NWoW and GMHW/PCMHW/Clinical Associate/IAPT roles

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NWoW and GMHW/PCMHW/Clinical Associate/IAPT roles

Post by miriam » Wed Apr 04, 2007 1:40 am

Compiled by h2eau from forum discussions

Graduate Mental Health Worker / Primary Care Mental Health Worker role
This role was first introduced by the government around 2002/2003 to aid GP's with the increasing numbers of people presenting with mild to moderate mental health difficulties. The role involves brief therapeutic interventions as well as setting up and maintaining mental health case registers for people with more complex or severe difficulties. The job also involves studying a post-graduate certificate in mental health practice part-time at a local university. Typical duties include face to face and telephone work with patients, using CBT approaches and problem solving techniques, guided self-help and signposting to other services and resources. There may also be an element of health promotion, running groups, audit work and gathering information about local services.

The aim is to fill the gap between patients seeing their GP then waiting for counselling, for example, to make sure they are still taking medication and to provide them with therapy in the meantime or to provide an alternative intervention. Service users with more long-standing difficulties have highlighted that if support from GMHWs had been available when they first started to experience symptoms of anxiety/depression/etc. then this early intervention may have prevented escalation and entrenchment of their difficulties.

The roles of GMHWs are wide and varied (this was highlighted at the recent GMHW conference). Some people may have experience similar to that of assistants, whereas others do not. Settings where people are based also vary, from GP surgeries to psychology teams. Supervision arrangements also differ, with some people supervised by clinical psychologists and others by health visitors and nurse practitioners who are in turn supervised and trained by a designated psychologist. However, as long as supervision is appropriate to the job being done there is no reason why individuals should not be supervised by a suitably qualified person from another profession. There are usually opportunities to mix with clinical psychologists in primary care mental health teams. Some GMHWs are supported by a line manager, practice mentor, clinical supervisor and university staff who are specialists in mental health.

There has been some concern that there is no clear career path for GMHWs and these posts seemed to be taken up by people who would otherwise have been assistants. There have also been concerns raised about availability of jobs beyond the initial 12 month fixed term contract that is initially offered. However, the role is recognised as useful clinical experience in mental health and many people have gained places on the clinical doctorate following experience in this type of role.

Proposed new role of Associate Psychologist
The Associate Psychologist is an altogether new scheme being considered by the BPS to possibly replace assistants. There are details about this on their website.

Added by h2eau:

Clinical Associate in Applied Psychology role (Scotland)
There are several differences/similarities between the Clinical Associate in Applied Psychology (CAAP) role that we have in Scotland and GMHW/PCMHW/LIT roles in the rest of the UK.

CAAPs work either in primary care adult mental health settings or in a range of settings working with children, young people and their families. The training consists of an MSc either in Psychological Therapies in Primary Care (Dundee/Stirling Universities) or Applied Psychology for Children and Young People (University of Edinburgh). A BPS accredited psychology degree with GBC is a prerequisite for studying these one year taught courses that involve placements, timetabled teaching and a research dissertation. The training is CBT/manualised therapy oriented and has been described as similar to the adult and child core teaching on the doctorate in clinical psychology. Trainee CAAPs are paid at the same level as trainee clinical psychologists (Band 6).

Following the MSc, the idea is that people can apply for CAAP posts in the NHS (Band 7 posts). In recent years there have been more CAAP jobs available in adult mental health settings, and child CAAP posts have been harder to find. However, the Scottish Government have recently pledged an investment of several million pounds for CAMHS provision in Scotland and this will include funding for more Child MSc training places and child CAAP roles.

The CAAP role in adult mental health appears to be different from a Psychological Wellbeing Practitioner/Low Intensity Therapist in that CAAPs have a varied caseload that is not restricted to a certain level of complexity. They are supervised by clinical psychologists and carry their own caseload, in addition to engaging in health promotion activities such as psychoeducational classes in the community. Their work seems to be more independent than that of say an AP and they seem to be the level 'in between' an AP and a qualified clinical psychologist. In the department I have been in on placement, the CAAPs are also conducting research evaluating these psychoeducational packages. I know that in some areas, child CAAPs are referred to as 'child and adolescent therapists' and are paid on Band 6 (the job description may be slightly different). I am aware of child CAAP roles in CAMHS learning disability services and services for Looked After and Accommodated Children and they seem to be targeting early intervention and are trained to deliver parenting groups such as the Incredible Years and Mellow Parenting.

Like GMHW/PCMHW roles, there is little scope for promotion within the CAAP role as it is meant to be a career in its own right. It seems like the CAAP roles are very similar to the Associate Psychologist roles that have been suggested by the BPS south of the border to overcome the 'bottleneck' of psychology graduates that do not get onto/choose not to pursue the clinical doctorate. However, individuals who have trained as CAAPs have gone on to the doctorate in clinical psychology, although this route was not designed to be a stepping stone.

In terms of service provision, it looks like the CAAP role enables the common 'tier 2 gap' between primary care and higher intensity services to be bridged to some extent and this facilitates early intervention. This is part of NHS Education Scotland's Increasing the Availability of Evidence-Based Psychological Therapies in Scotland: Phase 1 Plan which echoes the sentiments of IAPT.

Added by h2eau based on information from sarum:

How the new IAPT Low Intensity and High Intensity Therapist roles fit in
GMHWs in some trusts have now been taken over by IAPT and divided between low intensity (LIW) and high intensity workers (HIW). Some have remained on Band 4 or 5 as LIW, and others applied for and obtained the post of trainee HIW (currently paid at Band 6).

Former regional meetings between GMHWs across the South West were disbanded about 6 months ago as the group lost its support from sponsors CSIP and NIMHE. This may be because IAPT services intend to 'swallow' GMHW roles and incorporate them within their structure - but it is unclear whether GMHWs still exist where IAPT services have not yet been set up.

If anyone has any further information, please feel free to add.

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Last modified by h2eau on 27/07/2010

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Post by maven » Thu Sep 17, 2009 7:35 pm

We are busy updating this wiki, so anyone with anything to add about GMHW roles, perhaps on whether they are the same or made obsolete by IAPT should post now!

Wise men talk because they have something to say, fools because they have to say something - Plato
The fool thinks himself to be wise, but the wise man knows himself to be a fool - Shakespeare

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Post by Will » Wed Nov 17, 2010 11:21 pm

It might be worth considering the best practice guidance for PWPs published on the IAPT site a few months ago.

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