HEALTH PSYCHOLOGY IN
SCOTLAND
Dr Vivien Swanson,
Senior Lecturer, Health Psychologist
University of Stirling
Programme Director (Health Psychology) NHS Education Scotland
Health Psychology in Scotland-Stage 2 Training
Motivation
• Context… health challenges in Scotland
• The NHS in Scotland
• Public Health
• NHS Education Scotland
The Action Plan:
• The set-up – developing the stage 2 training pilot
Maintenance
• Evaluation, achievements, current progress, issues and
challenges, sustainability
Key priorities?
What ….. areas of work?
How……. to deliver?
health inequalities . maternity care .
early years . healthy weight .
parenting . self-management .
addictions . patient safety .
long-term conditions . re-ablement .
anticipatory care .
asset approaches . co-production .
skilled workforce . collaboration .
equality and diversity . sharing best
practice. inclusive learning .
fitness to practice .
quality clinical learning environments
“Mutually beneficial partnerships between patients, their families and those
delivering healthcare services. Partnerships which respect individual needs and
values and which demonstrate compassion, continuity, clear communication
and shared decision-making” (NHS Quality Strategy)
Revised targets for HEAT 2007-8
Target
H.01T
Reduce health inequalities … across a range of indicators including CHD,
Cancer, adult smoking, smoking during pregnancy, teenage pregnancy and
suicides in young people
H.02T
Reduce adults smoking rates from 26.5% (2004) to 22% (2010)
H.03T
Reduce incidence of exceeding the weekly alcohol limit of 21 units to 29% for men
and of 14 units to 11% of women by 2010.
H.04T
50% of all adults (aged 16+) accumulating a minimum of 30 minutes per day of
physical activity on 5 or more days per week
H.05T
95% uptake target for all childhood vaccinations (ongoing)
H.06T
Reduce suicide rate between 2002 and 2013 by 20%
H.07T
Reduce by 20% the pregnancy rate (per 1000 population) in 13-15 year olds from
8.5 in 1995 to 6.8 by 2010
H.08T
60% of 5 year olds to have no experience of dental disease by 2010.
T.03T
Cervical screening target 80%, ongoing
THE ACTION PLAN FOR
STAGE 2 TRAINING
Set-up
Goal:
To develop effective, sustainable, fully
funded Stage 2 training posts for health
psychologists in the NHS in Scotland
To ‘add value’ to the health
improvement agenda (HEAT Targets)
in Scotland
February 2006
March 2007
DHP-Scotland Working Group on NHS Careers for Health Psychologists;
Preliminary discussions with NES Psychology Programme Director.
DHP-S Proposal document for creation of training places for 4 health
psychologists in NHS Scotland, to address HEAT targets; Included costings
and overview of evidence for benefit of health psychology interventions
April 2007
Meeting with Heads of Psychology Services, Scotland – ‘What is health
psychology?’ presentation and briefing document (stage 2 competencies,
evidence re HEAT targets)
May 2007
Meeting with NES and other stakeholders to discuss
May 2007
NES present Resource Prioritisation plan to employ health psychologists in
training (joint NES NHS funded)
June 2007
Bid framework document for NHS Health Boards developed; Potential
supervisors approached
July 2007
Evaluation panel for bids (inc DHP-UK representative)
August 2007
Job description/person spec for posts written; Advertised
September 2007 Closing date for applications
November 2007
Interviews held; NES, NHS, Supervisors
January 2008
HPiTs in post
Key features : Support structure
• Health psychology trainees have BPS/DHP Approved Stage 2
Supervisor, and NHS based supervision from their line manager
or Head of Psychology services as appropriate.
• Regular face to face meetings with DHP supervisor, and joint
supervision meetings
• Peer support crucial for trainees - 4 informal meetings a year
• Regular group networking meetings (quarterly - bi-annually)
• Shared space on NHS Knowledge Network
Key features : Funding
Trainee Salary Costs :
• Agenda for Change Band 6 (Equivalent to years 2 and 3 of Clinical
Psychology Training) [employment costs not included
Supervision :
• Fee per student per annum (including University Overheads @FEC)
• ½ Day per month academic supervision
Administrative Costs:
• ½ day per week administrative support
• Consumables : Telephone, photocopy, stationery
Travel Expenses:
• Supervision (Trainee and Supervisor)
• + 4 peer support meetings per annum)
BPS Registration Costs :
• Enrolment and supervisory approval
• Annual Maintenance Fee
• Examination of Portfolio Fee
Estimated Total Costs per Trainee : Year 1 : £28K,
Year 2 : £30K
Summary
The NHS Education for Scotland Programme
• Aims to address government health targets
• Stage 2 ‘Independent route’
• Joint funding ( NHS Boards. NHS Education for Scotland)
• Workplace and DHP Stage 2 supervision
• Collaborative network
• Small scale ‘Programme’ from 2010
• 2007 – 4 trainees
• 2008 – 3 trainees
• 2010 - 3 trainees
• 2012 – 3 joint funded + 2 fully funded
MAINTENANCE : FROM
PILOT TO PROGRAMME
…outputs, strengths and challenges
Successes : Programme outputs….
NHS Board
Project
Ayrshire &
Arran
Predictors of binge drinking in 18-24 year olds
Ayrshire &
Arran
Breastfeeding practices in teenage mothers in socially deprived areas
Ayrshire &
Arran
Working with residents and partners in a local community establish a coproduction approach to improving health in the area.
Ayrshire &
Arran
Working with the Medical Paediatric Psychology Service at NHS Ayrshire &
Arran on a research project that aims to validate the Paediatric Index of
Emotional Distress (PI-ED).
