IAPT Accreditation Advice INTRODUCTION Purpose This advice provides an overview of the accreditation requirements for IAPT education and training courses and the procedures whereby individual practitioners can register their competences in delivering IAPT therapies. 1. IAPT therapies include: NICE approved low and high intensity Cognitive Behavioural Therapies 1 together with additional IAPT approved therapies for depression which include 2 : Brief Dynamic Psychotherapy, developed as Dynamic Interpersonal Therapy for Depression (DIT) Counselling for Depression (CfD) Interpersonal Psychotherapy (IPT) Behavioural Couple Therapy, developed as Couple Therapy for Depression (CTD) Working closely with the relevant professional bodies concerned, a robust framework of accreditation procedures has been established for each of the training programmes developed so far. This advice identifies the relevant professional bodies involved in the accreditation of IAPT approved therapies and summarises their accreditation requirements. Accreditation requirements cover three areas: 1; Education and training programmes provided by Higher Education Institutions (HEIs), 2; The qualifications and professional experience of individual practitioners, and 3; The qualifications and professional experience of therapy supervisors. Audiences 2. The advice is intended primarily for commissioners of either psychological therapy services or education and training programmes 3. As highlighted in Equity and excellence: liberating the NHS (July 2010), professional bodies have a major role in identifying the quality 1 See http://www.iapt.nhs.uk/workforce/. 2 For further information on these approved therapies see http://www.iapt.nhs. uk/workforce/high-intensity and http://www.iapt.nhs.uk/ news/which-talking-therapy-for-depression/ 3 This document should be read in conjunction with the Guidance for Commissioning IAPT Training 2011/12 2014/15 (available at http://www.iapt.nhs.uk/workforce/iapt-education-training-and-development/) which outlines the role of Multi Professional Education and Training (MPET) funding in relation to IAPT 1
standards that should guide the commissioning of services and the training, qualifications and experience of the workforce employed within these services. 3. This advice should also be of use to HEIs, individual practitioners and therapists. Similarly, mental health charities and individual patients or clients might also find the information helpful in identifying therapists who have been trained on an IAPT commissioned course and whether they have joined a voluntary register indicating the nature of their training and possibly, in some cases, fitness to practice. Accreditation and professional bodies 4. Both psychotherapy and psychological therapies are not yet subject to statutory regulation, despite there having been widely publicised discussions between professional bodies and the previous government. Nevertheless, many therapists are subject to regulation since they are members of healthcare professions regulated by the General Medical Council (GMC), the Nursing and Midwifery Council (NMC) or the Healthcare Professions Council (HPC). Hence medical practitioners, nurses, psychologists, social workers and other registered practitioners who practice psychotherapy are subject to statutory regulation, whereas many other psychotherapists and counsellors who are not members of these professions are not. However, there are many professional bodies associated with these practitioners who offer voluntary registers which many therapists join and hence are subject to registration and accreditation. 5. Prior to the IAPT programme, relevant professional bodies 4 had extensive accreditation procedures for existing psychological therapies training programmes. Modifications to these procedures have been implemented to encompass the specific requirements of the IAPT national curricula and their training programmes. Course Accreditation 6. The main focus has been on course accreditation whereby each IAPT training programme hosted within an HEI has had its curriculum and teaching materials scrutinised, its staffing and resources judged as appropriate, and its management and governance structures reviewed, including interfaces with trainees, supervisors, local NHS services and service users. The scrutiny process, in particular, determines that the course is delivered consistently with the national curricula as agreed and laid down for IAPT. 7. IAPT training is a joint initiative between HEIs and clinical services, with key aspects of the training (such as observing skilled therapists in practice and regular supervision) being delivered by the IAPT services that partner the HEIs. For this reason, the services in which IAPT trainees are trained and supervised are also required to meet certain IAPT quality standards (See IAPT Implementation Plan: National guidelines for regional delivery ; in particular Chapter 4, Characteristics of an IAPT Service and Annex A: Criteria for training provider selection ; http://www.iapt.nhs.uk/silo/files/implementation-plan-national-guidelinesfor-regional-delivery.pdf). 4 BACP; British Association of Counselling and Psychotherapy: BABCP; British Association of Cognitive and Behavioural Psychotherapy: BPC; British Psychoanalytic Council: BPS; British Psychological Society: BSCPS; British Society of Couple Psychotherapists and Counsellors: IPTUK; Interpersonal Therapy UK: UKCP; United Kingdom Council for Psychotherapy: HPC; Health Professions Council 2
