What is it really like to work in IAPT?

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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jawa
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Joined: Fri Apr 26, 2013 10:15 pm

What is it really like to work in IAPT?

Post by jawa »

Hi. I am writing a chapter on IAPT, and would love to hear your experiences - good or bad - of working in IAPT services. Thank you!

Jay

Dr Jay Watts CPsychol AFBPsS
Http://www.jaywatts.co.uk
musicalhen
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Joined: Mon Jun 09, 2014 9:47 am

Re: What is it really like to work in IAPT?

Post by musicalhen »

Hi,

I worked as a PWP and supervisor for two and half years in North Devon - I completed my PG Cert to work as a PWP at Exeter University.

I don't have that positive a view of the whole IAPT machine for several reasons:

1) My training was poor and did not prepare me well for seeing "actual" people with "real" problems that cannot be solved with some insincere empathy and a problem statement! I saw people with sometimes a 20 or 30+ year history of mental health difficulties all of which impact on them in the here and now and very little of which I could actually, realistically help with. All of our therapy practice was done through role plays with each other and then trained actors. I am really glad I had had done 18 months as a nursing assistant prior to this on inpatient wards as I would have been thrown well and truly into the deep end when I started my PWP training.

2) There is no emphasis on looking after you as an individual with a potentially ridiculous caseload and high stress levels due to the complex nature of the people you are asked to see (don't be fooled by the mild to moderate labels you might have heard!) (my caseload at one point was 75+) in PWP supervision - it is literally a numbers exercise e.g. how many people are you carrying, their difficulty and what you are going to do to help them. When I raised concerns that I was stressed I more or less got told to 'put up and shut up'.

3) You are poorly resourced as a PWP, both skills wise when dealing with increased levels of complexity and actual tangible information you can give to patients. I regularly printed resources from outside sources such as getselfhelp.co.uk as we had little standard IAPT resources to give out! This started to improve after I had trained in terms of workbooks etc but still not enough.

4) I regularly felt like I ( & clients) were permanantly stuck on a treadmill... a horribly predictable one!

Sorry its quite a negative account but I am being honest!
jawa
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Joined: Fri Apr 26, 2013 10:15 pm

Re: What is it really like to work in IAPT?

Post by jawa »

Thank you so much for your reply, Musicthen. So little support and such a huge caseload! I wonder if this mirrors others experiences...
Molly
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Re: What is it really like to work in IAPT?

Post by Molly »

I'm really sorry to hear about your experience in IAPT musicalhen. It sounds like a really challenging place to work.

I have worked in IAPT for the past 6 years in three different IAPT services. I've been working as a Senior PWP for the past 2 years. From what I hear from friends in other services, from people at a PWP networking forum that I attended in July and comments on the forum it does seem that the norm is to work in IAPT services where PWP's are less feeling unsupported and with high caseloads of patients with complex presentations. However that isn't my experience in my current service.

The caseload targets for our PWP's is 34 contacts per week. Triages and treatments all count as one contact each, psychoeducational groups are 4 contacts, clinical skills is 1 contact. We still do see quite a high amount of complexity within our service as unemployment rates and deprivation is high in this area. We are an integrated service however and have a team of CPN's who work as part of the service so can see clients who might not find a structured CBT approach to be beneficial.

I think one big difference in our service is that the PWP workforce is so valued by the management team. As Senior PWP's we provide the majority of the skills, CMS and line management supervision and are very involved in service development and performance. I think having Senior PWP's was a really beneficial addition to the senior team as we have a clear understanding of the PWP role.

Our PWP's are regularly given opportunities to lead on project work and any special interests are taken into account. All of the PWP's have had the opportunity to attend additional IAPT long term condition and older adult training. A number of the PWP's have been supported to complete the supervisors course and are currently providing CMS supervision. Our service has set up CPD training for all PWP's in the region - the happens once a month and covers a variety of topics including specific anxiety disorders, coping with the transition from trainee to qualified, sleep, career development and leadership. PWP's are supported to be guest lecturers on the PWP course for a few sessions a year. Some are involved in a research study. I guess what I'm saying is that the PWP's are highly invested in within the service and I think that's key. They receive additional training, are well supported and as a result they generally feel happy to be at work and are excellent clinicians.

It is constantly a balancing act between providing safe and effective clinical work, staff wellbeing and targets/KPI's which can be challenging. I feel really lucky to be part of the IAPT service I work for but I appreciate that this isn't the case for a lot of IAPT services nationally.
musicalhen
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Re: What is it really like to work in IAPT?

