Remote Delivery of CBT Training, Clinical Supervision and Services: In Times of Crisis or Business As Usual
14 October 2020
Last update: 05/10/20 20:20
The October 2020 British Association for Behavioural and Cognitive Psychotherapies (BABCP) Article of the Month is from the Cognitive Behaviour Therapist (tCBT) and is entitled “Remote delivery of CBT training, clinical supervision and services: in times of crisis or business as usual” by Paul Cromarty, Dominic Gallagher and Julianne Watson.
We wrote this paper following the worldwide impact of COVID-19, realising our model of remotely delivering IAPT continued as normal even though the team at CBT Institute are based in different cities (including Adelaide, Melbourne, Canberra and Sydney) only meeting face to face once per year. What the team has in common is CBT training equivalent to BABCP accreditation requirements. This team bond exists in a country where such CBT training is at best optional and IAPT services are not structurally embedded within the health system. Having worked in England, now experiencing the challenges of a country without a totally free health system where NICE Guidance does not drive interventions, highlights the achievement of IAPT and the NHS.
IAPT fundamentally involves a commitment to 1. Training and supervision in evidence-based interventions and 2. Systemic service improvement. With traditional mental health systems not based on demonstrating clinical recovery, resistance and problems implementing changes are likely even if they are hugely positive. The main beneficiary of change is the service user who receives early interventions by trained and supervised therapists. On this theme, a paper based on my presentations at the 2016 CBT World Congress coined the term ‘Service Model Fidelity’. The phenomenon of ‘therapeutic drift’ was described by Waller (2009) but if the structure of the health system fails to deliver proven interventions the way they have been designed, this is service drift not therapist drift. The presentation concluded, if IAPT fails, blame the system, do not blame the evidence base! Adhering to treatment and service model fidelity are essential despite the delivery method. Remote methods in training, supervision and services have proven successful over vast distances and during a pandemic while retaining fidelity to the IAPT model. High recovery rates from the three-year IAPT pilot, delivered by all three authors, proved remote methods did not impair clinical outcomes. Remote Methods have been categorised as, 1. Real Time, 2. Independent and 3. Blended Delivery. All are supported and maintained by disruptive technology and a Virtual Learning Environment. Bennet Levy’s (2006) DPR Model has proved a successful framework for remote training and supervision in roll out of Australian IAPT. Fewer adaptions are required for Low Intensity practitioners due to standard remote service delivery and High Intensity therapists can learn from them. A remote system can continue to treat any excess mental health issues during and after COVID 19.
References:
Bennett-Levy, J. (2006). Therapist Skills: A Cognitive Model of their Acquisition and Refinement. Behavioural and Cognitive Psychotherapy, 34(1), 57-78. doi:10.1017/S1352465805002420
Cromarty, Paul. Improving access to psychological therapies (IAPT) in Australia: Evidence-based cognitive-behaviour therapy interventions for anxiety, depression and gambling addiction. In: Menzies, Ross G; Kyrios, Michael; Kazantzis, Nikolaos (Eds). Innovations and Future Directions in the Behavioural and Cognitive Therapies. Samford Valley, QLD: Australian Academic Press, 2016: 272-276.
Waller G. (2009). Evidence-based treatment and therapist drift. Behaviour research and therapy, 47(2), 119–127. https://doi.org/10.1016/j.brat.2008.10.018
From Richard Thwaites, the Editor-in-Chief of tCBT: Why I chose this article.
This article was one of the few to start to address the remote delivery of CBT training during the pandemic and uses a well-known skill acquisition model (DPR model) as a framework to reflect on how things can be delivered remotely.
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