8. Decisions to accredit a programme are arrived at after a detailed examination of the course s documentation and procedures, including those that rely on partnership with services. The examination usually includes a visit to the programme by a team of experts (i.e. therapists and trainers), with meetings between trainees, senior HEI managers, Regional IAPT Leads, and representatives from supervisors, local NHS services and the SHA. 9. Programmes have to meet conditions before they are fully accredited. Once these are met, the period of accreditation can be for a number of years, and renewed annually assuming the programme has not experienced major changes or been subject to complaints. The period for which a course is accredited varies for each professional body. The professional bodies have a list of all IAPT courses currently accredited on their respective websites. Details of complaints processes, against courses or individuals, can also be found on the professional body s website. Individual Accreditation 10. In addition to course accreditation, some professional bodies also offer individual accreditation for IAPT practitioners. There are many reasons why individual accreditation is offered including: Newly qualified therapists having to gain additional experience before being fully recognised as competent to practice in IAPT services (e.g. BABCP), Some practitioners having been employed as Psychological Well-being Practitioners (PWPs) in IAPT services on the basis of prior experience and training as graduate mental health workers, and who wish to register their new PWP role, Where practitioners have benefited from top-up or continuing professional development (CPD) IAPT training, or have previously trained on a relevant and professionally accredited training course for an IAPT recognised psychological therapy, but prior to the implementation of IAPT as a mode of delivery of psychological therapy. 11. In such cases, individual therapists have to prove that they have successfully completed a relevant training course, supply a portfolio or log of clinical work and additional training, and usually have supervisors reports or references. Once a practitioner gains individual accreditation status, their individual name is usually recorded on a voluntary register, available for inspection on the website of the respective professional body. 12. Most professional bodies require practitioners to renew their registration annually or be reaccredited on a regular basis. It is usual to require evidence of ongoing supervision and CPD during the renewal period. Services employing IAPT practitioners should ensure that they are able to meet these renewal or re-accreditation requirements. One approach is to ensure that they provide access to regular supervision and CPD, to ensure that practitioners meet the requirements for either annual renewal or re-accreditation. Services can also require that practitioners are individually accredited with appropriate organisations before they are appointed by ensuring that such requirements are included in person specifications and job descriptions. 13. Some professional bodies will also deal with complaints against registrants and deal with fitness to practice cases. However, the responsibility for registration and fitness to practice for nurses, psychiatrists, psychologists, and some other professions usually falls to the 3
relevant healthcare regulatory body (e.g. HPC, GMC, NMC). Since not all practitioners will be voluntarily registered with a relevant professional body, employers should ensure that all IAPT practitioners/therapists agree to abide by an appropriate Code of Ethical Conduct and Behaviour, as part of their contract of employment 5. 14. Given that many psychological therapists, including those working in IAPT services are not statutorily regulated but subject only to voluntary registration, services need to consider how they can encourage their practitioners to become accredited and remain registered with the relevant professional bodies that have developed IAPT relevant accreditations. Employers also have a responsibility to ensure that staff operate within their clinical governance standards. 15. In summary, both course and practitioner accreditation provides the assurances to commissioners and the public that training programmes have met the required quality standards, and that the services commissioned have employed a suitably trained workforce. There are numerous psychotherapy organisations offering training in psychotherapy, and it is essential that IAPT services employ those practitioners whose training or equivalent experience has been recognised by the relevant professional body. ACCREDITATION OF IAPT PROGRAMMES 6 Low intensity CBT and PWP courses 16. Psychological Well-being Practitioner (PWP) courses are accredited by the British Psychological Society. The accreditation process involves representatives of PWP courses, which have received full accreditation for five years. Further information is provided on the BPS website 7. There are two schemes of individual practitioner accreditation offered by both BABCP and the BPS. The BPS offers a voluntary register of psychology graduates who have successfully completed an accredited PWP programme. A more extensive scheme of