Applying Psychology In Health Settings - University Of Edinburgh
Applying Psychology inHealth SettingsVivien SwansonReader, Department of Psychology, University of StirlingPaul Graham MorrisLecturer in Health Psychology, Clinical and Health Psychology, University of Edinburgh
Session OverviewWhat is Health Psychology?Training Routes via Clinical and Health Psychologyprofessional training programmesAreas where health psychologists may be employedExamples of the areas of work in applied healthpsychologyQ&A
What is Health Psychology? The application of psychological theories andapproaches to health care Multidisciplinary in approach and application Related to health promotion, behavioural health,public health, medical sociology etc.
Introductory TextsOgden’s text is now on 5th edition– older versions are fine as intro
Responsibility for HealthBiomedical Model Illness caused by factors outside individual’s control Treatment is responsibility of medical professionals Emphasis on treating illnessHealth Psychology Individuals often have influence over risk of illnessand recovery from illness Maintenance of health & treatment of illness
Roles for PsychologyBiomedical Model Inclined to view psychological factors as aconsequence of illness, e.g. anxiety and depressionHealth Psychology Greater recognition that psychological factors alsoinvolved in cause and maintenance of illness Thus roles in prevention and treatment Interactions between psychological andphysiological factors
Provision of servicesDirectly individual patients / small groupsIndirectly consultancy with other health care professionals training in psychological approaches / skills Interventions applied by others. Supporting selfmanagement where appropriate. research to assess needs & evaluate interventions develop interventions aimed to prevent illness
Transferable / Unifying Themes Multidisciplinary TeamWorking * Prevention / HealthPromotion Chronic DiseaseManagement Use of Health Models * Health beliefs (inclmisconceptions) Adherence * Communication * Loss * Avoidance / Denial * Coping * Consultancy * Somatisation * Behaviour change ** Relevant to Clinical Psychology even in absence of physical health difficulties
Clinical Psychology Training Routes Mostly doctorate training programmesMixture of teaching, placements and researchUsually 3 years full timeUsually need GBC, 2.1 or above, right to work in UKand relevant experience – though requirements varybetween courses Employed as an NHS trainee psychologist Leads to Chartered Psychologist status as ClinicalPsychologist and ability to register with HCPC Can specialise in areas of health psychology
My Experience – Health PsychologistBSc DegreeWorked as care assistantin learning disabilities (1 year)and residential home for elderly(6 months)Health PsychologyMScAssociate Lecturer1 year Postdoc researchin Brain Injury outcome/ gained chartershipOpen UniversityPhD NeuropsychologicalOutcomefollowing Brain InjuryLectureship in Health Psychologyon DClinPsychol ProgrammeResearchDirector
Work in NHS Settings Currently most psychologists working in NHS are clinicalpsychologists, but there is significant potential to expandthe number of health psychologists. Areas include: Chronic PainCardiacDiabetesCancerHIV / AIDSChronic FatigueObesityPreparation for surgery Assessment for surgeryDermatologyCystic FibrosisRehabilitation medicineLiver DiseaseMedically UnexplainedSymptoms
Other work contexts for HealthPsychologists Academic Clinical and Health Psychology Units Other University Health Programmes (e.g. training forNursing, Medicine, etc.) Government Health Departments Public Health / Policy making Health Promotion
Best and worst parts of the work Intellectually stimulating Demanding, time-consuming Emotionally rewarding Climbing a mountain Connecting with people Scratching the surface Doing something good Issues rarely black and white Discovering new things Funding issues Research Lengthy training Teaching and Training Political uncertainties Getting psychology in there Administration
Taste of Health Psychology The next 10 slides are selected fromteaching and research presentations Although out of context, they willhopefully give an idea of what NHSrelated health psychology can involve
Some Health BehavioursSmokingAttendanceTaking medicationSocialising
Health Beliefs / Misinterpretations‘Hospital tests arealways needed’‘Changes to bodilysymptoms are always asign of illness’‘My father suffered aheart attack in his40s so I will as well’‘Medics must thinksomething is wrongas they’ve sent mefor more tests’Paul Graham Morris
DEVELOPING HEALTH PSYCHOLOGYPRACTICE IN SCOTLAND:THE ‘NES’ PROGRAMMEDr Vivien Swanson,Reader, Health Psychologist, University of StirlingProgramme Director (Health Psychology) NHS Education Scotland
Training in health psychologyEssential requirements: BPS accredited BSc/BA in PsychologyFirst class or 2:1 Honours degree in Psychology or related subject.STAGE 1: BPS accredited MSc in Health Psychology (3 courses in Scotland)- Knowledge/Theoretical Dimension- Research (Part 1)STAGE 2: Professional Practice (Portfolio of Competence Viva Voce)PRACTICE DIMENSION:1. Generic Professional Competence2. Behaviour Change Interventions3. Research (Part 2)4. Consultancy5. Teaching & TrainingAwarded: Qualification in Health Psychology (Stage 2)BPS registered: C. PsycholHCPC registered: Health Psychologist
NHS EDUCATION forSCOTLAND
NES Stage 2 programmeTo develop effective, sustainable,fully funded Stage 2 practitionerposts for trainee healthpsychologists in the NHS inScotlandTo ‘add value’ to the healthimprovement agenda in Scotland
NHS Boards involved in the programme
NHS Education for Scotland Programme BPS Stage 2 ‘Independent route’, 5 competencies – 2 broad areas of work RESEARCH, INTERVENTIONS, (Group, 1:1) TEACHING AND TRAINING, (Including health professionals) PROFESSIONAL COMPETENCE, CONSULTANCY Locality NHS Health Board based 2 year FT programme 33 trainees 2007 – 2016 (c 4 per annum)
