A Week in the Life of an IAPT Low Intensity Worker

[baa]

A week in the life of a trainee Low Intensity Worker/Psychological Wellbeing Practitioner.

I work part time at the moment: one day at uni and four days out in practice. My team has been established for approx 2 years, so we're over most of the teething problems, however, we're expanding up to three LIWs and three HIWs. Yes, we are taking over the world. I've worked here since Aug 2008. It's a very rural area, I cover 3 GP surgeries, two in one town and one out in the middle of nowhere.

Monday:

Monday is uni day, so I arrive early to attempt to find a car parking space and to fill up on coffee before teaching starts. There are at least two NHS Trust represented in my uni group, plus extra people from Mind and employment support charities. Today we cover Employment and Occupation. Have a bit of a vague lecture on reasons to work vs reasons not to work. I decide that I need to trade in The Bf for a richer model. Discuss how each NHS Trust's IAPT team views the LIW role in getting people back to work - my view of my role in this is to address any issues related to anxiety and/or depression that is impacting on the person's work life, however, if there are issues relating to relationships with managers/colleagues, issues around disputes and disciplinaries, or the need for general career advice - I tend to refer my people on to the employment support charity - who are much, much better at this sort of thing than me!

The teaching session then collapses into the usual chaos of various people discussing the difficulties with IAPT in their area - this often happens, more so with the very new services.

Lunch and a good gossip with people from my Trust and the other Trusts, always good to hear what everyone else is up to. This can be one of the best things about the training course given the isolation you can experience in the LIW role.

Afternoon - a quick run through of our looming assessment. It's going to be a group activity: each person presents a person they have seen who has "some kind of diversity", then we all decide to focus on one in more detail and discuss the impact of that "kind of diversity" on the assessment and treatment plan. We discuss three people who have physical health issues alongside and sometimes related to the mental health issue, one Portuguese person, and mine: a clergyman with anxiety. We decide to focus on mine and decide on some topics to cover in the assessment next week. We also get an outline of the reflective essay we will have to write on our discussion.

Tuesday:
Off to work. I start off planning to see a young man in one of the bases, he can't make my usual slot at her GP surgery as he's at college. Unfortunately he misses the bus (one an hour, my patch is rather rural), so I need to call him to rearrange. I was going to focus on social phobia with him, mostly cognitive restructuring alongisde some exposure work. He may well be stepped up once I've had my six sessions with him as he has a history of mental health difficulties as well as difficult family dynamics, but we'll see how he goes.
Drive to the other base to see a young lady at midday (again, she can't make my usual GP slot due to work commitments). More social phobia, so we focus on exposure and set some tasks for her to try out over the next two weeks.

After lunch, I badger the clinical psychologist for info on intrusive thoughts, I want a list of them to show people in sessions to help them to normalise their own intrusive thoughts. I run through the list myself and workout that I experience the majority of them. Oops. Tweak a few thought diaries for different clients, photocopy a million self-help guides.

Regular Tuesday afternoon at one of my GP surgeries, usual routine, turn up, forget yet another door code, find a spare GP room to borrow, and remove all medical objects from the desk. Two new assessments: One lady I'm quite worried about in terms of risk to self as there's a lot going on for her in terms of her family situation. So I let her know that I will discuss this with my supervisor and will contact her after supervision to discuss her seeing me or the high intensity worker. Second assessment: nice vague assessment letter about anxiety and depression. The lady is doing very well on antidepressants, can challenge her own negative thoughts, can use distraction well. So I suggest Overcoming Insomnia and Sleep Problems and discharge her. Have a DNA for my final appointment (social phobia, was going to discuss exposure work), so I write up some info on intrusive thoughts while I'm waiting.

Wednesday:
Regular Wednesday morning clinic at the GP surgery in the middle of nowhere, first person previously experienced health anxiety, but is feeling much better, is knowledgeable about their own triggers, and has a good number of coping strategies. Doesn't want more appointments, so I discharge her. Second person attends for second session and we focus on testing the reality of thoughts related to GAD. Have had to make sure that they understand that my role involves looking at the anxiety rather than the difficult relationship with her parents, I let her know I could refer on to Relate if they feel it would help. Third person DNAs - this was the woman I needed to research intrusive thoughts for. Shame she's not here as I have actually planned the session! Have jinxed myself.

