Annual Family Therapy Conference 2014 Adelphi 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? AFT Conference 2014 SFP CYP IAPT

Transformation of Mental Health Services for Children and Young People in England? With thanks to Anne O’Herlihy and Judith Lask for many of these slides

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 AFT Conference 2014 SFP CYP IAPT

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. AFT Conference 2014 SFP CYP IAPT

CYP-IAPT: Core Implementation Components Identification of partnerships Training of supervisors Training of therapists Workplace supervision Routine outcomes monitoring Leadership and management training CAPA and other collaborative systems Integrated & Compensatory AFT Conference 2014 SFP CYP IAPT

The CYP IAPT Learning Collaborative HEIs (n=5) Assure quality Organise training Deliver content in partnership Yr1 Partnerships (n=18; 2011/12) CAMHS-Vol.S/LA-Commissioners Yr2 Partnerships (n=24; 2012/13) Yr3 Partnerships (n=25; 2013/14) AFT Conference 2014 SFP CYP IAPT Mentorship & peer support

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 CBT for anxiety disorders and depression Parenting training (age 3-10) Interpersonal Psychotherapy for adolescents (IPT-A) for depression Competency based curriculum using Roth and Pilling CAMHS competencies Systemic Family Practice for conduct disorder (over 10s), depression and self-harm, and eating disorders AFT Conference 2014 SFP CYP IAPT 7

Systemic Family Practice (SFP) course covers; Core CYP IAPT curriculum (60 credits) Systemic Family Practice and basic skills (30 credits) Module specific pathway; Conduct disorder (over 10’s) and depression and self-harm (30 credits) Eating disorder pathway (30 credits) –specific entry requirements (hub) Trainees need to be members of an existing or developing specialist ED multidisciplinary team in community Min of 50 new ED referrals a year Cover min pop of 500,000 Knowledge and skill required to be held within a team as a whole AFT Conference 2014 SFP CYP IAPT

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. AFT Conference 2014 SFP CYP IAPT

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. AFT Conference 2014 SFP CYP IAPT

Challenges in drawing up the curriculum To provide a theoretical foundation Base on evidence Integrate with CYP IAPT principles Develop skill level to work confidently with day to day work Develop understanding of ethics and working with difference AFT Conference 2014 SFP CYP IAPT

Curriculum consists of Basic module plus Depression and Self harm Or Conduct disorder or Eating Disorders AFT Conference 2014 SFP CYP IAPT

Who can do the training? CAMHS workers with Prior relevant professional training Ability to study at a postgraduate level Experience of working in CAMHS Some experience of working with families 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 Conference 2014 SFP CYP IAPT

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 AFT Conference 2014 SFP CYP IAPT

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. AFT Conference 2014 SFP CYP IAPT

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. AFT Conference 2014 SFP CYP IAPT

Specialist Module in Eating Disorders This 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 AFT Conference 2014 SFP CYP IAPT

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 AFT Conference 2014 SFP CYP IAPT

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) AFT Conference 2014 SFP CYP IAPT

Some wider reverberations AFT Conference 2014 SFP CYP IAPT

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. AFT Conference 2014 SFP CYP IAPT

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. AFT Conference 2014 SFP CYP IAPT