Applying Psychology in Health Settings

Applying Psychology in Health Settings Session Overview What is Health Psychology? Training Routes via Clinical and Health Psychology professional training programmes Areas where health psychologists may be employed Examples of the areas of work in applied health psychology Q&A What is Health Psychology? • The application of psychological theories and approaches to health care • Multidisciplinary in approach and application • Related to health promotion, behavioural health, public health, medical sociology etc. Introductory Texts Ogden’s text is now on 5th edition– older versions are fine as intro Responsibility for Health Biomedical Model • Illness caused by factors outside individual’s control • Treatment is responsibility of medical professionals • Emphasis on treating illness Health Psychology • Individuals often have influence over risk of illness and recovery from illness • Maintenance of health & treatment of illness Roles for Psychology Biomedical Model • Inclined to view psychological factors as a consequence of illness, e.g. anxiety and depression Health Psychology • Greater recognition that psychological factors also involved in cause and maintenance of illness • Thus roles in prevention and treatment • Interactions between psychological and physiological factors Provision of services Directly • individual patients / small groups Indirectly • consultancy with other health care professionals • training in psychological approaches / skills • Interventions applied by others. Supporting selfmanagement where appropriate. • research to assess needs & evaluate interventions • develop interventions aimed to prevent illness Transferable / Unifying Themes • Multidisciplinary Team Working * • Prevention / Health Promotion • Chronic Disease Management • Use of Health Models * • Health beliefs (incl misconceptions)  Adherence *  Communication *  Loss *  Avoidance / Denial *  Coping *  Consultancy *  Somatisation *  Behaviour change * * Relevant to Clinical Psychology even in absence of physical health difficulties Clinical Psychology Training Routes • • • • Mostly doctorate training programmes Mixture of teaching, placements and research Usually 3 years full time Usually need GBC, 2.1 or above, right to work in UK and relevant experience – though requirements vary between courses • Employed as an NHS trainee psychologist • Leads to Chartered Psychologist status as Clinical Psychologist and ability to register with HCPC • Can specialise in areas of health psychology My Experience – Health Psychologist BSc Degree Worked as care assistant in learning disabilities (1+year) and residential home for elderly (6+ months) Health Psychology MSc Associate Lecturer 1 year Postdoc research in Brain Injury outcome / gained chartership Open University PhD Neuropsychological Outcome following Brain Injury Lectureship in Health Psychology on DClinPsychol Programme Research Director Work in NHS Settings • Currently most psychologists working in NHS are clinical psychologists, but there is significant potential to expand the number of health psychologists. Areas include: • • • • • • • • Chronic Pain Cardiac Diabetes Cancer HIV / AIDS Chronic Fatigue Obesity Preparation for surgery • • • • • • Assessment for surgery Dermatology Cystic Fibrosis Rehabilitation medicine Liver Disease Medically Unexplained Symptoms Other work contexts for Health Psychologists • Academic Clinical and Health Psychology Units • Other University Health Programmes (e.g. training for Nursing, Medicine, etc.) • Government Health Departments • Public Health / Policy making • Health Promotion Best and worst parts of the work • Intellectually stimulating • Demanding, time-consuming • Emotionally rewarding • Climbing a mountain • Connecting with people • Scratching the surface • Doing something good • Issues rarely black and white • Discovering new things • Funding issues • Research • Lengthy training • Teaching and Training • Political uncertainties • Getting psychology in there • Administration Taste of Health Psychology • The next 10 slides are selected from teaching and research presentations • Although out of context, they will hopefully give an idea of what NHS related health psychology can involve Some Health Behaviours Smoking Attendance Taking medication Socialising Health Beliefs / Misinterpretations ‘Hospital tests are always needed’ ‘Changes to bodily symptoms are always a sign of illness’ ‘My father suffered a heart attack in his 40s so I will as well’ ‘Medics must think something is wrong as they’ve sent me for more tests’ Paul Graham Morris DEVELOPING HEALTH PSYCHOLOGY PRACTICE IN SCOTLAND: THE ‘NES’ PROGRAMME Training in health psychology Essential requirements: BPS accredited BSc/BA in Psychology First class or 2:1 Honours degree in Psychology or related subject. STAGE 1: BPS accredited MSc in Health Psychology (3 courses in Scotland) - Knowledge/Theoretical Dimension - Research (Part 1) STAGE 2: Professional Practice (Portfolio of Competence + Viva Voce) PRACTICE DIMENSION: 1. Generic Professional Competence 2. Behaviour Change Interventions 3. Research (Part 2) 4. Consultancy 5. Teaching & Training Awarded: Qualification in Health Psychology (Stage 2) BPS registered: C. Psychol HCPC registered: Health Psychologist NHS EDUCATION for SCOTLAND NES Stage 2 programme To develop effective, sustainable, fully funded Stage 2 practitioner posts for trainee health psychologists in the NHS in Scotland To ‘add value’ to the health improvement agenda in Scotland NHS Boards involved in the programme NHS Education for Scotland Programme • BPS Stage 2 ‘Independent route’, • 5 competencies – 2 