Afternoon - admin time at the moment, it's all about DNA letters and discharge letters. I also need to play phone tag with the counselling service to organise two referrals for people I have assessed but would benefit more from a counsellor than from a LIW. Telephone a bunch of people, if I don't get through then I send out opt-in letters. I have too many people on my caseload to send out appointments to everyone, especially as a good chunk will DNA the first appt and will never make contact. Just started the opt in system, hoping it will reduce the DNA rate!
4pm is supervision, so we run through my supervisor alerts on our record system, then run through my new referrals (five for this week), we sift out the ones that need a HIW, and discuss the focus of the assessment for the others. Then I discuss any people who I have concerns with/need help with. The lady I was worried about from Tuesday will be stepped up to a HIW.

Thursday:
First thing I call the lady from Tuesday back to discuss stepping him up to HIW, then it's more admin time - Send out a bunch of first appointment letters, attempting to stick within our 10 day target - managing it with one surgery, but failing miserably with the other two.
Get an email from my supervisor - apparently one of my GP surgeries has been singing my praises. Lovely to hear this, especially as they were a more reluctant surgery at the outset! There will be more referrals coming my way apparently!

12:30 IAPT team meeting.
I discuss running some workshops on anxiety and depression, I went to a Living Life to the Full training course and the outline for the workshops sound promising! We're hoping to start them off in the two towns that we cover. Pretty much all of the other LIW/HIWs are interested in running the workshops.
I also discuss referrals to LIWs of people with some symptoms of body dysmorphic disorder, I'm happy to take these people, but only if I get some training and actually know what I'm doing! It's aggreed that these referrals are suitable for a LIW and my supervisor gives me a whole lot of reading and asks me to prepare an overview of the CBT model of BDD for our next supervision session.

Then I have an overspill clinic from one of my busier surgeries, I've based it in the secondary care services building for the time being, but will be moving these appointments to a community centre. Three clients, all new, one with a stress related problem who DNAs, one man with mild OCD who has been stepped down from Secondary Care (he has bipolar depression, but that is under control via the psychiatrist), I do a basic assessment of his OCD and provide him with a self-help guide on OCD. I highlight the parts we will be focusing on in the session and ask him to read through them. The third person appears to have a mix of GAD and panic. They were seen by the psychology dept in secondary care, but has been stepped down to IAPT.

Friday:
Regular morning clinic at my third GP surgery. I have two new assessments, and the newest HIW is shadowing me. I quite like having people shadowing me, as I have someone to talk to during DNAs!
The first is a young man who has been through most of the services in the area! From the psychosis early intervention, to drug and alcohol, to a government run employment training course and finally back to me. The employment course has worked it's magic, so I discharge him.
The second is a woman with panic disorder with agoraphobia since a bereavement some years ago, plus some possible symptoms of OCD. Definitely, definitely needs stepping up as too complex for six sessions of guided self-help.
Last of my Friday afternoon clinics (had to move the day due to an increase of referrals from the GP, he's sending more people to us than the counsellors now, it's good to know he thinks we're useful!). I see two people, one new assesment and one followup.
Finally dash back to base to see one more person at 4pm (bad timing on a Friday!). Supporting a person to reduce their hairpulling.

I wrote this a while ago, but never got around to posting it! I've now qualified and am working full time. I now have 5 surgeries, I cover four on my own and share the other with another LIW.


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[kelebek]

My experience is quite different as my service is fairly new.

I do not have any GP's and I don't get to see clients at all. All our work is done over the phone. We wont be having any face to face work in this service.

I am not doing uni as I was upgraded to band 5, qualified position soon after I started as band 4. Although, I have started to question this decsion as it seems like a ''money saving project'' for my service. But I am going to push them for top up training as it gets accrecited now.

I contact up to 15 patients every day. I usually get hold of 5 to 6 of them. go thorugh an assessment with them, it usually involves risk assessment. The patient and I decide suitable treatment for them, usually guided self helo cCBT or groupd work. I then type a letter to send them with our decisions about treatment.

I am going to run depression and anxiety groups very soon, that will give some face to face patient contact.

We have a reflective group meetings every week where we off load all our isues as a team. I have not received any supervison yet despite asking my manager every single day. I have been working without supervision for 2 months. But I got a promise today I am starting to receive supervision from this thursday onwards.