of physical health can be found in the article 'Strengthening the connections: Psychological interventions and physical health' which was published in the Division of Clinical Psychology (DCP-S) Review Summer 2016 edition.  This  article can be found here.