Edinburgh 13-14, February, London 17-18, February

Real World ACT Workshop Applications in the NHS: Pediatric Rheumatology, Pediatric Cystic Fibrosis, Pediatric Diabetes, Pediatric Gastroenterology, Youth Care Providers, Pediatric Nursing, Public Health, Child and Adolescent Psychology!

Here is a story from my friend Jim Lemon, an NHS psychologist, who came to a Self-Care and Self-Compassion workshop about 1 1/2 years ago.

Just in case you were wondering, this workshop is not specifically aimed at kids and families. That is just the people my friend Jim serves. 

How to Take Care of a Human!

People who follow me know that several years back, I decided to really start taking care of myself after a lifetime of either active self-harm, in the form of alcoholism, addiction, and other forms of self destruction in my youth, to more socially acceptable, but troubling self-neglect through middle-age.

Because I am a super geeky science guy, I did not just go ask a personal trainer, a dietician, or my physician what I ought to do. I did those things too. But the other thing I did was read and read and read and read and read and read. In fact, I took a year sabbatical from my university post in order to read mountains of science.

Somewhere along the way, I set down 8 daily practices in a blog that I have applied to my own life in order to optimize my own health and wellbeing. Some are based on direct clinical evidence, but they are also based on a very, very broad range of other theory and evidence.

I have two of these workshops integrating ACT, Self-Care, and Self-Compassion in a Stressed Out World coming up in Edinburgh and London.

Jim Lemon, D Clin Psych. came to one of these trainings about a year and a half ago.  He is a Consultant Clinical Psychologist in Medical Paediatrics in the UK National Health Service in the Dumfries and Galloway region of Scotland. Jim went home to his service and put these self-care interventions in front of his co-workers. Together, they have done some astonishing work across their physical and mental health services.

I just wanted to share a bit of what Jim and his amazing colleagues have done.

Here are some of the challenges facing public services and Jim’s journey developing this work into real world interventions–in his own words:

  1. Lots of Staff are struggling. In the NHS, staff absence/long-term sickness is a significant issue. The nature of sickness absence has changed over 30 years. Occupational Health are now dealing with more stress-related issues. As pressures continue to rise for staff, Managers, Chief Executives, and Government are very aware of the need to improve the staff situation. The same pattern is also seen across Health and Social Care Partnerships and Education (it was reported recently that the average length of time qualified teachers spend in this career post- qualification is five years). This level of struggling is within the group who are employed and trained to help the people who are struggling in their lives.
  1. Lots of the general population are struggling. There is a huge unmet need in the general population to support psychological wellbeing.
  1. Lots of children, young people and their families struggle/are at risk for additional suffering. In Medical Paediatrics (my area of work) having a child with a chronic health condition amounts to approx 4X level of stress on a child and their family. We know that this has a direct impact on adherence to medical regimes and therefore clinical outcomes.
  1. The funding for services is variable or short-term so we have to be creative and innovative.
  1.  We need good ‘tools’. In applied settings, clinicians need simple effective tools, but with real science behind them. We do not have time to analyse all the data out there but we must be evidenced-based in our work. There are a number of ideas and ‘tools’ I have gained from Kelly’s workshop. They are brilliant. Many many hours of work have been put into these tools. Kelly has processed and condensed huge amounts of data into ‘bite-sized’ chunks.
  1. Kelly’s ‘tools’ are easy to understand and remember.  We teach them to people, they can self-assess how they are doing in these areas and make a plan to change or maintain behaviours in these areas. TBH you could write down the ‘8 daily practices’ and stick it on your fridge as a reminder! The ACT Matrix which Kelly works through is also extremely user-friendly and can be also be stuck on the side of the fridge. So why spend two-days at a workshop when a hand-out would cover all the major points? Any tool can appear simple, but this does not necessarily mean it is easy to use, and if used incorrectly, could cause harm. In the workshops we learn the context for using these tools and gain direct experience of the process issues. Without context the tools are a handy ‘to-do’ list but could just make people aware of what they ‘should’ do but aren’t. Most people have a general idea about what medicines they need and why. I have yet to meet anyone who has always had 100% adherence!
  1. Kelly outlines the science behind the workshop and bridges the behavioural and biological sciences. This is crucial and very well received in particular by non-psychology colleagues and friends who may not be familiar with psychological research but are comfortable within the medical model. Managers and Clinicians have, quite rightly, asked me to demonstrate the science behind the ‘tools’ and Kelly has provided this.
  1. Kelly brings ‘himself’ to the workshop, not just photocopied handouts. In my opinion, as both a Chartered Consultant Clinical Psychologist with 16 years post-qualification experience, and as a human being, that is a key ingredient. A hand-out would be stuck on a shelf along with many other useful yet unused advice. It is the honesty, humanity and compassion that Kelly shares which explains and experientially teaches the ‘tools’ to attendees. We aim to continue that as we pass the tool onto others.
  1. The applied psychology world is messy. There are many factors at work here. Teasing out ‘a’ single factor above and beyond others is not always possible. However, in my opinion, I have been using what I learn from Kelly and applying it in real world settings. Where this has been done, we can clearly see improvements in physical health of children with various chronic health conditions, ratings of staff and patient wellbeing, reduced levels of psychological distress and improved satisfaction and quality of life measures.

