Educational Psychologists and therapeutic intervention: findings

Educational Psychologists and therapeutic intervention: findings from a UK wide study Dr Cathy Atkinson 1

Context for the study Funded ddby RSF Seedcorn grant approved August 2011 Duration of project Sept 2010 Sept 2011 Two part study Part 1 large scale online survey Part 2 four site visits of services reporting and enabling effective therapeutic practice Steering Group Director of Doctorate in Educational Psychology, Principal EP, Private provider, Research Assistant 2

Educational Psychology in the UK 2500 EPs in the UK 1 All applied py psychologists with a degree in psychology and post graduate qualifications (now doctorate) Trained at 10 universities slightly different emphasis in training Based in local authorities and work with a patch of schools responding to different local political agendas 1 Squires, G., & Farrell, P. (2006). Educational Psychology in England and Wales. In S. R. Jimerson, T. D. Oakland & P. T. Farrell (Eds.), The Handbook of International School Psychology Thousand Oaks, California Sage Publications Inc. 3

Mental health in the UK Economic reasons for addressing mental health in adults Layard(LSE, 2009) 20% of children and young people are purported p to have a mental health problem of some description (Meltzer et al, 2000) CAMHS take referrals, but not enough to meet demand (Stallard et al, 2007) Sh Schools have an important trole (Tier 1 & host of initiatives designed to be preventative) 4

Educational Psychologist (EP) contribution EPs work with schools and parents in a number of ways: Individual casework Consultation Group work Whole school approaches Multi agency working 5

Rationale for study Increasing interest/focus on the role of EP as therapeutic provider (MacKay, 2007) Government focus on social and emotional wellbeing (SEAL, TaMHS) Sought to extend and develop the findings of two pieces of small scale research undertaken by trainee educational psychologists (Corban, 2009; Templeton, 2010) 6

Part t1 The Research Questions What therapeutic interventions do EPs use? How do they use them in practice? What are the barriers and enablers to EPs engaging in therapeutic practice? 7

Methodology Online questionnaire i distributed ib t d to all UK Educational Psychology Services and via professional forum and bulletin Questions derived from literature and the findings of previous small scaledoctoral research projects Open and closed questions 455 responses received via online (75%) and paper pp (25%) versions of the questionnaire www.epsandtherapy.co.uk 8

Definition of therapy For the purposes of the research, the following definitions were provided. Therapy The treatment of mental or psychological disorders by psychological means (Oxford English Dictionary, 2010) Therapeutic work may involve the direct intervention of a psychologist with an individual id child or a group of children. Equally it is applicable to the wider role of supporting others who work with children on a daily basis (MacKay and Greig, 2007). 9

Do you use therapeutic interventions as part of your current professional practice? Number of EPs using therapeutic interventions as part of their current practice 8% Yes No 92% 10

How have you used therapeutic intervention? 90 Percentage of EPs using therapeutic intervention in different contexts 80 70 Percentage e 60 50 40 30 20 10 0 Individual direct therapeutic intervention As part of assessment Consultation Working through others Context Group work Systemic work (eg training) Other 11

What therapeutic intervention(s) have you used during the last two years? 90 Therapies used by EPs in the last two years 80 70 Perce entage 60 50 40 30 20 10 0 Therapy used 12

Key facilitators 1. Access to training i (e.g. The amount of work done in this area by individual EPs varies considerably, depending di on the training i they have received ) 2. Service culture offers flexibility in the model dl of working 3. Personal interest in therapeutic intervention 4. Schools valuing therapeutic intervention and their relationship with the EP 13

Key barriers 1. Limitations of service time allocation model/service capacity (e.g. The service does not operate a time allocation model, and so EPs have the flexibility to target more intensive support where needed ) 2. Otherpriorities identified via stakeholders 3. Lack of training 4. Lack of practice 14

Factor analysis of facilitators and barriers Looked at facilitators and barriers using factor analysis (PrincipalComponentsAnalysis) Oblimin Rotation used as overlap between the three variables Items above.4 (in red) are considered to load strongly with a factor 15