broad areas of work • RESEARCH, • INTERVENTIONS, (Group, 1:1) • TEACHING AND TRAINING, (Including health professionals) • PROFESSIONAL COMPETENCE, • CONSULTANCY • Locality NHS Health Board based • 2 year FT programme • 33 trainees 2007 – 2016 (c 4 per annum) Key features : NES Funding Trainee Salary Costs : • Agenda for Change Band 6 (£27K approx,Equivalent to years 2 and 3 of Clinical Psychology Training) Travel Expenses: • Supervision (Trainee and Supervisor) • + 4 peer support meetings per annum) BPS Costs : • All BPS fees (including registration, supervision, assessment) paid in full Research Supervision costs: to Universities Key features : NES Support structure • Health psychology trainees have BPS/DHP Approved Stage 2 Supervisor, (Course Tutor), a Research Supervisor, and NHS based supervision from their line manager or Head of Psychology services as appropriate. • Regular face to face meetings with Course Tutor, and joint supervision meetings • NES Centralised curriculum support for 5 areas of competence • (sessions on teaching and training, assessment/formulation, professional skills, systematic reviews, research writing etc..) • Peer support crucial for trainees - 4 informal meetings a year Regular group networking meetings (quarterly - bi-annually) Shared digital space on NHS Knowledge Network • Health Improvement/Inequalities/Prevention impact . • Community pharmacy public health service: attitudes to behaviour change • Long Term Conditions/Physical Health • Developing an intervention to prevent re-infection of Hepatitis C after treatment • Drugs and Alcohol • Alcohol brief interventions in hard-to-reach groups • Healthy Eating/Activity/Weight Management • Development of a group pilot weight management intervention for people prior to bariatric surgery • Antenatal and Postnatal • Understanding breastfeeding maintenance in new mothers • Frailty and dementia • Communication skills training to health and social care staff working with older people • Internationally unique, showcase programme benefits • Developing links and sharing knowledge, best practice between NHS Health Boards in the programme • Linking stakeholders: Public health, Psychology, 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) • JOBS !! (4 Boards to date have created posts) TRAINEES’ WORK EXAMPLES Questions? Ellen Jardine NES Trainee 2013-2015 NHS Dumfries and Galloway NHS State Hospital All-male in-patient psychiatric facility Covers Scotland and Northern Ireland. Patients average stay over 8 years Most have a psychotic disorder, usually with co-morbid diagnosis. The Psychology service at the State Hospital is large and well established. It is led by a Head of Psychological Services and there are four other Consultant Forensic Clinical Psychologists (including a specialist Forensic Clinical Neuropsychologist). Snapshot of chronic physical health conditions Primary Health Care Annual Report 1st August 2014 – 31st July 2015 Chronic Health Condition % (n) of patients Ischaemic Heart Disease 4% (5 patients) Hypertension 4.8% (6 patients) On cardiovascular medication 29% (36) Diabetes 18% (23patients) 2 Type-1 21 Type 2 Asthma 4% (5 patients) Obesity (July 2016) 53% (BMI>30) Overweight 33% Behaviour Change Intervention • Healthy Living Group: Weight Management Programme • 1:1 Dental anxiety, weight management • Type 2 Diabetes self-management Group Intervention Research • Mixed method Evaluation of the Healthy Living Group. • Systematic Review: ‘Health behaviour interventions to address overweight and obese individuals with severe mental illness in inpatient settings’ Teaching & Training Consultancy • Health Behaviour Change training : Health Professionals • Collaboration Health Centre – Study exploring the barriers and facilitators to bowel screening uptake for patients • Development of online module: Physical and mental illness and behavior change. • Teaching to University of Glasgow medical students: Models of health & Illness • MSc Health Psychology Students: University of Stirling Generic Professional Development Behaviour Change Intervention (oneto-one): Reducing injecting risk-taking behaviour in drug users on hepatitis C treatment: increasing self-efficacy to refuse sharing. Behaviour Change Intervention (Group): Training harm reduction staff in motivational interviewing skills to deliver brief interventions. Systematic Review: Psychosocial factors associated with injecting risktaking behaviour and hepatitis C infection risk: a systematic review. Research Project: Staff’s attitudes toward injecting drug users who are infected with Hepatitis C. Consultancy: Evaluating One2one: an online counselling service for young people in Tayside. Teaching : tutorials with MSc Health Psychology students at the University of Stirling: - Sexual Health; - Alcohol Brief Interventions; - Substance Misuse and Hepatitis C. Training: Training specialist viral hepatitis nurses in the delivery of a behaviour change intervention to increase self-efficacy in injecting drug users. Work setting of 24 HPs 10 18 Client groups that HPs work with Competencies that HPs deliver in current post Applied Psychologists employed by NHS Scotland Total = 901 (743.8 WTE) (30th September 2015) Clinical Psychologist 834 (686 WTE) Counselling Psychologist 50 (43.5 WTE) Health Psychologist 11 (8.9 WTE) Forensic Psychologist 6 (5.4 WTE) Neuropsychologist 0 Forensic Psychologist Health Psychologist 0.67% 1.22% Counselling Psychologist 0.1% Neuropsychologist 5.55% Clinical Psychologist 92.56% (ISD (2015). Workforce Planning for Psychology Services in NHS Scotland: Characteristics of the Workforce Supply as at 30th September 2015.) Any Questions?