individual practitioner accreditation is offered by BABCP, which is not restricted to just psychology graduates, as is the case for the BPS, but is open to all PWPs and also to people who may have been employed as a PWP initially in IAPT services and before the training was available 8. These latter individuals have usually done a top-up PWP training consisting of the first two modules of the national PWP curriculum. Requirements for supervisors are detailed by both BPS and BABCP. High Intensity CBT courses 5 See the example supervision agreement provided by the BABCP at Annex 1 of: http://www.iapt.nhs.uk/silo/files/ethical-codes-for-non-professionally-affiliated-staff-.doc 6 We have signposted readers for further information to the relevant websites of the professional bodies involved. However, these sites may be updated, and the address modified from time to time by the professional bodies involved. If you are unable to access any of the addresses within this guidance, please contact the professional body directly for guidance. 7 http://www.bps.org.uk/careers-education-training/accredited-courses-trainingprogrammes/psychological-wellbeing-practition 8 http://www.babcp.com/accreditation/pwp/pwp_accreditation.aspx 4
17. High intensity CBT courses are accredited by BABCP 9. Visiting accreditation teams will have IAPT advisors and course staff/trainees from other IAPT training programmes, as well as BABCP accreditation officers. 18. Newly qualified graduates from High Intensity IAPT CBT courses are only provisionally accredited in their first 12 months following qualification. Again, there are two schemes of individual practitioner accreditation. An extensive scheme is offered by BABCP and is summarised on its website 10. 19. Further information about supervision in IAPT services and competency requirements for supervisors is available at http://www.iapt.nhs.uk/workforce/supervisors/. 20. The BPS also operates a register of HPC registered Chartered Psychologists who have successfully completed an accredited High Intensity IAPT CBT course (available to view at http://www.bps.org.uk/psychology-public/find-psychologist/get-directory/iapt-registerapplications/improving-access-psycho). Brief Dynamic Interpersonal Therapy for Depression (DIT) 11 21. The British Psychoanalytic Council (BPC) is now acting as a fully functioning accrediting organisation and has recently approved the Anna Freud Centre and The Tavistock and Portman NHS Foundation Trust as an accredited training provider for DIT. Accreditation will examine the 4-day DIT course, one additional day for IAPT, and the end of course role-play. Trainees have to pass all elements, including the role-play to go forward to become practitioners, and then subsequently and successfully complete two supervised case studies. 22. For new providers to become an accredited DIT training provider, training establishments need a course leader who has shadowed an accredited DIT course, and a DIT accredited practitioner to co-lead the first course. Further information is available from the BPC website 12. Counselling for Depression (CfD) 23. Accreditation for CfD is through the British Association for Counselling and Psychotherapy (BACP). Successful completion of an appropriately commissioned CfD course, including the practice hours, can be counted towards the training and practice criteria of an application for accreditation as a BACP accredited counsellor/ psychotherapist or for an application as a BACP accredited Supervisor of counsellors/ psychotherapists. 9 See http://www.babcp.com/accreditation/course/iapt_course_accreditation.aspx 10 See http://www.babcp.com/accreditation/practitioner/practitioner_accreditation.aspx and also http://www.iapt.nhs.uk/silo/files/iaptbabcp-pwp-statement-august-2011-final.pdf 11 The training programmes for all four IAPT modalities in addition to CBT, have been designed to deliver their associated competence frameworks and national curricula. In addition, the relevant professional bodies have been developing or adapting their existing accreditation processes. With the commissioning of further training places across the modalities as described in Talking Therapies: A four Year Plan of Action, further work will be required to monitor how courses are meeting the combined requirements for accreditation and quality assurance for IAPT service delivery and the relevant professional body. 12 http://www.psychoanalytic-council.org/main/index.php?page=15952 5
24. For counsellors who are already accredited members of BACP, successful completion of a commissioned CfD course would be accepted as evidence of meeting CPD requirements for their annual renewal of accreditation. A new category of sector specific Senior Accreditation in IAPT High-Intensity Counselling has been developed and is being launched by BACP in 2011. 25. BACP has developed a quality assurance procedure for CPD training programmes. The associated award is designed to reassure trainees about the quality standards and relevance of the CPD activity on offer. This award would be applicable to the CfD training programme. 