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Playing a key role in maintaining the nations wellbeing

Psychological
Wellbeing Practitioners
Best Practice Guide
Forewords
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The publication of this good practice guide is a fantastic opportunity to
showcase the Psychological Wellbeing Practitioner (PWP) role and gives
recognition to the benets that we bring to the nations wellbeing.
The PWP role is highly skilled and it is great to be part of a team of workers
who are all focused on supporting patients through evidence based practice
and research driven services.

I nd being a PWP is an exciting and rewarding career and this guide
provides timely information to all our key stakeholders to outline just how
important our role is within the stepped care model.
Gemma Richardson
Psychological Wellbeing Practitioner,
Clinical Educator at The University of Nottingham
Depression and anxiety are common. Feeling depressed or anxious is
distressing, disabling and can destroy lives. Psychological Wellbeing
Practitioners (PWPs) are a signicant element of the UKs commitment
to relieve distress, reduce disability and rebuild lives. PWPs help people
use evidence-based psychological treatment in a way which is effective,
accessible and person-centred. They use proven, straightforward and
effective techniques which focus on peoples own strengths. Make no
mistake, PWPs skilled combination of giving information and supporting
people transforms lives. PWPs are in demand and rightly so. They make a
difference. I hope this guide can be part of that difference.
David Richards
IAPT National Adviser and Professor of Mental Health Services Research,
University of Exeter

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Introduction 4
The role of a PWP 5
Stepped Care 6
What made me become a PWP? 7
What do PWPs Do? 7
The Impact PWPs are making 8
Establishing this new role 8
What did I do before becoming a PWP 9
Training Programme 9
Accreditation 11
My work with PWPs 11
Enriching the PWP role 12
Progressing my role as a PWP 12
How a PWP has helped me 13
Career Progression 14
What action can you take now? 15
Contents
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Introduction
The Improving Access to Psychological Therapies
(IAPT) programme was established in 2008
with the aim of establishing psychological
therapy services to enable 900,000 extra people
to receive evidence based, NICE approved
psychological therapies and interventions for
common mental health problems (namely
depression and anxiety disorders). A key part
of the programme has been to develop a
competent workforce to deliver the stepped
care model in IAPT services.
The Psychological Wellbeing Practitioner (PWP)
role was developed specically to deliver low
intensity interventions. PWPs work alongside
High Intensity Therapists within a stepped care
model of service delivery, which sees patients
receive the least burdensome treatment, regular
monitoring and the opportunity to step up to
a higher intensity treatment if required. Both
types of practitioners form part of the new
workforce, which is aiming to deliver 3,600
therapists by 2011.
Initially the role was described as a Low
Intensity Worker and although this was just a
working title to reect the type of interventions
offered, it was rightly criticised as implying
lower value than High Intensity Practitioners.
After consultation, it was agreed that the title
PWP was more accurate in that it recognised
that the person was working psychologically in
a framework based on cognitive behavioural
therapy (CBT) principles, engaging with
people earlier in their journey of mental health
issues to promote their well being and that on
qualication they would achieve practitioner
status as dened by the NHS Career Framework
This guide aims to give an insight into how
PWPs can deliver the maximum benets to
patients within IAPT services and the wider
health service.
To nd out more visit: www.iapt.nhs.uk

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The role
This is a new role. Although it builds on the role
of the graduate worker in primary mental health
care, it is more focussed on guided self-help,
supporting patients with managing common
medications, particularly antidepressants, case-
managing referrals and signposting to other
agencies such as social care and condition
management organisations.
A PWPs professional relationship with patients
can be likened to a CBT self-help coach role,
such as an athletics coach, or a personal tness
trainer. If people go to the gym or play sports,
tness trainers do not do the actual physical work
of getting them t. That is up to the individual.
However, the trainer will help devise a tness plan,
monitor a persons progress and keep encouraging
them when the going gets tough. A PWP will act
in the same way. As a coach, PWPs have a role
as educator and supporter, helping motivate the
patient to use evidence based Low Intensity CBT
interventions but always acknowledging that the
work is being undertaken by the patient, who is
seen as the expert in their own recovery journey.
Coaches devise treatment according to a coaching
manual, and this idea can help differentiate
between traditional therapy, as delivered by high-
intensity therapists, and low-intensity interventions
delivered by a PWP. In low-intensity treatment,
the main focus of the treatment is on supporting
the patients use of a published manual, self-help
guide or other CBT Self-Help material (sometimes
this can be computerised CBT self-help).