Component 1 2 3 Facilitators - schools valuing relationship with EP.741 -.110 -.134 Facilitators - schools valuing therapeutic intervention.727.002 -.122 Barriers - other priorities identified via stakeholders.644.083.097 Barriers - stakeholders do not identify EPs as providers of therapy.624 -.003.032 Barriers - historical context for EP work.544 -.164.141 Barriers - not tbest use of fepti time.401 -.328.259 Facilitators - service culture offers flexibility in model of working.368.059.206 Facilitators autonomy.360 -.280.152 Facilitators - recent legislation supports broadening of EP role.356 -.266.224 Barriers - lack of training -.050 -.873 -.033 Barriers - lack of practice.117 -.778 -.028 Facilitators - access to training -.008 -.536.033 Barriers - access to supervision -.113 -.520.465 Facilitators - personal interest in therapeutic intervention.203 -.403 -.044 Facilitators supervision -.313 -.284.723 Facilitators - management support.001 -.074.708 Facilitators t - peer support.087 -.252.568 Barriers - service capacity.162.196.522 Barriers - limitations of service time allocation model.199.196 16.459

Three components 1. Role of the EP 2. Training and practice 3. Support and service context The emergent components were then triangulated with the qualitative data 17

Role of the EP Stakeholders did not always identify if EPs as providers of therapy Health based professionals, particularly l those working for CAMHS did not readily identify EPs in this role The statutory duties placed on the EP may significantly impinge on the potential for EPs to work therapeutically Given the prevalence of children and young people with mental health needs, schools and families do value therapeutic input and there is demand for it 18

Training and practice ManyEPs have significant additional counselling or therapeutic skills in a whole range of therapeutic approaches Some EPs are additionally accredited by professional bodies such as the British Association for Counselling and Psychotherapy (BACP) A number of EPs reported that the training received was inadequate, particularly in helping them develop the higher order skills involved in therapy It was not always easy to find opportunities to practise or consolidate skills developed through training Supervisory structures were not always in place to enable EPs to effectively deliver therapeutic interventions Interest in therapeutic interventions led to significant personal attempts to prioritise the deliveryof therapyasas part of their casework 19

Support and service context Management and peer support were seen as integral to the delivery of therapeutic interventions In many cases, service capacity and/or the service time allocation model dllimited i opportunities ii for therapeutic interventioni Availability of time a significant issue Indications that t EPs might ihtsignpost schools to other therapeutic ti providers, rather than delivering the therapeutic interventions themselves Problems: time to undertake ongoing work; a lack of flexibility to enable intensive support where required; competing priorities (e.g. statutory work); limited number of school visits; schools willingness to pay for ongoing work via a traded services model; only a small number of EPs available to deliver therapeutic interventions. 20

Part 2 Research question: What features enable and ensure effective provision of therapeutic interventions by EPs? Methodology Participants i t identified d from Part t1 of the study Four site visits to EPSs reporting the capacity to enable and ensure effective provision of therapeutic interventions Interview with PEP; focus groups with EPs and stakeholders; documentary analysis Data audiotaped and transcribed 21

Initial themes fromthe qualitative survey data and site visits (currently being coded using Nvivo) Individual values /priorities Personal interest Role of the Educational Psychologist Changing context of EP role Multiagency working Role of EP in relation to therapeutic intervention 22

Qualitative codes Service context t Contracting/organising therapeutic work Leadership Opportunities to practise Specialist work with vulnerable groups Supervision Time/resources Training What are therapeutic interventions? Approaches/practice Definition of therapeutic intervention 23

Part 2 example Supervision Learning and educational function 4 Cs Competence Confidence Compassion Creativity Developmental Function Quality control Function Public protection (e.g. HPC) Organisational procedures are followed (administrative) Consistency of standards (Normative) Managers can be sure of service delivery (monitoring function) Supportive Function Managing emotional resources Restorative function Supportive function Resource function 24

Exemplar theme supervision British Psychological Society (BPS) and Health Professions Council (HPC) )guidance indicates all EPs should access supervision Supervision may be by line management or peers General and specialist supervision 25

