BABCP/IAPT standpoint on PWPs -> CBT

This section is for discussion relating to the Layard report, and subsequent schemes like Improving Access to Psychological Therapies where lower intensity inteventions are offered in primary care
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Borrowed Cone
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Re: BABCP/IAPT standpoint on PWPs -> CBT

Post by Borrowed Cone » Thu Dec 22, 2011 8:36 pm

Will wrote:
Borrowed Cone wrote:I don't believe "senior PWPs" should be managing services.
Had to respond to this one :wink: Why not? The PWP role requires specialised skills and is very different to many other jobs. Additionally it's a new role and many services are still developing. In my opinion, someone who has experience of the role is well placed to manage a service.
I do not deny that the PWP post requires specialist skills, nor that it is different to "many other jobs". They are no market traders, that's for sure. I think you are missing the point.

I do not see how anyone can possibly justify how someone without professional mental health training can manage a mental health service. Quite frankly, with respect, PWPs are in no position to. PWPs have an important role, and their training is very specific, and limited to that role. Running an entire service requires much more than just knowing how to do a specific job.

I've been trying to think of something to compare this situation to but I'm struggling. Maybe an example would be me knowing how to draw blood for testing, or what dose antidepressants to prescribe. Just because I "know how to do it" doesn't mean I can just say, "right, I think I should be doing this now with my clients", or "right, I'm going to manage the accident and emergency department". Extreme examples, yes. Hopefully that makes some sort of sense to someone.

Anyway, this is all starting to get away from the original thread, so just to bring it back, I'm not saying their should be no progression within the PWP role. But we must not forget that it is a specific role, and if you want to do all the other stuff, then it would seem sensible to use your valuable experience thus far to apply for training in an allied healthcare profession, or even medicine!

Now, hand me a syringe...
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Re: BABCP/IAPT standpoint on PWPs -> CBT

Post by the-bengologist » Thu Dec 22, 2011 8:47 pm

Borrowed Cone wrote:
I would also like clarification from someone (perhaps baa) re clinical responsibility, as it is my understanding that PWPs do not hold this for their clients.

The Cone
Hi Cone,

Well as a PWP in my service, we are fully responsible for monitoring risk; and also utilising case supervision to manage any potential changes. The PWPs in my service are responsible for dealing with any child protection issues and having to directly speak to safeguarding teams and hold responsiblity for that. Being on the so called 'frontline' we also refer directly to crisis teams/secondary care, however if required we can run our suggestions or queries past a senior clinician.

Returning back to risk, the PWP would be the first point of contact (in terms of accountability) if, for instance, someone was to commit suicide and there had been indicators or risk factors that were not picked up. Therefore I do feel this role holds quite a lot of client responsibility, as we independantly manage our own caseload.

I do agree with you regarding the specific training issue and management.

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Re: BABCP/IAPT standpoint on PWPs -> CBT

Post by Borrowed Cone » Fri Dec 23, 2011 12:16 am

the-bengologist wrote:
Hi Cone,

Well as a PWP in my service, we are fully responsible for monitoring risk; and also utilising case supervision to manage any potential changes. The PWPs in my service are responsible for dealing with any child protection issues and having to directly speak to safeguarding teams and hold responsiblity for that. Being on the so called 'frontline' we also refer directly to crisis teams/secondary care, however if required we can run our suggestions or queries past a senior clinician.

Returning back to risk, the PWP would be the first point of contact (in terms of accountability) if, for instance, someone was to commit suicide and there had been indicators or risk factors that were not picked up. Therefore I do feel this role holds quite a lot of client responsibility, as we independantly manage our own caseload.

I do agree with you regarding the specific training issue and management.
Thanks Bengologist, that is most helpful, although those responsibilities do not necessarily mean overall clinical responsibility, which, with a cynical hat on, is more of a legal thing and sort of about who ends up in the dock when it all goes pear-shaped... hypothetically of course... but it is also about the person who determines whether/what care someone will receive. So, when I referred to IAPT from secondary care, it would go to the clinical psychologist running that particular IAPT team, who would then allocate the person to the appropriate step.