PWPs are trained to identify and assess common
mental health disorders and devise a shared
treatment plan with a patient that is both
personalised and evidence based. They are
skilled in delivering psychological interventions
whose specic content is less intensive than high
intensity treatments, such as step three Cognitive
Behavioural Therapy (CBT) or Interpersonal
Therapy (IPT), Couple Therapy, Counselling or Brief
Dynamic Interpersonal Therapy.

PWPs are explicitly educated and skilled in
common as well as specic therapeutic factors,
so they know how to establish, develop and
maintain therapeutic alliances with patients, are
able to be responsive to and deal with real or
potential ruptures in the alliance.
Although PWPs are skilled in face-to-face work
with patients, they often deliver their treatment
through a range of alternative delivery systems
such as the telephone or web based support,
telephone delivery can be the main contact
method in some services.
In the IAPT system, PWPs use the IAPT clinical
record (CR). They collect measures at every session
and use them for individual patient management,
feedback on progress to patients and in
supervision.
The role of a Psychological Wellbeing Practitioner
6
The role
PWPs perform a high volume, low intensity
role, so they will have fewer contacts but with
a larger number of patients. They will generally
spend less time in sessions or contacts than their
high-intensity colleagues, with an average session
time of 20-30 minutes, but they can be shorter.
However, the number of low-intensity sessions per
patient is not limited and some PWPs may have
ongoing contact with patients to assist in chronic
disease management and relapse-prevention.
PWPs are recruited to a post within services as a
PWP trainee at band 4 (agenda for change) or
assistant practitioner level (career framework).
They move to a band 5 (agenda for change) on
qualication and hence to a practitioner level
(career framework).
Career progression options are currently being
developed and some services have now employed
band 6 senior PWPs. This role would include some
or all of the following: the provision of supervision,
education, management and specialist clinical
expertise with underpinning continuing
professional development (CPD) support.
Stepped Care
IAPT services use a stepped-care model. Step
two is where PWPs undertake their work,
providing low-intensity interventions. Patients
are able to be stepped up to step three for high-
intensity interventions or stepped down as they
recover.
STEP 3:
High Intensity
Service
Depression - Mild Moderate & Severe
Depression - Mild Moderate
Panic Disorder
(GAD) Generalised Anxiety Disorder -
Mild Morderate
Social Phobia
Post Traumatic Stress Disorder (PTSD)
Obsessive Compulsive Disorder (OCD)
CBT, IPT, Behavioural Activation
Counselling Couples Therapy
CBT
CBT
CBT
CBT, Eye Movement Desensitisation &
Reprocessing (EMDR)
CBT
STEP 2:
Low Intensity
Service
Depression - Mild Moderate
Panic Disorder - Mild Moderate
(GAD) Generalised Anxiety Disorder -
Mild Morderate
OCD - Mild Moderate
cCBT, Guided Self-Help, Behavioural
Activation, Exercise.
cCBT, Guided Self-Help, Pure Self Help
cCBT, Guided Self-Help, Pure Self Help,
Psychoeducation Groups
Guided Self-Help
STEP 1:
Primary Care /
IAPT Service
Recognition of Problem Assessment / Watchful Waiting
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I became a PWP because I wanted to improve my own clinical skills and
knowledge, whilst working with individuals suffering with common mental
health problems. I enjoy working one to one with individuals and seeing
them improve on their individual journey. It is a privilege to be able to help
facilitate this process. Being a PWP means that my skills are recognised
within the discipline, and the work we do is valued.
In my previous role I worked as a Graduate Mental Health Worker for 9
months. I hope that my career will continue to progress and I would like to
develop towards supervising low intensity trainees.
Siobhan Moore
Psychological Wellbeing Practitioner, Avon and Wiltshire IAPT Service
Becoming a PWP
What made me become a PWP?
PWPs Dont
Assess and treat people with common mental
health problems
Assist people to help themselves
Work through telephone and internet contact
methods
See clients face to face
Provide support with medication management
Work with Health Trainers
Work with Employment Advisors
Work within a collaborative care approach
Receive both case management and clinical
skills supervision
Work with the local community to enhance
access and self referral such as psychosis or
bipolar disorder
Carry out High Intensity CBT therapy
Carry out medium intensity therapy (e.g.
drift from using evidence based lowintensity
principles like CBT self-help resources aimed at
step two, into doing therapy)
Support non-evidence based interventions
Work in isolation from other colleagues
See patients with complex and serious and
enduring problems such as psychosis or bipolar
disorder
PWPs Do
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PWP Impact
PWPs are already making a signicant impact
on the wellbeing of people with anxiety and
depression. During the rst year of full roll out,
where 34 providers were able to download
clinical and service data on 137,285 referrals,
79,310 people had an initial assessment and
26,780 patients had completed treatment with
two or more contacts. Of course, many more
of those assessed were still receiving treatment
at the time of the audit. The audit showed that
61% of IAPT patients were seen by PWPs and
helped with low-intensity interventions. Recovery
rates overall were excellent, demonstrating that
PWPs were contributing solidly to mental health
outcomes achieved by IAPT services.