Quality Control function Three authorities work quite closely l together. th We have a consultants group and provide joint in service training for people p to come along to. That also goes towards their accreditation for practitioner status. Consultants are available for supervision but we need to find the time for it. [I offer therapeutic intervention] only really via motivational interviewing which I will offer over 4/5 sessions. I do not feel there are adequate supervision structures in place to support any other therapeutic work. 26

Developmental function Trainee EP I found it really useful just in terms of moving my thinking on and I found I came out of supervision sessions thinking in different ways about my [CBT] case, which I found really useful I think what s been helpful for me is effective supervision. I don t mean supervision particular to a specific therapeutic intervention, I mean just informal and peer supervision and that abilityto to reflect and to realise when something s s not going well and to acknowledge that and to do something else I feel I would need ongoing supervision as I develop my CBT skills further 27

Supportive function Sometimes when you come in, you might need to grab someone now, and there s always someone who will speak to you, or arrange to see you at some other point particularly as a team we vebeen quite supportive of each other regarding some of the potential suicide stuff that s come up fairly recently and it s been really useful bouncing ideas off people at different times. When something like that happens, or there s a critical incident, it s having colleagues around 28

Supervision of therapeutic work issues specific versus general supervision quality and competence purpose; utility; efficacy underpinning assumptions what makes therapy work and what do I do if it is not working degree of case complexity flexibility versus manualised approaches (and fidelity) 29

General supervision Supervision has been increased to help the team deal with substantial changes taking place in the service (reorganisation and reducing of staff numbers). Also the service is picking up more and more complex cases as a result of moving to a needs led model (means the most complex children are being seen) Peer supervision provides more of an opportunity for discussing feelings around a case (offloading) and to decide whether there is a need to pass onto a manager. Managerial supervision may lead to the identification of a need for supervision in a particular area the Principal EP signposts who this might be and then tips the person off so that they can actively facilitate a conversation. 30

Specific supervision Therapeutic Play Supervision comes from a trained therapist funded from an external source when the funding stops then the EPS will have to look again at how to fund it. Parenting programme Clinical psychologists provide supervision for mellow parenting but now EPs have sufficient experience they could put themselves forward for the role of acting as supervisors. Critical Incident work Smallteam in the service meets to develop skills, regular monthly meetings which are supportive and developmental 31

Specific versus general supervision There should be two kinds of supervision, (1) by therapists per se skilled in the therapeutic intervention that you use as a tool in the EP toolkit, and (2) by more experienced EPs skilled in the general practice of Educational Psychology. A therapist once commented, "Just because you can use a hammer does not make you a joiner". And so, there are serious ramifications/implications there for EPs who are simply "tool users" " of therapeutic ti interventions. 32

Difficulties with outsider supervision I could travel 20 or so miles to get my supervision with a group that mostly work with adults. Some of them work with children and young people, but mostly with adults and not in a school context. They don t see things from that uniquely educational psychology perspective that the rest of this team would do. 33

Possible solutions ( see also Squires, 2010; Squires and Dunsmuir, 2011) Buying in supervision ii Group supervision Pairing of neighbouring EPSs to provide peer support Peer supervision, particularly where colleagues have accessed similar CPD Setting up networks and support groups for EPs Specialist supervision from multiagency partners (e.g. CAMHS) Virtual supervision (e.g. email contact or Skype with a specialist practitioner) 34

Publications to date Aki Atkinson, C., Bragg, J., Squires, G., Muscutt, J., & Wasilewski, D. (2011). Debate, 140, 6 12 Atkinson, C., Corban, I & Templeton, J. (2011 in press). Educational psychologists use of therapeutic interventions: issues arising from two explanatory case studies. Support for Learning, 26, 4. [Pilot study] Atkinson, C., Squires, G., Bragg, J., Muscutt, J. & Wasilewski, D. (submitted) Facilitators and barriers to the provision of therapeutic interventions by UK based educational psychologists. School Psychology International. 35

Discussion Further info: cathy.atkinson@manchester.ac.uk Thanks to Dr Garry Squires for his contribution to this presentation 36