The ‘Push and Pull’ of NHS Talking Therapies: A Qualitative Study of Adaptations and Accommodations in a UK Mental Health Workforce Pilot

Aims:This paper explores the perspectives of recent entrants to the profession of educational psychology, specifically with regard to their discursive constructions about their professional role in delivering therapeutic interventions.Rationale:The purpose of this paper stems from an interest in how Educational Psychologists (EPs), new to the profession, attribute meaning to therapeutic practices and the language they use to describe such approaches.Methods:This research reports on a Discourse Analytical study (DA) that explores the discursive constructions of therapeutic practice within educational psychology. These constructions were taken from the perspective of 15 EPs who were new to the profession. Drawing on data from four focus groups, comprising of three to four participants, Discursive Psychology (DP) was used to analyse the psychological themes emerging from participant talk.Findings:Analysis indicated that five interpretative repertoires were used to discuss therapeutic practice within educational psychology. These included: ‘therapeutic-as-skilled’; ‘therapeutic-as-eclectic’;‘therapeutic-asthreatening’; ‘therapeutic-as-limited’ and ‘therapeutic-as-emerging’.Conclusions:It is argued that participants were able to take up varying subject positions in relation to therapeutic practice; this seemed to present them as both passive and active agents. When talking about therapeutic work participants appeared to position themselves as confused, reluctant and unconfident, as well as valuable, skilled and motivated practitioners. It is concluded that the relational aspects of therapeutic EP practice are as important as the technical aids or tools used to facilitate this type of work. It is suggested that the uncertainty that exists around therapeutic work within educational psychology reflects the uncertainty of an emerging EP identity. It is felt that EPs, who are new to the profession, have the sufficient agency to negotiate and reconstruct new therapeutic practices that can be embedded alongside other EP roles. However, this will require further investment from leaders and other individuals within the profession.

Litigation Claims in Vascular Surgery in the United Kingdom's NHS

We consider contracting issues in the care of patients with chronic conditions within the principal-agent framework. The government, acting as a principal, contracts with several health care providers in an effort to maximise population health minus the cost. We consider the decision of whether to contract with individual health care providers or groups of such providers, as well as which contract type to use. We show that the first best outcome can be achieved by both individual and group contracts through the use of either outcomes-adjusted capitation or outcomes-adjusted per-patient contracts. We also examine possible issues which can arise as the entities that are contracted with are not necessarily the ones making decisions about patient care. Individual contracts can fail to provide the desired incentives if providers under such contracts jointly make decisions about the care for their patients (collusion); however, so can group contracts if the group members fail to coordinate their actions (free-riding). We show that both of those result in potential deviations from optimal decisions, with direction and magnitude of deviation depending on the contract type held. We conduct numerical experiments calibrated using data from United Kingdom's NHS and demonstrate that individual outcomes-adjusted capitation contracts are the most robust to these adverse effects.

The economic woes of the United States (U.S.) healthcare system have given rise to an unprecedented federal effort to modernize the information systems and promote the adoption of health information technology (HIT). The recent economic stimulus package—the American Recovery and Reinvestment Act of 2009 (ARRA)—has a HIT component (HITECH Act) that will allocate $17 billion in financial incentives intended to persuade doctors and hospitals to adopt meaningful use of an electronic health record (EHR) and $2 billion for support systems and requisite infrastructure [1, 2]. The purpose of the HITECH Act is to encourage health care providers to leverage HIT tools to achieve quality and efficiency goals. Although this primary value proposition for HIT adoption by health care professionals remains a matter of debate, the potential for secondary benefits such as the reuse of clinical data for research and quality improvement is inevitable [8]. The U.S. is not alone in their efforts to adopt HIT. The United Kingdom’s NHS Connecting for Health (http://www.informatics.nhs.uh), Australia’s HealthConnect (www.healthconnect.gov.au) and Canada’s Health Infoway (www.infoway-inforoute.ca) represent three such efforts at different stages of implementation. EHRs, however, are just one of the many tools of health informatics. The tools of informatics encompass clinical guidelines and decision support, formal health languages, information systems (EHRs, PACS, integrated databases and registries) and communication systems (Internet, telemedicine). It is important to remember that these tools are only a means to an end—the delivery of the best possible healthcare. Informatics is the intersection of people, information and technology. Within the field of informatics are several major subcategories, each with their own domain (Fig. 1). Health informatics has been defined broadly as the logic of healthcare [3]. It is a field concerned with the optimal use of information, often aided by technology, to improve individual health, health care, public health, and biomedical research [6]. Fig. 1 Major subcategories of informatics. (Reprinted with courtesy from Hersh W. A stimulus to define informatics and health information technology. BMC Med Inform Decis Mak. 2009;9:24.) Substantial differences have been identified between various clinical fields to justify the creation of areas of “subspecialty” informatics. Certainly there is enough uniqueness in our information needs, those of our patients and the technologies we routinely use to make clinical decisions to warrant the existence of orthopaedic informatics. Orthopaedic informatics is therefore the logic of orthopaedics—the rational study of the way we think about patients: the way we define, select and evolve treatments; how we create, share and apply clinical knowledge; the information needs of our consumers. It is aided by informatics tools to obtain the information we need in the appropriate detail, of the appropriate quality, when we need it, where we need it, to improve the efficiency and effectiveness of patient care, research and education. Informatics skills underpin communicating effectively, structuring information, questioning to find information, searching for knowledge and making decisions. Informatics has been recognized as a core competency for patient-centered care and the requirements of a changing health system [5]. It is important to note that informatics competency is not just computer literacy. Fig. 2 Christian Veillette, MD is shown. The 2009 ABJS Carl T. Brighton Workshop on Health Informatics in Orthopaedic Surgery brought together various stakeholders in health informatics from across the World to present, debate and develop recommendations for advancing the field of orthopaedic informatics. Representatives from health care institutions, surgeons, HIT vendors, researchers, informaticians, regulators and policymakers, and payers participated in the active discussions on the eight major themes covered including (1) patient education and the Internet; (2) Internet-based education and simulation; (3) telemedicine, disparities in utilization, access to information communication technology (ICT); (4) Web 2.0 and publishing; (5) ontologies and search; (6) informatics in orthopaedic training; (7) information systems, databases, registries – aligning data models in orthopaedics; and (8) EHRs in orthopaedics. We asked each of the Workshop participants to provide constructive feedback with the objective to create summary recommendations and answer the three questions originally asked by Dr. Carl Brighton who established these Workshops in 1996: (1) Where are we now? (2) Where do we need to go? and (3) How do we get there?