Caseloads for PWPs tend to be higher than for
high intensity therapists and counsellors. This is
because PWPs work by assisting patients to help
themselves and case manage, rather than act as
therapists. A fully qualied PWP can expect to
help more than 250 patients every year. During
training, however, trainee caseload should vary
as follows:
During the rst few months of training no
caseload (time set aside for shadowing, skills
rehearsal and clinical skills supervision).
During the rest of their training their caseload
will be approximately 80% of a full caseload.
Month 10 onwards full caseload whilst
working towards practice outcomes.
Working on the above gures it is anticipated
that PWPs in training will work with in the
region of 170 patients during their training year.

Recruits to this new role
It is clear PWPs have come from a range of
other careers and backgrounds. Trainees have
previously been, administrators, teachers,
healthcare support workers, occupational
therapists, police ofcers and a wide range of
jobs in the public and private sector.
From years one to two of the IAPT programme
there have been increases in the proportion of
PWP trainees recruited from roles in Assistant
Psychologists, Education, Healthcare Support
Workers (HSW). Overall, highest proportions
are from Assistant Psychologists and Healthcare
Support roles.
Data shows, that to date qualied PWPs are
more likely to be women, with men making up
approximately 20% of the workforce and staff
are most likely to be between 20 and 29 years
old. Services need to ensure they have a balance
of staff to reect local diversity across a range
of equalities measures, including age, race and
gender.
From years one to two of the IAPT programme
there have been increases in the proportion of
staff from almost all BME communities in PWP
trainee roles.
Services should be monitoring turnover of
staff and continuously seeking to widen the
representation of the PWP workforce to reect
that of specic groups e.g. deaf community.
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My background is 16 years in Mental Health Services. I started as a
housekeeper on the mental health wards and went on to become a
Healthcare Assistant on the Intensive Care Ward, progressing to a level 2
Nursing Assistant. Later I became a Community Psychiatric Nurse Support
Worker and then a Primary Care Mental Health Worker.
I have now completed the Low Intensity Psychological Interventions Course
and having done so, the experience I have gained enables me to be an
effective member of the team. I am working towards a lead role also
looking at supervision for the PWPs. I feel that being a PWP is a career in
its own right.
Nikki Smith
Psychological Wellbeing Practitioner, Solihull Healthy Minds IAPT Service
What did I do before becoming a PWP?
Training
Training Programme
PWPs are trained to a national curriculum, with
bespoke learning materials (Richards and Whyte,
2009, Reach Out 2nd Edition), which requires
trainees to demonstrate competence across a
range of well specied skills required to undertake
a patient-centred interview, to support a range
of low-intensity CBT interventions and to work
within an inclusive values base that promotes
recovery and respects diversity.
The PWP national curriculum and training
materials can be found at www.iapt.nhs.uk
There are currently three Reach Out manuals;
a student guide, an educators manual and a
manual for those supervising PWPs.As specied
by the national curriculum, trainees should, at the
end of training, demonstrate competence in the
following interventions according to the protocols
as specied in the curriculum:
Behavioural activation
Exposure therapy
Cognitive restructuring
Medication support
Problem solving
Panic management
Sleep hygiene
The training programme is 45 days long, with 25
of these within the education provider and 20 of
these are university directed learning days which
occur within the workplace.
The PWP training programme should be completed
within 12 months from the start of training. The
education provider should seek to award successful
trainees with the PWP qualication, which is
currently either a post graduate certicate or
undergraduate award, as soon after the end of
training as possible to enable them to progress to
Agenda for Change B and 5.
Supervision
PWPs should receive of supervision both in
training and when qualied:
1. They should receive one hour per week
clinical case management supervision in which
all patients on their caseload are reviewed at least
every four weeks and/or in response to specic
clinical criteria using data from the IAPT Clinical
Record.
2. PWPs should receive one hour per fortnight of
clinical skills supervision, which can be delivered
on an individual or group basis.
People providing supervision should have a good
understanding of the PWP role and be skilled
in delivering PWP interventions themselves.
They need to have attended a low intensity
supervisor training programme provided by an
IAPT accredited training provider to enable PWPs
supervised by them to submit an application for
individual accreditation.
