CBRT™– the case for NHS Adoption Providing patients with structured relaxation support sessions
CBRT is a new innovation in mental healthcare NHS Change and transformation“Colour Breathing Relaxation Therapy is a vital tool that we use within our community to enablerelaxation and stress management techniques, which focuses and calms the mind” Aidan Hamilton – CALM Programme Coordinator CBRT (Colour Breathing Relaxation Technique) is a UK innovation which provides all users with a simple, yet very effective, mind - body awareness technique through structured and guided relaxation support sessions.
A missing piece of the puzzle • CBRT provides the NHS with a Value for Money, practical and unique system for physical health, mental health and wellbeing. • CBRT provides a ‘safe care’ and ‘right care’ solution to the ever growing requirement for increased capacity within integrated care for patients with anxiety, mild to medium depression and long term conditions. This need was highlighted in the report, “How Mental Illness Loses Out in the NHS”, produced by a distinguished team of economists, psychologists, doctors and NHS managers convened by Professor Lord Layard of the LSE Centre for Economic Performance. • CBRT can contribute to productive patient care and strengthen staff and patient communication skills; CBRT is empowering. • CBRT is a high quality, yet low cost product. • A relaxation technique and therapeutic intervention - CBRT is a safe product. It is a CE Class 1 Medical Device and is made of printed matter. • CBRT is a motivational, inclusive, non-pharmaceutical, non-invasive, non-denominational and non-tactile intervention, for all ages and abilities.
Relaxation supports patients’ rehabilitationA positive outlook to aid patients’ wellbeing
Aligning with IAPT Commissioning goalsFeedback from an NHS Commissioner of Psychological Therapies An NHS Commissioner of Psychological Therapies has written the following about the CBRT NHS Training Initiative: “The principles of building confidence and socialisation are good, as commissioners we understand how important this is for a patient’s recovery.” “The proposal is very good and well presented, with a good evidence base and clinical outcomes.” “On paper, the savings are good, a reduction in primary care presentations, and this is similar to IAPT where we also know there are reductions in referrals to secondary care.”
NICE Quality Standards ProgrammeQS for Depression in adults In March 2013, the CBRT Initiative was supported by the Innovation Promotion Manager of NHS South of England. It was suggested that the paper “NICE – Quality Standards Programme – Cost impact and commissioning assessment: quality standard for depression in adults - March 2011” should be provided as an example of potential cost savings for the CBRT Initiative as it states on pages 8 and 9 that the total expected saving per IAPT patient rounded as being £340.00 in a two year period. http://www.nice.org.uk/media/01D/C3/DepressionQSCostAssessment.pdf 125 staff trained in CBRT would therefore only need to support a minimum of 264 Patients in Year One (less than one per day) to recoup the initial investment in the whole CBRT Training Initiative. (2.11 Patients per trained staff member.) Supporting more patients would, the NICE paper suggests, result in a saving to the organisation as well as enhanced quality of care and experience for the patient.
CBRT Intervention Evidence Base“An intelligent amalgamation of Evidence Based Interventions” Here are the key components of CBRT and Interventions embraced with CBRT number of independent studies currently with already with NICE approval include: NHS Evidence: • CBT • Guided relaxation • Mind-Body Relaxation Technique (74) • Mindfulness based stress reduction. • breathing techniques (1,888) • Mindfulness approach (375) When CBRT is introduced into 8 NHS • positive thinking (7,383) CCGs /Trusts it will very quickly support • self-help and guided self-help (2,935) patients across the board and within 6 to 8 • MBSR (Mindfulness –based stress months, create c.17,000 CBRT NHS case reduction) (24) studies for NHS Evidence from the NHS staff post-training case studies alone. • Mind-body interventions (5,418) • creative visualisation (60) • Meditation (565) • group therapy (46,805) • Anxiety breathing techniques (971)
CBRT Initiative for NHS Trusts and CCGsTaking the lead in Patient Care and Innovation From 1st April 2013, CBRT will focus on working initially with 8 NHS Trusts and CCGs: • To train 28 staff per Trust/CCG (224 in total) • To “Train the Trainer” (40 in total) • Each NHS Trainer to train a further 20 staff (800 in total) • Evaluate Post Training assessment papers and case studies from each individual NHS Trust and CCG group and provide these as case studies for NHS Evidence. • Work with partners to create an NHS quality database for Assessment Paper(s) feedback; Case Studies Feedback; Patients/Users feedback. • Work with the RCN Accreditation Unit to complete the RCN CPD accreditation process and similar process with COT (The College of Occupational Therapists.) • See contact details on last side if interested in being in this initial cohort
CBRT Training is delivered in two daysTraining and Evaluation Before training: Evaluating feedback - After training: Learner skills and knowledge is assessed Learner provides course feedback. CBRT provides course assessment feedback to During training: the learner. Short tests are conducted at regular Actual outcomes - see slides 24 – 28 examples. intervals during activities and learning including: Follow up: CBRT “Initial response sheets” - Transfer of learning to the workplace Listening Exercise - Patient feedback Working as a group and in pairs - Results and impact on organisation - Return of investment study Techniques of evaluation used include: - CBRT intend to provide NHS Trainers with Observation ½ day refresher training every 12 – 18 months. Questionnaires Listening skills Validating learning Post Training Programme Paperwork: 40 question Assessment paper 10 case studies (2 groups of 5 users - twice, 2 individuals – twice.)
