Overview of
Positive Step
and
Cognitive Behaviour Therapy
Adrian Dugmore, Clinical lead
Philip Adkins, Service Manager
Agenda
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Who are Positive Step?
How do I refer?
Service targets and 25% access rate
What to expect, the patient journey
through our service and stepped care
• CBT and the various therapies on offer
• Resources to use
What is Positive Step?
• NHS Primary Care IAPT Service
• Partnership between AWP and Second
Step
• Work with Common Mental Health issues
such as depression and anxiety disorders
• Based at the Coast Resource Centre in
Worle and work at local surgeries
Additional services
• Long Term Health Conditions (LTHC)
pathway
• Carers pathway
• STEPPS programme (Systems Training
for Emotional Predictability and
Prevention).
Referral pathways
• Self referral – 0300 300 0834
• GP/Health Professional referral via the website
• Booking on to courses via the website
www.positivestep.org.uk
Referral Statistics
• North Somerset Population approximately
167,111 (GP registered adults)
• Mental Health Population based on 15%
25,066
• 15% annual target – 3,760
• 2015 – 2016, 4681 referrals received
• 3,867 went on to receive treatment
Looking Ahead
• North Somerset Population approximately
– 215,000
• Access targets for IAPT services nationally
will increase to 25% by 2020
• Positive Step will need to treat 6,266 to hit
target in 2020, an increase of 2,506
• Areas to target include 16-17 year olds,
over 65’s and males
What to expect and the patient journey through our service
Step 4
Positive Step: High Level Service Map
Step 3
High Intensity
Step 4 Interventions
Step 1
Step 2a
Low Intensity
Step 2b
Low Intensity
Interventions
Step 2a
Triage
Primary
Care
Step 2a
Assessment and Low
Intensity Brief
Intervention
Step 1 Watchful
Waiting
Step 2b
Low Intensity
Review
Step 3
High Intensity Review &
Follow up
Supervision and support
Step 2b
Low Intensity
Step 3
High Intensity
Interventions
Step 1
GP Management
Watchful waiting, Books on Prescription, Internet resources, Self-help material,
Signposting to relevant agencies.
Step 2
Receive, process and triage referrals – Book patients on to Psycho-education
courses or book initial telephone assessment appointments with Step 2
workers.
Low Intensity Intervention by Step 2 Worker
Assessment, Books on Prescription, Internet, relevant agencies, Computer
CBT, Guided self help, psych-education courses, individual low intensity CBT
intervention and reviews.
Step 3
High Intensity Intervention by Step 3 Worker
Assessment, Individual CBT up to 12 sessions, Therapy groups spanning 8 to
16 weeks, EMDR.
Step 4
Secondary Services,
Recovery Teams, Early Intervention for
Psychosis Team, Intensive Support Team, Consultant Psychiatrist.
Step 5
In-patient services.
CBT and the various therapies on offer
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Phone Assessments
Various resources and guided self help
Psycho-educational courses
1:1 Cognitive Behaviour Therapy
Step 3 therapy groups
Long term health conditions
Carers Workshops and Individual Sessions
Signpost to other services
Restricted counselling provision
Our Psycho-education Courses
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Last 4-6 weeks
20 or less participants in the room
Led by a presenter at the front of the room
Education and develop skills and
techniques to practice at home through the
use of workbooks
• Involve informal discussions and activities
What courses we offer
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Low Mood
Anxiety/Worry
Self-Esteem
Stress and Mood Management
Getting Ready for Change / Weight
Management
• Carers’ Workshops
• Keeping Well
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Individual Interventions
Low Intensity – Single Strand,
Up to 6 sessions
Sleep hygiene
Medication review
Cognitive restructuring
Behaviour experiments
Behaviour activation
Graded exposure
Panic management
GAD
Problem solving
Individual High Intensity CBT
Up to 12 sessions
• Formulation incorporating disorder specific
protocols
• Beckian longitudinal formulation
• Therapy incorporating above interventions
Different types of anxiety
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General Anxiety
Social Anxiety
Panic Disorder
Health Anxiety
Specific phobia
OCD
PTSD
Mild to Moderate Eating Disorder
Symptoms of Anxiety
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Frequent worrying or nervousness
Rapid heartbeat or palpitations
Dizziness / light headed
Nausea / stomach problems
Avoiding people or situations
Difficulty concentrating
Thoughts that you can’t cope
Thoughts that something bad will happen
Symptoms of Depression
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Feeling sad
Feeling guilty or worthless
Irritable
Less interest in usual activities
Trouble making decisions or concentrating
Focussing on the negative
Tired / loss of energy /difficulty sleeping
Thoughts of death or hopelessness
Withdrawal and isolation
Loss of appetite
Resources to Use
Helpful CBT Websites
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Psychology.tools
Self-help.tools
Northumberland self help
Centre for Clinical Interventions
Living Life to the Full
Mood gym