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Staffing & Recruitment
There is a commitment in Delivering for Mental Health to increase the availability of evidence-based psychological therapies for all age groups in a range of settings and through a range of providers (Commitment 4). This initiative is being taken forward by NHS Education for Scotland ( NES), and will include up-skilling the existing workforce in evidence-based psychological interventions. Work on this initiative will commence in April 2007.
The Doing Well by People with Depression Programme offered supported self-help interventions in levels 1 to 4 described above. The programme introduced the concept of a Guided Self-Help Worker, who undertook structured training and supervision in delivering interventions based on Cognitive Behavioural Therapy for people suffering from mild to moderate depression, anxiety and other common mental health issues.
The following staffing information relates only to the selection, training and supervision of Guided Self-help Workers (as the NES work on commitment 4 has not yet commenced)
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Staff Selection
Guided Self Help Workers selected by local health board areas during the Doing Well by People with Depression Programme came from a range of backgrounds including life-skilled people with no formal mental health qualifications, psychiatric nurses, psychology assistants and others. They were chosen, in part, for their personal qualities with regard to listening skills, empathetic nature and ability to relate well to distressed individuals.
Supervision and risk management were essential components of the delivery of these services. See below for further details.
Job Descriptions currently in use
Two examples of job descriptions used on Doing Well sites are included in this guide (see links below). These are offered as guidance only. Areas wishing to recruit Guided Self-help Workers are encouraged to contact the Doing Well sites to arrange site visits for further information.
Rural job description
Urban job description
Grade Technical Grade 1 (approx £18-20k)
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Staff Training
Many of the Doing Well sites offered training in SPIRIT or START. These courses deliver the basics of a CBT working model. Training is skills-based and includes role play. Other sites provided training in problem-solving skills, basic interviewing and solution focussed interviewing.
Experiential training using role play should form the basis with minimal theoretical input.
Whenever possible new Guided Self-help Workers should sit in on sessions with more experienced colleagues for at least one week following training.
Ongoing training and development is encouraged and planning of this could take place during on-to-one supervision sessions. See below for more details.
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Supervision and Risk Management
Ongoing supervision is mandatory and takes two forms - Group Supervision and Individual Supervision. The supervisor should have a psychological training and knowledge of the types of psycho-social problems which present to the self help service.
Another important factor is on -going training and development. Although much of the "learning" takes place as cases are seen and supervision is received, it is important that these workers are equipped with a range of therapeutic interventions to offer to patients and this can be achieved through continuous professional development ( CPD).
Group supervision should be 2 hours weekly in groups of no more than 4 self help workers. This supervision should include:-
- Assessment of the appropriateness of referral,
- Brief formulation to elicit area of work,
- Intervention,
- Self help material used
- Referral on to voluntary agency/ secondary service if appropriate.
- Any risk issues
Individual supervision of 30 minutes to 1 hour, every 3 months is recommended to discuss:-
- Areas of specific difficulty, further training requirements including CPD
- Relationships with primary care teams
- Personal issues which may interfere with the effectiveness of self help worker
Close supervision of the Guided Self-help Workers, as described above is an essential component of risk management. Training courses such as ASIST and SMHFA can contribute to the lessening of the risk profile. A formal risk management document should be utilised. In addition, risk should be briefly assessed using standardised questions at every contact with the patient. The patient should also be provided with a clear statement of how to get help if they feel worse at any stage.
Day-today operational considerations
As this is a mentally demanding role it is recommended that client contact time be limited to 60% per worker, with the remainder of the time being set aside for supervision, training and development, administration, preparation for sessions etc.
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