NHS Trust – a strong case for adoption – QiPPMeeting challenges whilst serving a need • The purpose of CBRT is to improve quality, • CBRT can be used in conjunction with and safety and provide value for money in programmes associated with reducing the NHS through the provision of structured the use of antipsychotic drugs and guided relaxation support sessions for particularly with dementia sufferers. patients. • Person centred care is provided though • Designed to support NHS savings targets. guided group support sessions. • An “invest to save” programme. • CBRT is a very flexible relaxation • An Innovation that supports mental health intervention - so is not “just about group and wellbeing - national NHS priorities. therapy” - it can easily be used as a “one • Enhances both Productivity and Prevention off” intervention for the anxious ward patient for example. • Helps address the demand for anti- depressants which is growing annually. • > 12,000 patients in a single Trust could benefit each year, including a reduction in primary care referrals and secondary care. • CBRT is a unique innovation and system. • Commissioners may note that Regulation 5 provides for commissioners to award a new contract without a competition where there is only one capable provider.
5 Case Model – Improving Patient Care Now • The Strategic Case - CBRT provides a response to “I have no idea why healthcare ‘Francis’ empowering patients and staff. As an IAPT providers do not offer relaxation technique evidence would suggest it can reduce prescribing and dependency on other services. It is a classes to Patients suffering from quality health improvement and modernisation long term conditions. Following an programme through training staff. It addresses the call for accident, I now live with chronic pain ‘Compassion in Practice’ 6C’s. syndrome and bouts of depression... • The Economic Case – CBRT optimises Value for Money I am not surprised so many people –A ‘compelling case’ for innovation supporting mental suffer with depression. Group health as an NHS priority. The Health and Care Act contact and regular support is far highlights the importance of integration and a mind and more important than a packet of body approach to care tablets.” • The Commercial Case – CBRT requires a modest initial investment and is commercially viable. In May 2012, Mrs P. CBRT scored 92.53% with the NHS National Innovation NHS Patient, South of England Technology Scorecard process. As a non-referral baseline activity, help to reduce unnecessary admissions and length of stay targets. Pre-admission clinics and prevention strategy. • The Financial Case – Improve your local public services and integrated self care programmes. CBRT is financially affordable and provides a demonstrable improvement in care and a demonstrable return on investment • The Management Case – CBRT is all inclusive and can be taught to and delivered by all nursing and allied healthcare staff.