26. Successful accreditation is conditional upon training providers being able to demonstrate that they have reached the required standard. An application in the form of a portfolio of evidence is submitted for scrutiny to the BACP Professional Standards Department. Assessment includes the recruitment and selection of trainers, trainee selection criteria, supervision arrangements and adherence to course content. BACP CPD endorsement entitles course providers to use the BACP logo when issuing a certificate to trainees who successfully complete both training and practice elements of CfD training (http://www.bacp.co.uk/accreditation/). Interpersonal Psychotherapy for Depression (IPT) 26. Interpersonal Psychotherapy UK (IPTUK) is the accrediting body. A formal course accreditation is under discussion. Contact should be made with IPTUK for details (http://www.interpersonalpsychotherapy.org.uk/). 27. Clinical groups who have evolved as trainers share materials. Existing courses have begun to link with HEIs (in London, Edinburgh and Surrey) and a formal transparent process is being developed by IPTUK. This will be paper-based to provide evidence for accreditation. Currently there is only one course provider for IPTUK/IAPT. 28. Accreditation of new IPT/IAPT training providers will require trainers to have completed an IPTUK recognised course and completed supervisor level accreditation with an IPTUK accredited supervisor. Existing IPTUK trainers must demonstrate capacity to deliver training in compliance with the IAPT training and supervision protocol. Novice IPT trainers must shadow one round of IPT IAPT training prior to delivering the training independently. 29. All new IPT/IAPT training providers will be asked to submit a course outline and programme of supervision to IPTUK, to be assessed against the IAPT national curriculum and training protocol. Details of accredited courses and supervisors are available at http://www.interpersonalpsychotherapy.org.uk/. Couple Therapy for Depression (CTD) 30. The British Society of Couple Psychotherapists and Counsellors (BSCPC) is the lead accrediting body for Couple Therapy for Depression practitioners, supervisors and training 6
courses. They offer a comprehensive approach to the accreditation of courses, practitioners and supervisors 13 ). 31. Accreditation as a Practitioner This is determined by successful completion of the two elements of the Practitioner Training; an accredited training course that delivers the IAPT curriculum, and successful completion of 2 Couple Therapy for Depression cases. Successful completion of each of these elements results in certification and the right to be listed as an Accredited Couple Therapy for Depression IAPT Practitioner on the BSCPC website. There is no obligation to apply for Membership of the BSCPC, but practitioners will be expected to be registered with their usual registering bodies (BABCP, BACP, BPS, HPC, etc), and adhere to their professional development standards. 32. Accreditation as a Supervisor This is determined by successful completion of the three elements of the Supervision Training; the supervisors training course, successful completion of a further two Couple Therapy for Depression cases, and a consultation exercise. Supervisors can then apply to have their names listed as an Accredited Couple Therapy for Depression IAPT Supervisor on the BSCPC website. As with Practitioners, there is no obligation to apply for membership of the BSCPC, but supervisors will be expected to be registered with their usual registering bodies (BABCP, BACP, BPS, HPC, etc), and adhere to their professional development standards. 33. Accreditation of Training Courses BSCPC will assess training and grant Provisional and Full accreditation. Provisional accreditation is designed for proposed training and is designed to help training providers reach the required standards. Proposed trainings that are granted Provisional accreditation will be able to recruit trainees. Once they evidence that they meet the required standards they will be granted Full accreditation. Further details of the requirements for Provisional and Full accreditation are provided on the IAPT pages of the BSCPC website 11. 34. Training courses will be granted Provisional accreditation for a maximum of 2 years, before it has to be re-applied for. They will be expected to achieve Full accreditation with their first cohort of training participants. Full accreditation will last for 4 years, or until there are substantial changes in the training that would make it inappropriate for automatic accreditation to continue (such as a significant change in trainers or supervisors used, or a change in the Curriculum). Summary 35. A key feature of IAPT services is the provision of well-trained therapists who can evidence that their training has been directed at acquiring and demonstrating the skills and competences underpinning psychological therapies as recommended by NICE. Training programmes have been developed covering those competencies recognised as essential to professional practice in IAPT services. To ensure that trainees benefit from training courses of a suitable standard, practitioners and courses are subject to stringent accreditation processes. 13 http://www.bscpcnew.com/index.php?option=com_content&view=section&layout=blog&id=8&itemid=32 7
36. Given that psychological therapists per se are not subject to statutory regulation, it is important that commissioners are aware of their responsibilities in relation to voluntary schemes of accreditation offered by the relevant professional bodies in order to provide a level of assurance for the public against incompetence or malpractice. IAPT National Team January 2012 8