Ayrshire &
Arran
Scoping and literature review to inform a structured approach for promoting
infant mental health to fathers.
Dumfries &
Galloway
Systematic review and development of an intervention for overweight and
obese children in relation to the Child Healthy Weight Strategy.
Dumfries &
Galloway
Attitudes to breastfeeding among health professionals
Fife
Assessing the needs of single (mainly older) men with cancer
Fife
Sexual health in looked after young people
Fife
Review of behaviour change techniques in relation to Keep Well projects
Fife
Supporting lifestyle change in long-term conditions
Forth Valley
Community pharmacy public health service: attitudes to behaviour change
Forth Valley
Alcohol brief intervention project with community pharmacists
Grampian
Supporting implementation of Keep Well Programme.
Grampian
Assessment of Health Behaviour change competencies
Grampian
Health coaching in primary care, pilot
Tayside
Oral health among pre-school nursery children in DEPCAT 6 & 7 postcodes
Tayside
Midwifery: Antenatal assessment and screening for alcohol consumption
Tayside
Sexual health in adolescents, preventing teenage pregnancy
• Developing links and sharing best practice
between NHS health boards in the programme
Other
benefits
• Linking expert supervisors with experience of
behaviour change and Universities with the NHS
via collaboration on specific projects
• Joint supervision develops shared
understandings
• Introducing theory into practice
• Showcases how health psychology can ‘add
value’
• Going beyond the NHS – opens other career
routes - 2 trainees from Change Fund ( Local
Authority 100% funded)
Challenges (interim evaluation)
• Location of posts
Trainees preferred psychology base because of support from psychology colleagues
(only one of the four trainees from yr 1 was based within psychology). Or split working
with a main base in psychology and a day or two a week in a public health or other
department?
• Supervision
Better role definition with regard to supervision and line management arrangements. Trainees
reported to many different people - responsibilities of each should be explicit from the outset.
• Skill-sets
Some trainees would have liked more opportunity to develop clinical/therapeutic skills which
the original design (tasks) of their posts did not incorporate.
• Stress and Pressure:
A lack of ground work at the start of the scheme meant that the setting up the projects was
slower in some areas than others.
Being a ‘sole health psychologist’ was demanding in terms of workload, responsibility and
expectations
•
More Challenges
•
•
•
•
•
•
•
•
•
Need ‘local champions’ at a senior level to push for NHS posts
Health psychologists may need to apply for posts which allow them to apply
health psychology skills - may not be ‘framed’ in terms of psychology.
Using a mixed psychology skill-set could be explored in health board
departments which have traditionally only employed clinical psychologists.
Leverage by the Scottish Government might be required to highlight the value of
health psychology to the wider NHS.
In one area, additional short-term funding was secured for continuation of the
trainee
Need to build a critical mass of health psychologists working in practice in the
NHS Scotland which could increase the awareness of this skill-set more widely.
NES funding could support fuller implementation of the interventions designed
by trainees.
Trainees leaving before the end of the two-year post to take up other posts with their work remaining unfinished.
Time ‘lag’ between end of post and completion of portfolio
Summary and future plans…
Health Psychology Stage 2 Training Programme
Successes: National programme, unique in UK - 10 + 5 trainees to date high level of output contribution to Govt health targets – network of trainees
and supervisors – raises awareness of applied psychology in NHS Boards
Challenges: Expand across Scotland – increase awareness outside NHS –
commissioning – identifying funding streams – network of trainees and
supervisors – increase supervision skills – BCTs training – CPD - NHS
posts for health psychologists
Applied psychologists
Links with clinical health psychology
CPD - BCT Skills
Further outcomes….
Health Psychology into Government
Creation of 2 Health Psychology Programme Director
posts in the Psychology Directorate of NHS Education
for Scotland
Aims :
• Add value to existing government programmes
• Further develop extent and sustainability of Stage 2
training (including NHS posts for health
psychologists)
• Develop training in health psychology theory and
BCTs for other health professionals
• Develop integrated working with other applied
psychologists
Contact :
[email protected]
[email protected]
Tel : 01786 467685
Scottish Government Secondment
• 2009: Health Psychologists seconded into Scottish Government
– Secondment negotiated by Chair DHP-S (Ronan O’Carroll)
– Joint funding from DHP and Scottish Government
– Interviews held by a combined committee of representatives
from DHP, DHP-S and Government Health Directorates
– Diane Dixon and Marie Johnston (University of Aberdeen)
were seconded to Health Improvement Strategy Division (HISD)
Negotiating the HP remit
• After consulting with policy staff
• offered to deliver the following:
1.
2.
3.
An evidence based health behaviour change competency
framework for use across different health behaviours
A series of 3 briefing seminars on key topics relevant to health
behaviour change
Comment on policy and other documents as required
Page |0
Framework is available at:
http://www.healthscotland.com/upl
oads/documents/14543HBCC_framework1.pdf
Health Behaviour Change
Competency Framework:
Competencies to deliver interventions to
change lifestyle behaviours that affect health
10/11/2010
Diane Dixon and Marie Johnston
Foundation Competencies:
examples
Basic Behaviour Change
Competencies:
examples
Behaviour Change Techniques:
number for each route
High Intensity
Interventions
capacity to adapt
interventions to client need
capacity to implement models
in a flexible manner
M = 7 BTCs A = 11 BCTs P = 39 BCTs
Medium Intensity
Interventions
ability to foster and maintain
a good intervention alliance
capacity to select and apply the
most appropriate intervention
method
M = 9 BTCs A = 13 BCTs P = 5 BCTs
Low Intensity
Interventions
knowledge of professional and
ethical guidelines
ability to take a generic
assessment
M = 5 BTCs A = 6 BCTs P = 3 BCTs