The case for adoption – Staff Skills,CPD Training“Training and education should be an integral part of any proposed service if it is to be of high quality and sustainable.” NHS Confederation – “Clinical responses to the downturn.” • The CBRT programme provides staff with skills transferable to many different clinical scenarios. • It offers a Team building opportunity. • Smaller CCGs can be provided the two day CBRT Training Programme for 12 - 20 staff . • CBRT provides Performance Measured Training (PMT) . Upon completion of two day training programme, staff are required to complete an online 40 question Assessment paper and 10 templates for their CBRT user case studies – (3 groups of five people twice and two individuals twice.) • Upon successful completion and marking of papers, staff receive assessment grade and a certificate is issued (within 8 -10 weeks of training.* Staff are then allowed to provide CBRT Relaxation Support Sessions to Measurable outcomes – All CBRT case patients. (*Based on staff completing study templates contain recognised paperwork to agreed schedule.) health and wellbeing statements
CBRT as a Service ImprovementHelping your Trust respond to “The Francis Report” • CBRT provides a unique product, service and results - with measurable outcomes. • Integrated healthcare for “whole patient” and self care pathway. Greater commitment and ownership Designed for easy large scale change and adoption. • Embedding Equality, Diversity and Inclusion. • The CBRT Initiative is a Project with a Value Stream – to quickly provide professional, structured, relaxation support sessions for all patients. A robust, quick diffusion model. • CBRT supports NHS staff training and resources appropriately, in the most serious period of financial constraint ever faced. • Meeting national policies – long term conditions, mental health, health prevention, innovation, QiPP. • Innovation procurement to meet local strategic needs. • Extends patient choice prior to IAPT Programme. • Designed for easy large scale change and adoption.
CBRT Initiative Goals“Any project worth doing is worth doing fast and right.” CBRT Initiative Project Goals: Long term goals: • Improve Quality - Patient experience, • To contribute to improving Patient mental health and wellbeing provision . experience through innovation led Staff make shared time with patients Compassion in Care. “Make Time to Save Time.” • To deliver cash releasing savings. • Meet RCN and COT CPD Training • To provide independent NHS led standards and requirements. evidence to work towards NICE • Reduce waiting times of IAPT approval as a relaxation intervention interventions, through Innovation and and technology. practical application of this new • The NHS Change model includes need technology. for “Rigorous Delivery.” • Reduce Total Costs – examples • Each member of staff trained will aim include: Group relaxation support to support 10 patients per week. provision, Length of stay – reducing • NHS Staff and Trainers to complete length of stay. training paperwork to agreed time. • Improves patient choice and • NHS Trainers to attend a ½ day CBRT experience. Learn how to relax before “Refresher” Training programme every starting a medication pathway. A tool 2 years. kit to help reduce boredom on the ward. • NHS Staff and Trainers to complete training paperwork to agreed time
Responding to Patients’ NeedsHelping your Trust respond to “The Francis Report” Compassion in Practice and the 6 C’s : Patients also need: • Care quality/safety • To have a vehicle to express their • Compassion thoughts and needs • Commitment • To feel they are being heard • Communication - understanding • Feel respected • Courage – change, adopting innovations • Experience calm • Competency • Learn relaxation skills • Positive thinking • Develop self – care tendencies • Feel involved and cared for • Interconnection.
An easy to use, ongoing self-care programme • CBRT provides Patients with a non-pharmaceutical intervention choice. • Patients are able to continue self directed Colour Breathing Technique everyday as the CBRT Kit is safe and suitable for home use. • CBRT encourages patients to become proactive in self-care. • Each CBRT Kit comprises: full colour book, set of seven Colour Breathing Disks easel set, Audio CD. • The new 2013 “Daily Observations Diary” will enable users to record their feelings and moods and which affirmations they choose to use each day. This will provide NHS staff with improved communication and regular weekly feedback from Patients in a simple format.
Adoption of CBRT – long term conditionsAs part of Patients’ Care Pathways CBRT may deliver many benefits • Relaxation awareness As part of a whole pathway holistic approach • Mindfulness, focus CBRT can contribute to: • Inner calm • Cardiac and stroke prevention • Breathing improvement, awareness • Respiratory Smoking cessation • Positive thinking • Long term conditions support • Group support • Mild – medium depression • Quality time with nursing staff • Anxiety, Insomnia toolkit • Self-help in action • Mild dementia , easy to use technique • Group participation • Antenatal, Postnatal skills • Rehabilitation pathway tool • Medication reduction support The Colour Breathing book is very easy to read and printed in full colour
How does CBRT support NHS staff?CBRT training to strengthen communication skills & team building • CBRT offers Quality Improvement - made • Structured CBRT Relaxation Support simple. Sessions – whether patients experience • Team building and Engagement to Mobilise. this as a ‘once-only experience’ or in Nurses, Allied healthcare and Social Care a series of 8 – 10 sessions, provides time Teams have the opportunity to train together, and space for positive, uplifting, calming attending a two day CBRT Training dialogue between staff and patients, Programme. contributing to overall staff and patients’ • Through interaction and learning how to use wellbeing. CBRT with both individuals and groups of • CBRT is a vehicle for engaging with patients, staff enhance their natural Patients with Care and Compassion. communication skills of listening, focus, • CBRT Relaxation Support Sessions could timing, patience and awareness. also be provided to support NHS staff. • Staff may feel more valued by management • In the community, clinics, wards, rest when given the opportunity to undertake rooms...CBRT is a flexible tool and additional training. efficient way to deliver a relaxation intervention in a group setting.
