CBRT™– a case for NHS AdoptionProviding patients with structured relaxation support sessions
CBRT is a new innovation in mental healthcareNHS Change and transformation CBRT (Colour Breathing Relaxation Technique) is a UK innovation which provides users with a simple, yet very effective, mind - body awareness technique through structured and guided relaxation support sessions. Mindfulness + Colour + Breathing + Positive Thinking = Calm
The missing piece of the puzzle • CBRT provides the NHS with a Value for Money (VFM) practical application and unique system for physical health, mental health and wellbeing. • Market ready and user-friendly, 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 provides opportunities to build a productive patient care network and strengthen communication skills. CBRT empowers patients. • CBRT is a high quality yet low cost product per unit. • A relaxation technique and therapeutic intervention - CBRT is a safe “technology enabler” and is a safe medical device, made of printed matter. • CBRT is an all inclusive, motivational, non-pharmaceutical, non-invasive, non- denominational and non-tactile intervention for all ages and abilities.
Relaxation supports rehabilitationA positive outlook supports wellbeing
Aligns with IAPT Commissioning goals An NHS Psychological Commissioning Manager 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.”
The case for adoption – a talking solution • CBRT helps people with anxiety learn how to relax naturally. Supporting patients at a ‘grass roots’ level, CBRT provides the benefits of group therapy with a visually appealing and easy to learn mindfulness technique. • Patients having individual CBRT sessions are encouraged to talk about how the colours make them feel – with the CBRT Initial Response Sheets prior to receiving their relaxation session. This has proven to be a very popular activity. • Patients waiting to join the IAPT Programme can safely be offered some initial support through provision of CBRT Relaxation Support Sessions, either as an individual or within a group setting. • CBRT sessions can be provided by all staff across multi disciplinary teams nurses, allied healthcare, social care across primary and secondary care, including occupational therapy, physiotherapy, clinics e.g. hypertension, smoking cessation, insomnia, obesity ,addictions, obesity, trauma, bereavement, maternity.
CBRT Intervention Evidence BaseCBRT is an intelligent amalgamation of Evidence Based Interventions” Here are the key components of CBRT and Another perspective - Patient Boredom. number of independent studies: Occupational therapy and specific evidence NHS EVIDENCE STUDIES: for boredom in acute mental health is only just emerging - think of the acute ward • Mind-Body Relaxation Technique (74) environment -Why are service users bored? • breathing techniques (1,888) • External causes i.e. lack of ward facilities and • Mindfulness approach (375) over structured or no routine? • positive thinking (7,383) • Internal causes – lacking skills and volition to • self-help and guided self-help (2,935) engage with occupations available? • MBSR (Mindfulness –based stress • Any other reasons? reduction) (24) • Do the reasons overlap? • Mind-body interventions (5,418) • Would we be the same as an inpatient? • creative visualisation (60) • Meditation (565) • Newell (2009) identifies that if an individual believes in their abilities/has high self efficacy they are more • group therapy (46,805) likely to engage in activity and therefore less prone to • Anxiety breathing techniques (971) boredom. Flow is likely to increase self efficacy. Those already with NICE approval: CBT, • Martin (2009) advocates mindfulness techniques; boredom rising from the inability to focus Guided relaxation, Mindfulness based stress attention mindfully, i.e. paying attention on purpose in reduction. the present moment – does this link to a potential The CBRT Initiative actioned with 8 NHS Trusts educational role for us re flow? and CCGs will quickly create c.17,000 • Illot (2007) Advocates boredom as an OT issue, and independent case studies for NHS Evidence is a focus of the Research Centre for Occupation and from NHS staff post training case studies. Mental Health (2008)
CBRT Training – A New Evidence BaseEvaluation of Training Effectiveness Before training: Evaluating feedback - After training : Learner skills and knowledge is assessed CBRT provides course assessment feedback to the learner During training: Actual outcomes (see slides 22 – 25 examples) Short tests are conducted at regular intervals – activities and learning Follow up: 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: Observation Questionnaires Listening skills Validating learning 40 question Assessment paper 10 case studies (2 groups of 5 users - twice, 2 individuals – twice.)
