Improving Access to Psychological Therapies (IAPT) services are basically primary care mental health services. They are very new in their current incarnation, although primary care services have been in existence in other forms for a while (Gateway workers, Graduate Mental Health Workers etc). It is not my intention to outline the political history of the IAPT agenda; you can look at http://www.iapt.nhs.uk to get more of that kind of information. What I will attempt to do is outline the roles of the clinical workers within IAPT services and how they relate to clinical psychology. There are generally two types of practitioner in an IAPT service; low intensity and high intensity.
Low intensity Workers (also known as: Psychological Wellbeing Practitioners, Graduate Mental Health Workers, Primary Care Mental Health Workers)
Low intensity workers (LIW’s) are usually taken on as trainees, paid at NHS Agenda for Change Band 4. They complete a one year post-graduate certificate, which involves one day a week in teaching and the other 4 in practice, with assignments to complete (including recordings of sessions, written pieces, practice logs and reflective work). The posts are intended for graduates (of any subject, with work experience in mental health) although there are pathways for non-graduates. After completing this certificate, LIW’s can apply for a job as a qualified LIW at band 5 (some services will be less formal and offer a transition to band 5 on completion of the certificate).
The mantra for this role is low intensity, high volume. Sessions are short at around 30 minutes, with plenty of telephone work as opposed to face-to-face sessions, and one-off contacts or short interventions. LIW’s use a ‘guided self help’ approach based on CBT techniques. This could be helping clients work through self-help work books, supporting them with computer-CBT or delivering brief interventions like behavioural activation.
Mostly, LIW’s will see clients with mild to moderate anxiety and depression, though my experience in this role is that a far more varied client group is seen. This is because until IAPT, GP’s had very little primary care mental health provision, so they are now sending referrals through for people who need help but do not fit eligibility criteria for secondary care. Subsequently you may also see; bereavement, anger, OCD, disordered eating habits, relationship problems, self-esteem/assertiveness issues…the list goes on. It is worth remembering, though, that like any role LIW’s must work within their competence, seek supervision and signpost where appropriate. LIW’s tend to be less ‘sheltered’ than assistant psychologist (bigger caseloads, less ‘cherry-picked’ cases); therefore they are expected to be quite responsible with bringing things to supervision.
LIW’s are often supervised by High Intensity Workers (see below). IAPT have recently written guidance on supervision for LIW’s – again, look around the website http://www.iapt.nhs.uk for more detailed info. The main thing to bear in mind is that HIW’s come from a variety of backgrounds, with many of them being mental health nurses by training (a convert from the old ‘gateway worker’ scheme). Others may be social workers, occupational therapists, counsellors or psychologists (amongst others). I personally feel this is one of the strengths of IAPT as it offers a variety of perspectives and experience. However, it does mean that if you’re interested in following a career in CP (and you’re in to box-ticking exercises) that you may not be supervised by a CP.
A lot of people ask whether low intensity work is a ‘step down’ from being an assistant psychologist. Generally, the answer is ‘no’ as it is a different job, and not directly comparable. I’ve found that people who move in to LIW roles expecting to be an ‘AP in primary care’ are disappointed, mostly because there is not as much in-depth face to face ‘therapy’ as they would like. However, there are a lot of valuable transferable skills you can get from this type of work (I’ll leave you to figure out what they are!). Also, when it comes down to it, it’s about what’s best for the client, not what’s best for your career. Low intensity interventions can be very empowering for people as they take charge of their own recovery, and do a lot of the work themselves – LIW’s are there to facilitate this.
High Intensity Workers (also known as Psychological Therapists)
There are two routes to high intensity work. You can progress to a High Intensity Trainee role once you have worked as a qualified LIW (usually for around 2 years, though this varies according to your experience prior to being employed as a PWP). You will need to prove that you can meet KSA (Knowledge, Skills and Attitudes) criteria as stipulated by the BABCP http://www.babcp.com/Accreditation/CBP/ ... ation.aspx. If you are applying for HIW posts from a non core-profession background, it is extremely important that you read through that information before even applying for posts to make sure that you can demonstrate all of the criterion.
You can also apply directly if you have the right qualifications (usually a professional qualification like social work or nursing, although experienced LIW’s with a post-grad certificate have been know to be accepted as trainees). As services have found their feet, there is more focus on recruiting from counsellors, clinical and counseling psychologists and psychotherapists (i.e. people with extensive psychological therapy experience).
Trainees are taken on at agenda for change band 6, and spend 2 days a week at uni doing a postgrad diploma in CBT/high intensity interventions, with the remaining 3 days in practice. On qualification they will be BABCP accredited and eligible for band 7 qualified HIW posts. People who already have BABCP accredited status in CBT can apply directly for band 7 posts (DClinPsy does not necessarily furnish you with this qualification, though some courses are changing some content to ensure they do).
HIW’s focus a lot more on face-to-face therapeutic work, with a heavy focus on CBT (although there are plans to widen this focus to other evidence based therapeutic modes). The clients tend to be more complex and their ‘symptomology’ more severe (the IAPT model can be quite economic/medical in its concepts and terminology, though the practitioners are not!). Sessions can last longer (up to an hour, though many services are pushing a 40-50 minute session) and there can be more of them (again variable, but around 12).
Careers-wise, there is large scope for CP’s to be involved in IAPT. Newly qualified CP’s with the right compmetencies can apply for Band 7 HIW jobs and have that something extra to offer in terms of supervision, teaching and consultancy. Many of the 8a team leader roles and 8c service leader roles (even 8d in larger services!) are staffed by psychologists.
What about IAPT as ‘relevant experience’ for the doctorate?
Being a practitioner in the IAPT scheme is intended to be a career in itself, not a stepping stone to clinical psychology. Many Trusts are wise to applicants with psychology degrees and a history of AP posts these days; many are building in contract clauses that mean you have to work a certain amount of time post-training or pay back the costs incurred. That said, many people have successfully gained places on doctorate courses following experience in an IAPT role. As previously mentioned though, this is often due to the transferable skills learnt and demonstrated in your form and at interview, not just the job title or volume of client contact.
Added by baa on 26th July 2010
Some useful links
Here are some links that I found incredibly useful during my time as a PWP
http://www.livinglifetothefull.com/ a free cCBT website
http://www.beatingtheblues.co.uk/ another free cCBT website with a focus on depression
http://www.cci.health.wa.gov.au/resources/mhp.cfm an Australian site with possibly the best guided self help info I have found yet. Everything is very clear and their brief info sheets are very good to give out in sessions.
http://glasgowsteps.com/ A Scottish site with a similar set out to IAPT (guided self help etc)
http://www.overcoming.co.uk/single.htm?ipg=4795 The Overcoming range of books are all based on CBT, and I tend to recommend these if anyone wants self help material that is in more depth than the manuals most services have. I think I should work on commission for them.
http://www.getselfhelp.co.uk/freedownloads.htm My new favourite site - brilliant for formulation template, thought diaries and every worksheet that you could dream of (and isn't in the CCI site above)
You might also want to take a look at baa's account of a week in the life of an IAPT low intensity worker and a week in the life of an IAPT Psychological Therapist in training
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Content checked by qualified Clinical Psychologist on 25.6.16[/b]