Real world outcomes

We have adapted some of Kelly’s workshop into ‘tools’ which we use as screening measures and guides. A simple eight-practice assessment ‘wheel’ starts the conversation about ‘the sort of monkeys we are’ (Kelly puts this all in an evolutionary perspective!). Then we give a score (0-10) for each area then mark it on the wheel (0 nearest centre). After we join the dots, a small circle or any ‘punctures’ means that we can do some work in that area! The wheel image was well received when we implemented the PROSOCIAL model with teams so we carried it on with the 8 daily practices work 

We are now building resources for self-help/guides/early intervention based around how to make small changes in each of these areas. We do this before we go into more formal assessment. Participants often recognise where they want to make a change before formal assessment even begins. Simple, but not easy. People really like the ACT Matrix ‘Kelly style’. Particularly the storage jars in the pantry! The focus in the right-hand side of the Matrix has changed the dynamics in team meetings, with families and patients.

Some of the ongoing impacts include

Paediatric Nursing

Setting: Paediatric Department within an Acute District General Hospital

Target Group:  Paediatric Nursing team (approx 40 staff who work on the Children’s Ward)

Programme: As part of bi-annual staff training / deployment day events we explore the ‘8 daily practices’ for staff and follow-up throughout the year as required. Matrix used for individual formulations and staff ask families about 8 daily practices – if deficits in an area then they refer to most appropriate service

Outcomes/evidence of usefulness: Positive feedback / evaluation from staff and managers. Patient feedback often comments on compassion of staff.

Youth Care Staff

Setting: Local Authority

Target Group: Young Carers Staff (14)

Programme: Self-Care

Outcomes/evidence of usefulness: Positive feedback / evaluation from staff and managers

Paediatric Diabetes

Setting: Paediatric Department

Target groups: 

  1. Paediatric Diabetes Team (multi-disciplinary team of 5)
  2. Patients and families screened at annual review (potentially approximately 80 children plus families) to see if there are areas they want to focus on

Programme: ‘8 daily practices’ for screening for children and families. Team ACT Matrix and ‘8 daily practices’ to staff

Outcomes/evidence of usefulness: Positive feedback / evaluation from staff and managers. A range of interventions by this team, including those listed here, is correlated with improvements in blood glucose control across population as a whole. Quality of life scores improved across population.

Paediatric Cystic Fibrosis

Setting:  Paediatric Department

Target group:

  1. Paediatric Cystic Fibrosis Team (multi-disciplinary team)
  2. Patients and families screened at annual review

Programme: ‘8 daily practices’ at screening at annual review. ACT Matrix for children and families and with Team

Outcomes/evidence of usefulness: Positive feedback / evaluation from staff and managers. Population sub-threshold on measures of distress. Children and families engage in a range of initiatives following the assessment including fitness training, cooking, running, Judo, fund–raising etc.

Paediatric Rheumatology

Setting:  Paediatric Department

Target groups:

  1. Paediatric Rheumatology Team (multi-disciplinary team of 5 + Consultants from Specialist Hospitals)
  2. Patients and families screened at annual review (approximately 15 children plus families) to see if there are areas they want to focus on

Programme: ‘8 daily practices’ for screening for children and families. Team ACT Matrix and ‘8 daily practices’ to staff

Outcomes/evidence of usefulness: Positive feedback / evaluation from staff and managers.

NHS Public Health

Setting:  Public Health Department

Target group: ‘Healthy Lives’ workers (multi-disciplinary team)

Programme: 3 sessions over 3 month period. ‘8 daily practices’

Outcomes/evidence of usefulness: Positive feedback / evaluation from staff and managers

Child and Adolescent Psychology

Potential future work:

Setting:  Child and Adolescent Psychology Service

Target group: All referrals to service

Programme: Screening for ‘8 daily practices’ and advice given as part of triage service

Outcomes/evidence of usefulness: not yet available – however, potentially could be huge. We are considering using what I have gained from attending Kelly’s workshop across services.

We are now developing a training resource for Clinical Psychologists working in Medical Paediatric Settings across Scotland. These psychologists then pass these skills onto any other staff working with Children with Physical Health Conditions (potentially in the 1,000s). I’ll keep you posted!

Dr. Jim Lemon
Consultant Clinical Psychologist
Medical Paediatrics
Dept. of Psychological Services and Research
Mental Health Directorate
Crichton Royal Hospital
Glencaple Road
DG1 4TG

To Jim and colleagues at Dumfries and Galloway: My hat is totally off to you! Sometimes out on the road, I have such self-doubt about whether I am doing any good. Seeing this sort of thing gives me heart for the next trip!

If you made it this far and are interested, I am doing two workshops in Edinburgh and London in February. These will be small events. We will be able to get up close and personal.

Come To Edinburgh February 13-14, 2017!

or

Come to London February 17-18, 2017!

with my warmest regards,

Kelly

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