Key features : NES FundingTrainee Salary Costs : Agenda for Change Band 6 ( 27K approx,Equivalent to years 2 and 3 ofClinical Psychology Training)Travel Expenses: Supervision (Trainee and Supervisor) 4 peer support meetings per annum)BPS Costs : All BPS fees (including registration, supervision, assessment) paid in fullResearch Supervision costs: to Universities
Key features : NES Support structure Health psychology trainees have BPS/DHP Approved Stage 2Supervisor, (Course Tutor), a Research Supervisor, and NHSbased supervision from their line manager or Head ofPsychology services as appropriate. Regular face to face meetings with Course Tutor, and jointsupervision meetings NES Centralised curriculum support for 5 areas of competence (sessions on teaching and training, assessment/formulation,professional skills, systematic reviews, research writing etc.) Peer support crucial for trainees - 4 informal meetings a yearRegular group networking meetings (quarterly - bi-annually)Shared digital space on NHS Knowledge Network
Health Improvement/Inequalities/Preventionimpact. Community pharmacy public health service: attitudes to behaviour change Long Term Conditions/Physical Health Developing an intervention to prevent re-infection of Hepatitis C aftertreatment Drugs and Alcohol Alcohol brief interventions in hard-to-reach groups Healthy Eating/Activity/Weight Management Development of a group pilot weight management intervention for peopleprior to bariatric surgery Antenatal and Postnatal Understanding breastfeeding maintenance in new mothers Frailty and dementia Communication skills training to health and social care staff working witholder people
Internationally unique, showcase programmebenefits Developing links and sharing knowledge, bestpractice between NHS Health Boards in theprogramme Linking stakeholders: Public health, Psychology,Universities with the NHS via collaboration onspecific projects Joint supervision develops shared understandingsIntroducing theory into practice Showcases how health psychology can ‘add value’ Going beyond the NHS – opens other career routes- 2 trainees from Change Fund ( Local Authority100% funded) JOBS !! (4 Boards to date have created posts)
TRAINEES’ WORK EXAMPLESQuestions?
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NHS State HospitalAll-male in-patient psychiatric facilityCovers Scotland and Northern Ireland.Patients average stay over 8 yearsMost have a psychotic disorder, usuallywith co-morbid diagnosis.The Psychology service at the StateHospital is large and well established.It is led by a Head of PsychologicalServices and there are four otherConsultant Forensic ClinicalPsychologists (including a specialistForensic Clinical Neuropsychologist).
Snapshot of chronic physical health conditionsPrimary Health Care Annual Report 1st August 2014 – 31st July 2015Chronic Health Condition% (n) of patientsIschaemic Heart Disease4% (5 patients)Hypertension4.8% (6 patients)On cardiovascular medication29% (36)Diabetes18% (23patients)2 Type-121 Type 2Asthma4% (5 patients)Obesity (July 2016)53% (BMI 30)Overweight33%
Kate Lynch, Trainee Health Psychologist, State HospitalBehaviour ChangeIntervention Healthy LivingGroup: WeightManagementProgramme 1:1 Dental anxiety,weightmanagement Type 2 Diabetesself-managementGroup InterventionResearch Mixed methodEvaluation of theHealthy LivingGroup. SystematicReview: ‘Healthbehaviourinterventions toaddressoverweight andobese individualswith severe mentalillness in inpatientsettings’Teaching & TrainingConsultancy Health BehaviourChange training :HealthProfessionals CollaborationHealth Centre –Study exploring thebarriers andfacilitators to bowelscreening uptakefor patients Development ofonline module:Physical and mentalillness and behaviorchange. Teaching to Universityof Glasgow medicalstudents: Models ofhealth & Illness MSc HealthPsychology Students:University of StirlingGeneric Professional Development
AMY MALAGUTI, TRAINEE NHS TAYSIDEBehaviour ChangeIntervention (oneto-one): Reducinginjecting risk-takingbehaviour in drugusers on hepatitis Ctreatment: increasingself-efficacy to refusesharing.Behaviour ChangeIntervention(Group): Trainingharm reduction staffin motivationalinterviewing skills todeliver ctors associatedwith injecting risktaking behaviourand hepatitis Cinfection risk: asystematic review.Research Project:Staff’s attitudestoward injectingdrug users who areinfected withHepatitis C.Consultancy:EvaluatingOne2one: an onlinecounselling servicefor young people inTayside.Teaching : tutorialswith MSc HealthPsychology studentsat the University ofStirling:- Sexual Health;- Alcohol BriefInterventions;- Substance Misuseand Hepatitis C.Training: Trainingspecialist viralhepatitis nurses inthe delivery of abehaviour changeintervention toincrease self-efficacyin injecting drugusers.
Work setting of 24 HPs1018
Client groups that HPs work with
Competencies that HPs deliver in current post
Applied Psychologists employed by NHS ScotlandTotal 901 (743.8 WTE) (30th September 2015)Clinical Psychologist 834 (686 WTE)Counselling Psychologist 50 (43.5 WTE)Health Psychologist 11 (8.9 WTE)Forensic Psychologist 6 (5.4 WTE)Neuropsychologist 0Forensic PsychologistHealth Psychologist 0.67%1.22%Counselling Psychologist0.1%Neuropsychologist5.55%Clinical Psychologist92.56%(ISD (2015). Workforce Planning for Psychology Services in NHS Scotland: Characteristics of theWorkforce Supply as at 30th September 2015.)
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Training in health psychology Essential requirements: BPS accredited BSc/BA in Psychology First class or 2:1 Honours degree in Psychology or related subject. STAGE 1: BPS accredited MSc in Health Psychology (3 courses in Scotland) - Knowledge/Theoretical Dimension - Research (Part 1) STAGE 2: Professional Practice (Portfolio of Competence .
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