How CBRT is delivered... CBRT™ Relaxation Support Sessions are a productive model and an efficient way of delivering group therapy. An established method, CBRT requires : • A trained member of staff. • 20 – 45 minutes of uninterrupted time. • A suitable, well ventilated room. • Comfortable seating, with table space, if possible. • Colour Breathing Disks – 1 set per user. • Colour Breathing Affirmation Cards – 1 set per group. • Initial Response Sheets (Individual use only)
Sustainable model – NHS ongoing cost savings Each Initiative comprises of Two days CBRT Training Programme for 28 staff + two days "Train the Trainer” for 5 staff + 100 Training Kits. • The Training Initiative provides ongoing sustainability to every NHS Trust and CCG, allowing greater flexibility with local training provision. • Stage 1 is an initial two day CBRT Training Programme for 28 nursing, allied healthcare and social care staff. • 8 weeks later a two day “Train the Trainer” regional Training Programme is provided for 5 members of staff. • Stage 2, The NHS Trust is now self-sufficient and receive their allocation of 100 CBRT Training Programme Kits and additional Colour Breathing Disk sets. Future Training Programme Kits will be available to purchase in sets of twenty as required.
Users feedback of “CALM Programme”“Colour Breathing Relaxation Therapy is a vital tool that we use within our community to enablerelaxation and stress management techniques, which focuses and calms the mind” Aidan Hamilton – CALM Programme Coordinator Participants of the CALM Programme were asked about their experience of CBRT training: their responses included: • Meeting new people that they can learn from, both other participants and the trainer; • Learning new skills that they can apply and building self-confidence; • A positive environment to come to and bring them out of their shell where they need to; • Promoting positive mental health and reducing suicide; • The way it has been delivered and the interaction between the group; • The CBRT is a valuable resource they now have available to them.
The next 5 slides demonstrate actual feedback received from 85 CBRT Userswho received CBRT sessions from 5 newly trained practitioners
85 Users - Overall improvement after 2 CBRT sessionsQuestions - Physical health & Mental Health
85 Users - Overall improvement after 2 CBRT sessionsQuestions : enjoyment of life and optimism
85 Users - Overall improvement after 2 CBRT sessionsQuestions : feeling useful and feeling relaxed
85 Users - Overall improvement after 2 CBRT sessionsQuestions: dealing with problems, thinking clearly
85 Users - Overall improvement after 2 CBRT sessionsQuestions: Feeling close to other people, able to make up own mind
CBRT creating a flexible solutionFor NHS CCGs and Trusts CBRT NHS bespoke versions CBRT future products All products are printed in full colour and to a • CBRT are to create additional sets of high quality. boxed Affirmation Cards to provide As CBRT is also an independent publishing positive thoughts and a low cost house, there is great flexibility and capacity solution to further support and address to create bespoke localised versions of all specific conditions and life such as: CBRT products for NHS Trusts and CCGs as • Hypertension, Anxiety, Stress, requested. E.g. The CBRT Book Kit can be Insomnia produced to include up to 10 pages of • Mild to medium depression relevant NHS Trust /CCG local information • Long term conditions in full colour for their patients, with the minimum print run being only 3,000 units per • Obesity, healthy weight product. • Substance misuse conditions CBRT can also create CBRT products and • Bereavement, Dementia. information leaflets: • In different language editions* : • Braille • Larger font • All formats - special needs.
Work with us as CBRT is affordable for all budgets! The CBRT NHS Training Initiative for Trustsand CCGs (125 staff & 5 Trainers) is payable in three stages, across a period of three months.Deposit on booking £5,000, Phase 1 £19,381, Phase 2 £19,381 (+ VAT) and / orSmaller CCGs Local Training Programmes for 12-28 staff @ £600 each + National Trainertravel costs, accommodation allowance + VAT. Contact : firstname.lastname@example.orgSupporting “Compassion In Practice and Innovation Health and Wealth” Updated 05.04.13