The trainees amongst us are also expected to do those things you mention above if relevant to the service; but ultimately it is the supervisor who holds responsibility for the client's care provision, and unless we actively do something illegal it would be their head on the chopping block 8)

However another difference should be noted here, in that a PWP is providing a service, whilst the trainee is providing a service as part of their training, so that may result in different expectations, perhaps.

I will also point out that child protection is everyone's responsibility :)
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Re: BABCP/IAPT standpoint on PWPs -> CBT

Post by LIWY » Fri Dec 23, 2011 3:38 am

Cone - have you ever actually worked in a service with PWPs? As you don't really seem to get the role - and have all sorts of assumptions about it that are incorrect as far as what happens/would happen in the service I work in for instance. Also, have you worked in primary care mental health? I'm wondering because you seem to presume it is all being run by CPs which is not the case at all, there are a lot of people who have worked up from counsellor/psychotherapist.

...and what is all this head on the chopping block stuff? No clinician nor supervisor has had their "head chopped" for the incidents that have taken place in the years I have been in my service. People have to go to inquests yes - have you been to an inquest? Did you see any metaphorical head chopping? I haven't - all I have seen is an explanation of procedure, how it was followed and what work was done with the service user.

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Re: BABCP/IAPT standpoint on PWPs -> CBT

Post by Spatch » Fri Dec 23, 2011 4:10 am

I think it is important to point out that trainee CPs are groomed (in the non pedo sense) to be a supervisory/ consultatory/ management role, via teaching, service related project, assessment and placement activity. Afaik this is not the same for PWPs, (and I have worked in primary care, albeit briefly). I wonder if this is what The Cone is getting at in terms of competency.

Then again I have to say, any PWPs that can outgun competing cps and sell themselves as more suitable quite frankly deserves that job...

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Re: BABCP/IAPT standpoint on PWPs -> CBT

Post by baa » Fri Dec 23, 2011 10:23 am

The medical responsibility lies with the GP, if that's any use. I'm not responsible for ALL of their cases as a supervisor, but I am responsible for the decisions made and info given in supervision. If that makes sense. They have a willion cases, I can only be responsible for the ones they talk about, they have a responsibility to bring them to me if there are Ishoos. Though PCMIS (the notes system) highlights every person regularly, it is the PWPs responsibility to tell me if there is anything that needs discussing. It's not the same as a CP supervising a trainee or an AP, as not everyone is discussed in the same depth, and as a supervisor, I'm not 'signing them off' in the same way that a CP might sign off a trainee (unless you are supervising trainee PWPs, then you are signing them off as competent). The information that I was given through the Trust policy and clinical supervision training (with a CP) was that I am not clinically responsible for their cases; they are. If the poo hits the fan, then the PWP will required to stand up in court as the person who was working with the patient and the one who has been conducting the risk assessment.

We have mental health practitioners who allocate cases (either through paper or appointment triage), rather than CPs.

The PWP qualification alone does not consitute a professional qualification, but being able to complete the KSA does, and the PWP qualification can be a part of that plus additional experience, and possibly other training.

Re: supervising PWPs - it is easier when your supervisor is fully aware of your role and responsibilities. In an ideal world, this would always be the case. But it ain't an ideal world! To combat this (I think) all PWP supervisors are required to attend an IAPT supervisor training course, I assume this will cover the PWP role, and the specific issues needed to be looked at in PWP supervision. I will report back when I have been on the training!
At least I'm not as mad as that one!

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Re: BABCP/IAPT standpoint on PWPs -> CBT

Post by Borrowed Cone » Fri Dec 23, 2011 12:39 pm

LIWY wrote:Cone - have you ever actually worked in a service with PWPs? As you don't really seem to get the role - and have all sorts of assumptions about it that are incorrect as far as what happens/would happen in the service I work in for instance. Also, have you worked in primary care mental health? I'm wondering because you seem to presume it is all being run by CPs which is not the case at all, there are a lot of people who have worked up from counsellor/psychotherapist.