NHS Trust - Business Case for Adoption – QiPPMeeting challenges whilst serving a need • The purpose of CBRT is to improve • Demand for anti-depressants is quality, safety and value for money in growing annually including the NHS through establishing the prescription addiction. availability and provision of structured • Person centred care is provided and guided relaxation support sessions though guided group support for patients. sessions. • A ‘cost neutral’ initiative designed to • Two day training for 125 staff support NHS savings targets. • > 12,000 patients could benefit • An “invest to save” programme. each year, which a reduction in • An Innovation supporting mental health primary care referrals and as a national NHS priority. secondary care • It enhances both Productivity and • “Room for innovation must be Prevention programmes.. allowed.” • CBRT is a unique innovation and system. Regulation 5 provides for commissioners to award a new contract without a competition where there is only one capable provider.
The Business Case – Improving Patient CareA Best Care Practice project. • Quality health improvement and modernisation “I have no idea why healthcare programme through training staff. providers do not offer relaxation • A ‘cost neutral’ initiative. Invest to save. classes to Patients suffering from • A ‘compelling case’ for innovation supporting mental long term conditions. Following an health as an NHS priority. The Health and Care Act accident, I now live with chronic highlights the importance of integration. pain syndrome and bouts of • Low intensity, practical solution, self care system. depression... • A non-referral baseline activity. Help to reduce I am not surprised so many unnecessary admissions and length of stay targets. people suffer with depression. Group contact and regular support • Pre-admission clinics and prevention strategy. is far more important than a packet • Improve your local public services and integrated self of tablets.” care programmes. • A demonstrable improvement in care. Mrs P. NHS Patient, South of England
CBRT Case For Adoption – Staff Skills 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 a team building opportunity for you and your staff. • Smaller CCGs can be provided with the two day CBRT Training Programme for 12 - 28 members of staff. • Advancing Quality Targets. Quality health reform and development. • 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 Measurable outcomes – All CBRT case CBRT Relaxation Support Sessions to study templates contain recognised patients. (*Based on staff completing health and wellbeing statements paperwork to agreed schedule.)
CBRT Lean Thinking for Service ImprovementBringing Lean to life. • CBRT is a Lean Methodology Project for your Trust and CCG. CBRT provides a unique product, service and results - with measurable outcomes. • Project as 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. • Embedding Equality, Diversity and Inclusion. • Extends patient choice prior to IAPT Programme. • Designed for easy large scale change and adoption. • Integrated healthcare for “whole patient” and self care pathway. Greater commitment and ownership.
CBRT Lean Thinking for Service Improvement“Any project worth doing is worth doing fast and right.” CBRT Lean Goals: CBRT Initiative Project Goals • Improve Quality - Patient experience, • Staff professional development – mental health and wellbeing provision engage and mobilise the right people. • Eliminate Waste across and in all areas • Staff make shared time with patients • Reduce Lead Time ,through Innovation “Make Time to Save Time.” and practical application of new • Enhance Patient Listening and technology Communication using the visual and • Reduce Total Costs – examples include accessible CBRT toolkit. group provision, medication, LOS, GP • Length of stay – reducing length of visits... stay. Reduce boredom on the ward. • Sustainability - Train the Trainer • Start CBRT Relaxation Support • Project system = people + process + Sessions as part of Community product + services = relationships. mental health programmes. • Improve patient choice. Learn to relax before starting a medication pathway? • NHS Staff and Trainers to complete training paperwork to agreed time • Meet RCN and COT performance standards and requirements. • The NHS Change model includes need for “Rigorous Delivery.” Each member of staff trained to aim to support 10 patients per week.