An international consensus on what constitutes intermediate care is needed I ntermediate care is an emerging concept in health care, which may offer attractive alternatives to hospital care for elderly...

Must be improved to reduce basic errors in clinical care Throughout the developed world, direct observation and reviews of patients' records reveal basic errors in the care of patients. A...

Litigation Claims in Vascular Surgery in the United Kingdom's NHS

Objective To assess the feasibility of introducing into the UK's NHS a national screening programme for colorectal cancer based on faecal occult blood testing.Design Demonstration pilot.Setting Two English health authorities...

The quest for quality in the NHS: still searching?

Recent developments put their future in doubt D o singlehanded general practices have a future in the United Kingdom's NHS? Singlehanded practices—those that have only one principal doctor with a...

Making Walk and Talk Therapy a Reality in Calgary ( breakout presentation )

Impact Each focus group had a single moderator and 7-9 participants. Two key questions were shared, and outcomes collated. 1. What resources do you have in your organisations to enable...

Pancreatic cancer is an aggressive tumor with short median survival and high mortality rate. Alternative therapeutic modalities are currently being evaluated for pancreatic cancer. Here we studied the effects of ascorbyl stearate (Asc-S), a nontoxic, lipophilic derivative of ascorbic acid, on pancreatic cancer. Treatment of human pancreatic carcinoma cells with Asc-S (50-200 microM) resulted in a dose-dependent inhibition of their proliferation. Asc-S slowed down the cell cycle, accumulating, PANC-1 cells in late G2-M phase. Furthermore, Asc-S treatment (150 microM) markedly inhibited growth in soft agar and facilitated apoptosis of PANC-1 cells but not of Capan-2 cells. These effects were accompanied by a significant reduction in insulin-like growth factor 1 receptor (IGF1-R) expression, as compared to untreated controls. Interestingly, Capan-2 cells, the least responsive to Asc-S treatment, did not overexpress the IGF1-R. The results demonstrate the efficacy of Asc-S in inhibing growth of pancreatic cancer cells and warrant additional studies to explore the potential utility of this compound as an alternative and/or adjuvant therapeutic modality for pancreatic cancer.

This article presents Intersubjectivity and Intersectionality, theoretical frameworks used to guide telemental health during a pandemic that has underscored issues of power and privilege. Intersubjectivity is a meta-theory of psychoanalytic psychotherapy that examines the interplay between subjectivities in the clinician/client relationship. Intersectionality addresses the importance of an intersectional understanding of the identity categories that inform intersubjectivity. This includes examining internalized societal relations, unconscious accommodations to oppressive social structures, and inequalities that may be implicitly enacted in therapeutic practices. The freedom to address these challenges is discussed in “third space” conversations, the interactional therapeutic field where the clinician’s and the client’s social identities and subjective attitudes are present and influential. The sudden move to telemental health provides the opportunity to examine the impact of this transition, clinically significant in addressing issues of privilege related to work from home, exposure to illness, flexibility in scheduling, access to telemental health, mental health challenges, and resilience during a pandemic that is both personal and collective.

The literature on cognitive behavioural therapy (CBT) practitioner development suggests that extensive training that monitors adherence and reinforces skilfulness produces increased therapist competence, which is related to better patient outcomes. However, little is still known about how trainees perceive their training and its impact on what they understand to be competent CBT practice. Fifteen trainee and recently qualified CBT practitioners who were taking or had taken a UK BABCP Level 2 CBT training course were recruited and asked to complete a photo elicitation task followed by a semi-structured individual interview. Reflexive thematic analysis resulted in an over-arching theme of training as a personal odyssey, consisting of four main themes: (1) an opportunity to work in a meaningful and interesting profession; (2) a reflective learning process, (3) a well-rounded practitioner, and (4) a worthwhile outcome. The multi-faceted nature of each theme is described and related to existing theory and to author reflexivity. Recommendations are made for ways these findings might be applied to help make CBT training more effective and less demanding, and for future research. Limitations of the study include the preponderance of participants drawn from the NHS Talking Therapies for Anxiety and Depression programme in England and the lack of gender and ethnic diversity. Key learning aims (1) To understand better the motivation to train, and the experience of training and its outcomes for trainee and recently qualified UK CBT practitioners. (2) To explore what competence in CBT means to participants, and how they evaluate their competence. (3) To describe participants’ perceptions of how training has influenced their own development of competence including the role of the personal and professional selves. (4) To consider practical implications for CBT training.