Post by musicalhen »

Wow! Your service feels really well supported and connected with other disciplines e.g. senior mental health practitioners Molly... I really could have done with that integration in North Devon!
I think it makes a difference when the seniors are putting themselves on 'an equal footing' with the PWP's they supervise as we essentially do the same job just with more management. This is also where my team fell down, we had two p/t seniors, both of which were not that much more experienced than me in terms of PWP'ing and came across as quite arrogant at times in supervision. Not very willing to take on board any suggestions for improvement/development - essentially one was there blatently to get to a HI training post!

Thankfully I am now working in an assistant psychologist post which I LOVE so not all bad now :D
GeekyMcGee
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Re: What is it really like to work in IAPT?

Post by GeekyMcGee »

I've worked in the same IAPT service since 2009. Firstly as a PWP and now employed as a HIW (after qualifying as a trainee-HIW.)

I mirror some of the sentiments above when working as a PWP. Felt as if the role was set up for us to not perform as well as we could. My service only allowed us to see patients for 4 sessions at 30 minute sessions (I know....! When you bear in mind the minimum data set had to be completed each session for those who didn't bring them back each session - this is not much time). Felt de-skilled a lot of the time, and felt that the training I received did not come near to meeting the clinical reality I faced on a daily basis. I consider myself extraordinarily lucky that I had an amazing supervisor who gave me incredible support through this period.

However, being employed as a HIW has helped tremendously. Feel like I'm now set up to actually complete therapeutic work with clients. It's unbelievable really, as a HIW, they give you more money, more training and less patients to see per week. I'm far happier as a HIW. The PWP role (at least in my service) was torrid and I couldn't wait to leave it! I'm now a PWP supervisor where I hope my experiences as a PWP will help them manage feelings of being de-skilled and develop skills that they can use in sessions in a safe way.
LIWY
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Re: What is it really like to work in IAPT?

Post by LIWY »

I don't see how that question can be neatly answered and summed up in a chapter. As witnessed by reading through this forum, services vary tremendously depending on who runs them, who funds them, the strengths of the personalities within and their individual agendas.
Playinginthesun
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Re: What is it really like to work in IAPT?

Post by Playinginthesun »

I think from both my own experience and talking to others in Iapt it can vary hugely depending on the service and support offered.
I started as a pwp and am now a HI in Central London. My pwp experience was in South west England and it was POOR - mainly due to the fact that I was a trainee in a new service which hadn't established it's referral criteria/care pathway so we would take anyone and everyone without question. Initially accepting both self referral and GP referral it meant we had lots of risky and inappropriate referrals coming through without a clear idea of what to do. Supervision was patchy with my supervisor sometimes not showing up or being unavailable to discuss cases - not great when you're a trainee pwp with no idea/confidence about what you should be doing!
This service gradually improved about a year in and I think has sorted themself out now...
Since then I've worked as a pwp in other Iapt services in/around London with a much better experience - clear criteria, targets and supervision.i think the pressure of pwps can be huge especially considering the supervision is generally case management and they usually are dealing with higher numbers of cases.
In my current Hi role I'm fortunate to be in a really supportive service with regular supervision. Although we clearly have targets we are given he flexibility to manage our own diaries/caseloads and there's a lot of trust that we'll do what we need. Caseload is high and client group very challenging given the area I work in but there are a number of organisations to signpost to, not enough but some which are helpful! I think I'm lucky to be in the service as from speaking to others there can be ridiculous targets, no/rubbish supervision and frequent inappropriate referrals....
SheRa
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Re: What is it really like to work in IAPT?

Post by SheRa »

I agree with what others have said here - there's such a lot of variation in the way services are commissioned and delivered eg targets, no. of sessions, supervision frequency, level of experience amongst recruits, groups, telephone or face to face.
I have worked in 2 services as a pwp and it was almost like learning a brand new job when I moved - a much less target focused and more patient centred approach to get used to, thankfully, and closer relationship with gp surgeries - I feel part of the team in most surgeries, and their reception teams book appts for us.
As in my last service though, I struggle to fit people into the IAPT boxes often, and find supervision lacking. I used to want to do the high intensity training but I think I'll have the same frustrations about the lack of acknowledgment of the importance and significance of relational aspects of
therapy, so I'm researching training in other types of psychotherapy but it's a long expensive road with few prospects at the end.
I try to just be grateful for what I've got and make the most of what I can offer. I keep a log of the positive feedback I get which helps.
By the Power of Grey Skull!
LIWY
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Re: What is it really like to work in IAPT?

