The report, How Mental Illness Loses Out in the NHS34 was produced by a distinguished team of economists, psychologists, doctors and NHS managers convened by Professor Lord Layard35 of the LSE Centre for Economic Performance.
CBRT™– a case for NHS AdoptionProviding patients with structured relaxation support sessions
CBRT is a new innovation in mental healthcareNHS 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.
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 can contribute to productive patient care 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 product. It has a CE file Class 1 Medical Device and is made of printed matter. • CBRT is a motivational, all inclusive, non-pharmaceutical, non-invasive, non-denominational and non-tactile intervention, for all ages and abilities..
Relaxation supports rehabilitationA positive outlook supports patients‟ wellbeing
Aligns with IAPT Commissioning goals 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.”
CBRT Intervention Evidence Base“CBRT is an intelligent amalgamation of Evidence Based Interventions” Here are the key components of CBRT and Interventions already with NICE approval number of independent studies currently with include: NHS Evidence: • CBT • Guided relaxation • Mind-Body Relaxation Technique (74) • Mindfulness based stress reduction. • breathing techniques (1,888) • Mindfulness approach (375) The CBRT Initiative actioned with 8 NHS • positive thinking (7,383) Trusts and CCGs will very quickly - within 6 • self-help and guided self-help (2,935) to 8 months - create c.17,000 independent • MBSR (Mindfulness –based stress case studies for NHS Evidence from the reduction) (24) NHS staff post-training case studies. • 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.)
How CBRT Training is delivered in two daysEvaluation of Training Effectiveness 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 could be used in conjunction with safety and value for money in the NHS programmes associated with reducing through establishing the availability and the use of antipsychotic drugs. provision of structured and guided • Person centred care is provided though relaxation support sessions for patients. guided group support sessions. • Designed to support NHS savings targets. • CBRT is a very flexible relaxation • An “invest to save” programme. intervention - so is not “just about group • An Innovation supporting mental health as therapy” - it could easily also be used as a national NHS priority. a “one off” patient situation in a ward. • Enhances both Productivity and Prevention • > 12,000 patients could benefit each programmes.. year, including a reduction in primary • Demand for anti-depressants is growing care referrals and secondary care. annually including prescription addiction. • “Room for innovation must be 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.
5 Case Model – Improving Patient Care • The Strategic Case – the NHS has a robust Case “I have no idea why healthcare for Change - CBRT provides towards all quality providers do not offer relaxation health improvement and modernisation classes to Patients suffering from programmes through training staff. Compassion in long term conditions. Following an Practice 6C‟s. accident, I now live with chronic pain • The Economic Case – CBRT optimises Value for syndrome and bouts of depression... Money –A „compelling case‟ for innovation I am not surprised so many people supporting mental health as an NHS priority. The suffer with depression. Group Health and Care Act highlights the importance of contact and regular support is far integration. more important than a packet of • The Commercial Case – CBRT requires a modest tablets.” initial investment and is commercially viable. In May 2012, CBRT scored 92.53% with the NHS National Mrs P. Innovation Technology Scorecard process. As a NHS Patient, South of England 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. • 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. • 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 • To contribute to improving Patient experience, mental health and experience through innovation led wellbeing provision . Staff make Compassionate Care. shared time with patients “Make Time • To provide independent NHS led to Save Time.” evidence to work towards NICE • Meet RCN and COT CPD Training approval as a relaxation intervention. standards and requirements. • The NHS Change model includes need • Reduce Lead Time, through for “Rigorous Delivery.” Innovation and practical application • Each member of staff trained will aim of new technology. to support 10 patients per week. • Reduce Total Costs – examples • NHS Staff and Trainers to complete include: Group relaxation support training paperwork to agreed time. provision, Length of stay – reducing • NHS Trainers to attend a ½ day CBRT length of stay. “Refresher” Training programme every • Improve patient choice. Learn how to 2 years. relax before starting a medication pathway. A tool kit to help reduce boredom on the ward. • NHS Staff and Trainers to complete training paperwork to agreed time
Responding to Our Patients‟ NeedsHelping your Trust respond to “The Francis Report” Compassion in Practice and the 6 C’s : 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 Patients with a non-pharmaceutical intervention choice. • Patients are able to continue using their Colour Breathing 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 CBRTAs part of Patients‟ Care Pathways CBRT may deliver many benefits • Relaxation awareness • 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 staff training in communication skills • Quality improvement made simple. • Structured CBRT Relaxation Support • Team building and Engagement to mobilise. Sessions – whether patients experience Nurses, Allied healthcare and Social Care this as a „once-only experience‟ or in Teams have the opportunity of training a series of 8 – 10 sessions, provides time together, attending a two day CBRT Training and space for positive, uplifting, calming Programme. dialogue between staff and patients, • Through interaction and learning how to use contributing to overall staff and patients‟ CBRT with both individuals and groups of wellbeing. patients, staff enhance their natural • CBRT is a vehicle for engaging with communication skills of listening, focus, Patients with Care and Compassion. timing, patience and awareness. • In the community, clinics, wards, rest • Staff may feel more valued by management rooms...CBRT is a flexible tool and when given the opportunity to undertake efficient way to deliver a relaxation additional training. 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)
Sustainability for ongoing NHS 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 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.
The next 5 slides demonstrate actualfeedback received from 85 CBRT Users by 5 newly trained individuals
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 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 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! 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. Supporting “Innovation Health and Wealth” firstname.lastname@example.org