In addition, PWPs should also receive appropriate
management supervision, regular appraisals and
advice regarding their continuing professional
development needs. The national training
programme Reach Out guide and DVD for case
management supervision are available at
www.iapt.nhs.uk
PWP Qualied Staff
Since the outset of IAPT commissioning, it has
been a requirement that PCTs provide sufcient
qualied staff to deliver interventions and to
supervise trainees (the ratio recommended was
1:2 qualied staff to trainees) in order to be
eligible to receive funding as an IAPT site. This
qualied workforce has had to incorporate the
PWP role. As the PWP is a new role, it is not
surprising that there has been variability in the
skills and experience people have brought to
the role, as already qualied staff who havent
undergone the specic PWP training. Data
suggest that these have included graduate
workers, nurses, social workers, counsellors,
gateway workers and others. The high volume,
low intensity nature of the work is new and it is
likely that most recruits will have had at best only
limited clinical experience of this way of working
and assessing.
It is recommended that those staff, with
professional mental health or graduate worker
backgrounds, who have not come through the
PWP IAPT training, undertake specic CPD for
the competences which capture the clinical
method of PWP working. This can be achieved
by undertaking the rst two modules of the PWP
training programme, which requires 15 days
at university and 10 days of university directed
learning to occur within the workplace. As this
is exactly the same as that undertaken by PWP
trainees, it can be easily provided by existing
courses. The time requirement is of course a
consideration. However, where qualied staff
have undergone this process it has been said to
be highly relevant and useful to practice and has
been welcomed by those staff. Some failed to
achieve competences rst time round, however,
but most succeeded second time round and every
effort is made between the HEI and provider to
support the successful completion of the course.
For these staff, undertaking these two modules
plus supervision would enable the worker to apply
for accreditation as a PWP.
Training
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Accreditation
Course accreditation
All of the PWP training courses are undergoing
an accreditation process, led by the British
Psychological Society and supported by
IAPT. The purpose is to ensure that there are
consistent standards of training in line with
the national curriculum and learning materials,
and that courses are demonstrably producing
competent practitioners.
Initial lessons arising from the process have
identied the best practice to be where
HEIs focus rmly on clinical competence
development and assessment in the rst two
modules as an initial educational priority. This
enables educators to rapidly educate and assess
trainees competence to see patients in the
workplace.
Individual Accreditation
For the most part, it is expected that the
individual practitioner accreditation processes
will be based upon the IAPT PWP course
accreditation process. The BABCP and BPS
are offering options for joining a voluntary
accreditation register, using similar eligibility
criteria, based on the same competences. See
www.babcp.com and www.bps.org.uk
Regulation
Currently the Health Professions Council (HPC)
is not proposing to include PWPs as part of the
cohort of Counsellors and Psychotherapists
being considered for regulation. A proposal was
submitted to them to make the case for the
regulation of PWPs (October 2009).
Of all my colleagues, I work closely with PWPs. There is a greater amount
of interaction due to stepping up and case management, with discussion
and advice about clients and interventions. Because PWPs are frontline
assessors, their work complements step three treatments and liaison.
Daniel Gardiner
High Intensity Therapist
Cheshire and Wirral Partnership NHS Foundation Trust
(IAPT Central and Eastern Cheshire)
My work with PWPs
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Enriching the role
The PWP role deliberately enables the practitioner
to work with a large number of people and to
assist patients to help themselves in a motivating
and practical manner. The PWP focus is on
mental health issues, but it is important that they
understand links to physical health, including
people with long-term conditions, and public
health issues in order to promote wellbeing and
prevent the development of mental ill health.
As newly qualied practitioners consolidate their
skills and condence, it is important that there is
an opportunity for them to sustain their interest
and make the best use of their developing
expertise to enrich their role. Some services are
already doing this by facilitating joint work with
Health Trainers, who focus on physical wellbeing
needs of people in relation to diet and exercise.
Consideration should be given to CPD needs
and further training for PWPs, this may include
undertaking training to provide supervision to
other PWPs or by becoming involved in work with
groups of specic patients, For example, those
on probation, receiving treatment for long-term
physical health conditions, those in prison or by
working with deaf patients.
It is vital that this role is valued in its own right
for the unique contribution it can make. It also
has enormous potential to recruit from local
communities and therefore make engagement
and improve access to services more possible.
I completed my PWP training at Exeter University in January 2010 and have
had some fantastic career opportunities. I now work at Exeter University
as a member of the Low Intensity training team. Within the role I help
deliver all elements of the course; academic components, clinical method,
and marking of students work, alongside the experienced trainers. I have
also taken part in the PWP Course accreditation visits in the role of Course
Trainer.