Post by LIWY »

SheRa wrote:I agree with what others have said here - there's such a lot of variation in the way services are commissioned and delivered eg targets, no. of sessions, supervision frequency, level of experience amongst recruits, groups, telephone or face to face.
I have worked in 2 services as a pwp and it was almost like learning a brand new job when I moved - a much less target focused and more patient centred approach to get used to, thankfully, and closer relationship with gp surgeries - I feel part of the team in most surgeries, and their reception teams book appts for us.
As in my last service though, I struggle to fit people into the IAPT boxes often, and find supervision lacking. I used to want to do the high intensity training but I think I'll have the same frustrations about the lack of acknowledgment of the importance and significance of relational aspects of
therapy, so I'm researching training in other types of psychotherapy but it's a long expensive road with few prospects at the end.
I try to just be grateful for what I've got and make the most of what I can offer. I keep a log of the positive feedback I get which helps.
Agree with all here.

Hope you find a good training and IAPT moves to allow getting people out of the boxes. The high intensity CBT training is, in my opinion, an absolute waste of opportunity, not to mention money, for getting to grips with really making primary care therapy something accessible to patients and practitioners alike. I've so often witnessed Hi CBT trainees bouncing back cases to the waitlist because the course has deemed them "not suitable training case". When 80% of your waitlist are "not a suitable training case", something is going very wrong in what you are training people to do. In contrast, placement people from other trainings seem to take on a far wider selection of cases.
SheRa
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Re: What is it really like to work in IAPT?

Post by SheRa »

Thanks LIWY, Pwps in my service often get cases we've stepped bounced back from HI cbt-ers too because they don't fit neatly into their boxes, though this varies among the cbt therapists depending on their previous trainings, personalities and top up trainings eg compassion focused therapy, ACT. I'd be interested to know what the 'other trainings' are that you've found people who bounce less cases back from are doing?
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GMT
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Re: What is it really like to work in IAPT?

Post by GMT »

Currently working as a trainee PWP in an NHS service

Really sucks that so many people are having a bad time. In our service we're supposed to do 32 contacts a week, but spend half a day call handling which counts as 4 contacts. Have had decent supervision so far and things are generally good.

I would agree that there's too much focus in the training on stuff we don't actually do (if I had to prepare for supervision Iike I had to prepare for a supervision OSCE, I'd never make my contacts) and too little attention is given to things we will have to deal with (assertiveness, anger, the fact that most of my caseload are what the reachout guide would consider "high scores", have comorbidities etc). Some of our lecturers were PWPs which helped, those that weren't often assumed that we'd be working under ideal conditions and had to be reminded often about things like our time limits and how much phone work we did. I found the roleplays outside the osce fairly useful if only because other trainees are likely to get bored and add in complicated stuff just to stay interested.
“What is to give light must endure burning.” - Dr. Viktor Frankl
orc
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Re: What is it really like to work in IAPT?

Post by orc »

I thought I would add my experience, even though this thread is a few months old.

I have worked as a PWP for almost 3 years, across 4 different services (3 technically but there was a tender change half way through one of them)

Generally my experience is negative of IAPT, its a good idea that is failing many both staff and clients. I mirror a lot of the negative experiences already mentioned, I've often had very complex clients and have always been told to persevere with step 2 in the first instance. Which I don't believe is always in the best interest of the client and some have even lost faith in therapy because of it and subsequently dropped out. I've had very little CPD, the general consensus is that management do not like PWP to take time out of clinics as it reduces targets.

A previous service never had team meetings and concerns were never raised. When they were they were ignored or PWPs were told that they were lying (yes you read correct). This service has just recently lost their tender bid, and I can honestly say I am glad, that service can only get better.

Targets ... 10 per day and its very much enforced I don't need to expand on this.

Before IAPT I was in a job that gave me a lot of skills and I felt that I was a member of a team and an individual. But it wasnt psychology/ mental health related. Most of the time I actually regret joining IAPT I should have stayed in my old sector (and yes I am making moves/ progress to get out of IAPT).

I wish I enjoyed IAPT I really do, I have tried to make it work for me for 3 years. But I feel that the odds are constantly against PWPs, its never 'well done' its always 'you can fit more clients in'.
jawa
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Re: What is it really like to work in IAPT?

Post by jawa »

[quote="LIWY"] Thank you to all of you who have bothered to respond - your words are so useful.

LIWY - There is no intention to attempt to have the questions "neatly answered and summed up in a chapter". Why would you think that? Rather, it is to try to capture something of the complexity of running and working in IAPTs.
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