Our Patients’ Needs: The 6 C’s of Nursing are listed as being: Patients also need: • Care quality/safety • To feel they are being heard • Compassion • Feel respected • Commitment • Experience calm • Communication - understanding • Learn relaxation skills • Courage – change, adopting innovations • Positive thinking • Competency • Develop self – care tendencies • Feel involved and cared for • Interconnection.
An Easy to Use, Ongoing Self-Care Programme • CBRT provides a patients with a non-pharmaceutical intervention choice. • Patients are able to continue using their Colour Breathing everyday - the CBRT Kit is safe and suitable for home use. • CBRT encourages patients to be 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 = Patient Benefits • Relaxation and education • Cardiac and stroke prevention • Mindfulness, focus • Respiratory Smoking cessation • Inner calm • Long term conditions support • Breathing improvement, awareness • Mild – medium depression • Positive thinking • Anxiety, Insomnia toolkit • Group support • Mild dementia , easy to use technique • Quality time with nursing staff • Antenatal, Postnatal skills • Self-help in action • Rehabilitation pathway tool • Group participation • Medication reduction support The Colour Breathing book is very easy to read and printed in full colour
How will CBRT help our Staff?CBRT includes Training in Communication Skills • Quality improvement made simple. • Structured CBRT Relaxation Support Sessions – whether patients experience • Engagement to mobilise. Nurses, Allied this as a ‘once-only experience’ or in healthcare and Social Care Teams have the a series of 8 – 10 sessions, provides time opportunity of training together, attending and space for positive, uplifting, calming a two day CBRT Training Programme. dialogue between staff and patients, contributing to overall staff and patients’ • Through interaction and learning how to use wellbeing. CBRT with both individuals and groups of patients, staff enhance their natural • An active interface for patient care and communication skills of listening, focus, compassion. timing, patience and awareness. • In the community, clinics, wards, rest • Some NHS staff have mentioned being sent rooms...CBRT is a flexible tool and on training programmes makes them feel relaxation intervention. ‘more valued’ by management.
An NHS Change ModelCBRT provides a New Peace and Calm strategy... CBRT™ Relaxation Support Sessions are an established method ,which require : • 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)
Sustainability to reduce NHS Costs further Each Initiative = Two days CBRT Training Programme for 28 staff + Two days "Train the Trainer” for 5 staff + 100 Training Kits = 128 staff • The Training Initiative provides ongoing sustainability to every NHS Trust and CCG, allowing flexibility with local training provision and discounted prices on materials.. • 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 / CCG receive their allocation of 100 CBRT Training Programme Kits and additional Colour Breathing Disk sets for staff to provide group CBRT Sessions.
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, Belfast, N.Ireland Participants of the CALM Programme were asked about their views on CBRT and 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 resources they now have available to them.
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 Working With NHS Trusts & CCGs 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 are also a publishing house, there positive thoughts and a low cost solution is the flexibility and capacity to create to further support and address specific bespoke localised versions of all CBRT conditions and life such as: products for NHS Trusts and CCGs where • Hypertension, requested. • Anxiety, Stress, E.g. The CBRT Book Kit can be produced to • Insomnia include 10 pages of relevant NHS Trust /CCG local information for patients, with the • Mild to medium depression minimum print run being only 3,000 units per • Long term conditions, product. CBRT can also create CBRT • Obesity products and information leaflets : • Smoking cessation • In different language editions* : • Bereavement • Braille • Larger font • All formats - special needs. *NHS Leaflets are currently produced in over 20 language editions.
Work with us! CBRT is affordable for all budgets. The CBRT NHS Training Initiative forTrusts and larger CCGs (125 staff & 5 Trainers) is payable in three stages across a periodof three months. Deposit on booking £5,000, Phase 1 £19,638, Phase 2 £20,489 orLocal training programme for 12-28 staff @ £600 each + National Trainer travel costs,accommodation allowance + VAT. Support UK innovation email@example.com