Alongside this I work 2 days a week as a PWP for NHS Devon which
includes patient work and case management supervision of PWPs. As
a practising PWP I bring direct experience to the teaching team at the
University which adds value to students learning experience. I am very
committed to PWP working and see a great future for the PWP workforce
with many career opportunities ahead. It is an exciting time to be a PWP!
Faye Small
NHS Devon Psychological Wellbeing Practitioner
University of Exeter Associate Teaching Fellow Low Intensity Training
Progressing my role as a PWP
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My PWP
A Patient Perspective
Nina, my Psychological Wellbeing Practitioner,
explained cognitive behavioural therapy and
how using this therapy could help me. I used
the self-help package for depression and with
her support I planned activities that I could
do, we looked at my thoughts and how they
were affecting me and I learnt how to using
problem solving techniques. It was then that I
identied that I would like to return to work as
I had stopped working due to my depression.
Nina referred me to the vocational adviser in her
team who supported me to nd voluntary work
in a local day centre. I have found friends there
and enjoy going there, I feel like a different
person now. I go for walks with my neighbour
and to yoga classes. When I was feeling
depressed my sister used to come round do the
housework and cooking for me but now I can
do everything for my self. I am feeling much
happier and have learnt how to overcome and
cope with my depression.
Simerjit
received treatment at the Ealing IAPT service
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Careers
Career Progression
The PWP role is an attractive one for people
working in the NHS or in Social Care as,
for example, support workers, psychology
assistants, Health Trainers, Support, Time and
Recovery Workers (STR) or indeed professionally
qualied staff, who want a change of direction
e.g. nurses. We have already seen people
from all these backgrounds entering the IAPT
Workforce.
PWPs are recruited as trainees at band 4 of
Agenda for change and qualify as PWPs when
they successfully complete their training,
enabling them to move on to band 5. This will
be a sufcient level of remuneration to continue
on for a long career for many, but it is important
to consider career development opportunities
for those who wish to progress. It is vital to
keep experienced people in the PWP role and
some areas have already developed senior PWP
posts (examples of job descriptions can be
found on the website). This role may include
supervision, management, liaison, specialism
and education (sometimes in a joint post with a
university or in an HEI full time).
PWPs may also want to move on to training in
psychological therapies e.g. high intensity CBT,
counselling or into different professions such as
social work. Indeed, there has been a worrying
exodus of PWPs, often newly qualied, into HI
CBT training or seeking admission into clinical
psychology training.
Whilst there is room for people who see the
PWP as a stepping stone to a different career,
this must not be the primary group of people
recruited into trainee roles; this would repeat
the mistake of the Graduate Worker in Primary
Care role, where most were psychology
graduates with good degrees, who went on to
train as professional psychologists. In the long
run, this led to an unsustainable workforce.
For the vast majority of PWPs, movement to
roles delivering high intensity therapies will
not occur within two years. Two years in a
psychological role, is seen as a minimum time
to consolidate psychological wellbeing skills,
before accessing high intensity training.
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Action To Take
1. Market the role to local GPs and
commissioners
Publicise the contribution PWPs make to IAPT
services and the treatment of common mental
health problems.
2. Target local communities to supply applicants
In recruiting for PWPs it is important not to rely
only on NHS Jobs, but also to advertise in local
communities and through the voluntary sector,
who often have an excellent track record on
local engagement.
3. Continue to commission PWP training places.
As SHAs are reviewing their commissioning
plans for the coming years, it is important to
plan for continuing training places for PWPs
to work in areas not yet employing them; to
address turnover and to consider the balance
of skills required in the workforce in the longer
term (IAPT initially recommended a ratio of
40:60 PWP to HI). Feedback from some areas
suggests favouring a higher proportion of PWPs,
but this will clearly depend on assessment of
local need.
4. Provide undergraduate routes to
PWP training
Offering undergraduate routes to training is
vital, but this needs to be supported by access
courses or other support that recognises the
likely differences between the needs of the
resultant trainees.
5. If you are thinking of becoming a PWP
Why not contact your local IAPT service and ask
if you can book a time to talk to the staff. You
can nd your local service by using the NHS
Choices service nder at: http://www.nhs.uk/
ServiceDirectories
You can nd example job descriptions and
person specications for the PWP role online at:
www.iapt.nhs.uk
What action can you now take?
Produced by the National IAPT Programme, with thanks to
those who have contributed to this document.
[email protected]
www.iapt.nhs.uk