...and what is all this head on the chopping block stuff? No clinician nor supervisor has had their "head chopped" for the incidents that have taken place in the years I have been in my service. People have to go to inquests yes - have you been to an inquest? Did you see any metaphorical head chopping? I haven't - all I have seen is an explanation of procedure, how it was followed and what work was done with the service user.
Yes, I am familiar with the role of PWPs however I realise that IaPt services are not all the same and may not be set up in the same way as the one I am talking about from my experience.

Spatch was right to say I was probably hinting at competencies, which I was, although I didn't want to put it quite like that. Perhaps I should have.

I in no way presume that all primary care mental health services are run by CPs, they are just one Mental health profession that might do it.

My point about the chopping block was meant as tongue in cheek. I am trying to remain objective in my posts, but it is difficult when one is met with such defensive response. I think it is important that we are all aware of the limits of what we can do, and what is within our competencies. My point is that this applies to PWPs as much as it does to CPs.

I really am not trying to knock PWPs at all. I think it it's great that more people have the opportunity to engage in mental health services, particular when the problems are more mild. I know several PWPs who certainly have a better knowledge of conducting low intensity interventions than I currently do, and who would make great trainees, if that's what they want to do. I also acknowledge that there should be greater clarity with regards to career progression within IAPT, and I agree that each person's experience is what should be taken into account when it comes to applying to HI training, not just whether they are PWPs or have a core profession.

The Cone

Many thanks to baa also for your helpful comments.
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Re: BABCP/IAPT standpoint on PWPs -> CBT

Post by CBTer » Wed Jan 11, 2012 10:45 pm

While I don't want to drag this issue on and on, I would just like to perhaps correct how my post came across.
I don't think Psych graduates are entitled to be able to obtain career progression in the NHS; who says that after your degree you should fall into a job? Rather I am frustrated by some of the assumptions that are held about Psych graduates; that they are usually young (and therefore the assumption is inexperienced and lacking in life experience) and the sense that they cannot move very far in their careers. Rather I think I was commenting on how those with a core profession appeared to be favoured (in some trusts BUT not all - I have evidence of this) for HI trainee posts over PWP's/ people with grad or assistant experience. I cannot help but think that a bit of Padesky's Prejudice Model perhaps applies here!
I suppose my frustration is that others from a core profession who may have little experience in CBT compared to a grad worker or PWP's are in SOME cases favoured for HI posts over PWP's. This is frustrating for PWP's who have an excellent grounding in CBT and the natural progression would be to then undertake training in step 3 CBT.

Unfortunately recently I have come across some very unhelpful comments about PWP's. The course is hard and often PWP trainees are selected from over 300 applications! I have also come across some very ageist comments which I am going to start beginning to challenge. I also feel this as a "non core professional" CBT Therapist. As a 28 year old who sometimes has a tendency to look 22 (!!) I am often quizzed (by other non CBT professionals with maybe a patch of jealousy) heavily about my background prior to CBT - yes I pick up on vibes, and no I don't think I am mind reading!!

Cone - unfortunately some of the defensiveness coming from Psych grads (well maybe I can just speak for myself here!) is usually based on previous experiences within trusts.

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Re: BABCP/IAPT standpoint on PWPs -> CBT

Post by LIWY » Thu Jan 12, 2012 1:21 am

CBTer wrote: I have also come across some very ageist comments which I am going to start beginning to challenge. I also feel this as a "non core professional" CBT Therapist. As a 28 year old who sometimes has a tendency to look 22 (!!) I am often quizzed (by other non CBT professionals with maybe a patch of jealousy) heavily about my background prior to CBT - yes I pick up on vibes, and no I don't think I am mind reading!!
Age question would make for a good debate but perhaps to be split off to another thread? The statement applied to all PWPs, didn't matter if they were 25 or 50, services etc were told, don't consider less than training + 2 years.

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