Christine Samuel, Occupational Therapy Clinical Lead, Rheumatology
Swansea Bay University Health Board
Emotional problems such as low mood and anxiety can impact on quality of life and influence people’s coping strategies with physical conditions. CBT (Cognitive Behavioural Therapy) is the leading evidence based “talking therapy”. It focuses on how thoughts, beliefs and attitudes affect feelings and behaviour, and teaches coping skills for dealing with different problems. Improving Occupational Therapy interventions using a CBT approach, can lead to better patient outcomes.
CBT is frequently delivered via group sessions (allowing more patients to be seen). However, individual face to face sessions may be more appropriate for some patients but waiting times can be significantly longer. Trained occupational therapists, with skills to offer a CBT approach as part of the patient’s treatment plan, could be more prudent by being timelier and ensure continuity of care. Patients requiring more specialist mental health interventions are identified and referred on to the appropriate service.
To enable occupational therapists to have a set of CBT-based skills and to incorporate these into everyday practice.
Attendance at a 4 day training programme delivered by an experienced CBT practitioner.
Training programme offered to occupational therapists from services within Swansea Bay University, Hywel Dda and Cwm Taf health boards who promote the self-management of a range of health conditions (Cardiac Rehab, Pulmonary rehab, Oncology, Paediatrics, Pain management, Rheumatology, Well Being, and Primary Care).
Training to commence with a 2 day programme, followed by 2 one day sessions.
In between training dates, therapists to put into practice techniques learnt with patients and to provide evidence to trainer of how they have utilised the skills.
Improve outcomes in terms of engagement in self-management for patients by utilising a CBT approach
Establish a protocol for screening patients’ suitability for using a CBT approach using Patient Health Questionnaire-9 (PHQ9) and Generalised Anxiety Disorder Assessment (GAD7) or for escalation to mental health services.
The first wave of Covid 19 occurred weeks after the initial training date and resulted in the majority of the therapists being redeployed to hospital wards to assist with rehabilitation and discharge planning. Therefore, they were unable to practice the CBT skills. Many of the therapists did not return to their substantive posts until the summer of 2020.
The second training date was delayed from March to November 2020. Following this, several therapists were redeployed with the second wave of Covid 19. Despite all these delays and setbacks, therapists have been able to practice the skills but not as consistently as planned.
It was planned that all of the training would be held face to face, but due to the pandemic we had to switch to virtual training. Initially this was challenging but the feedback from the sessions was that the quality of the training was not affected.
Training delivered to 18 occupational therapists working in 8 clinical areas which has led to a system improvement in these clinical areas.
Therapists are now familiar with various cognitive techniques to enable them to adopt a CBT approach in their different clinical areas.
Their knowledge and confidence has increased as the training has progressed.
Therapists are able to detect with greater sensitivity those patients who would benefit from a CBT approach and those patients who require more specialist input from mental health services.
In terms of value for money, the training cost was the equivalent of £242 per therapist and based on potential delivery to patients e.g. in Rheumatology Fibromyalgia patients over 2020 this would translate to £1.71 per patient.
Enhancing CPD Portfolio of therapists with approved training
“I found the use of the hot cross bun model allowed the patient to become engaged and activated. She was able to generate her own reasoning into how her emotions/thoughts was impacting her physical symptoms and then behaviour”
“The knowledge gained during the CBT training enabled me to explore issues raised in more depth than I might have previously done so e.g. using Socratic questioning”.
“This group of trainees have worked so hard and been so adaptable, not letting a pandemic get in the way of their learning. They have had to adapt to a changing course, and changed delivery methods. The patients and families that have been helped and continue to be helped with these new skills are evidence of this hard work”.
When therapists are able to return to their substantive posts and services have returned to full capacity, to consolidate the CBT skills learnt and for therapists to continue building confidence to use a CBT approach with appropriate patients.
We are exploring and developing supervision pathways, including peer support.
We plan to develop pathways with Mental Health Services to ensure a smoother transition for patients.
Evaluation of patient outcomes where CBT approach has been utilised
Our Exemplar Experience
Taking part in Bevan Exemplar scheme has been a really valuable experience and one which I would recommend to others. Highlights have included the opportunity to network with professionals from different part of Wales and to attend workshops le by renowned experts.
Bevan Exemplar Showcase 2021
I am extremely grateful to the Bevan Legacy Fund, Neath Port Talbot Hospital for funding this training.
Also to Kathy Burn (Former CBT lead St Christopher’s Hospice TCH, and supervisor King's College London) for leading the inspirational training