Workshop scenario paper for Frail Elderly themed workshop, Collaborating for Better Care Partnership Master Class 23rd October 2014

1. Workshop 2 ‘Frail Elderly’: NPT Master Class Implementation Scenario
Example implementation scenario: Cognitive Behavioural Therapy Intervention (CBTI) for Fear of Falling
What is the intervention?
The intervention is an individualised cognitive behavioural therapy intervention for people who have an excessive fear of falling. Fear of falling is widespread among older people living in the community (>50%) and can lead to fear, anxiety and loss of confidence resulting in activity avoidance, social isolation and increasing frailty.
What does the intervention consist of?
The intervention consists of 8 Individual face-to-face cognitive behavioural therapy (CBT) sessions with older individuals living in the community attending a falls service, who have an excessive fear of falling. The one-to-one sessions are delivered over an 8 week period, each lasting about one hour and are delivered in patients’ homes (or a convenient clinic if the patient prefers). Sessions are individually tailored around each patient’s needs.
How is this different from what staff ‘normally’ do (previously ‘did’)?
Patients attending a Falls Service usually undergo a series of assessments and a comprehensive medical review by a consultant geriatrician with falls expertise. Patients are then referred back to their general practitioner for medication or other review, to secondary care, day hospital, community physiotherapy and occupational therapy as appropriate. Patients involved in the CBTI receive usual care (as detailed) plus the Cognitive Behavioural Therapy Intervention (CBTI), delivered by trained Health Care Assistants (HCAs) at participant’s homes or a Falls Service. Health Care Assistants (HCA’s) would not normally be involved in providing care to these patients and undertake a 5 day training programme to enable them to deliver the intervention.
What are the different staff/individuals involved in delivering the intervention?
The key staff groups involved in delivering the Cognitive Behavioural Therapy Intervention (CBTI) are health professionals in Falls Services; clinical psychologists, and Band 4 Health Care Assistants (HCA’s).
What staff/individuals are most involved in delivery of the intervention?
The staff who are mostly involved in the delivery of the Cognitive Behavioural Therapy Intervention (CBTI) are Health Care Assistants (HCA’s).
What might make the implementation of this particularly complex?
The implementation of the Cognitive Behavioural Therapy Intervention (CBTI) is complex due to a number of factors, such as, pre-conceptions of older people by health professionals about the relevance and acceptability of psychological therapies to fear of falling; Band 4 Health Care Assistants trained to deliver an individualised rather than a manualised intervention; and practical issues such as transport to patient homes.
Associated publication: Finch et al. Making sense of a cognitive behavioural therapy intervention for fear of falling: qualitative study of intervention development. BMC Health Services Research 2014, 14:436