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Developing a Facilitator Training Program for CBT Skills Group Medical Visits
Julie Lawrence, MD1; Erin Burrell, MD FRCPC2 1UBC Psychiatry Resident, PGY-4, Vancouver Island Site
2Psychiatrist and CBT Skills Group Facilitator, CBT Skills Groups Society of Victoria
Acknowledgements and Contact Information Julie Lawrence, email: [email protected] Erin Burrell, email: [email protected] Christine Tomori, Project Lead, CBT Skills Groups Spread, email: [email protected]
Cognitive Behavioural Therapy (CBT) Skills Group Medical Visits: • Launched in fall 2015 by a group of nine
psychiatrists and family physicians in Victoria, BC • Offers self-management skills for primary care adult
patients suffering with mild-moderate mental health problems
• Integrates CBT, DBT, ACT & Mindfulness based strategies
• 90 minute groups of 15 patients for 8 consecutive weeks
• Pilot funding provided by the Victoria Division of Family Practice and Shared Care Committee
• By 2018, 25 groups offered every 3 months in Victoria, and pilot programs launched in Vancouver and Nanaimo
Background
Five (out of possible 18) facilitators completed Satisfaction Survey after testing version 2 of the Facilitator’s Guide and Competencies.
100% rated “very satisfied” with the format and content of the Facilitator’s Guide, Recipe Card and Competencies.
Using repeated measures of the GP Facilitator Needs Assessment, trainees reported increasing competence and confidence over the course of the training process.
Aim
Examples of questions from discussions: •How are facilitators currently using the Guide, and what format can best support this?
•How are debriefing sessions used? Improvement suggestions?
•What are the intentions/values we would like facilitators to embody? How to teach this?
•What is “core” material vs optional? How to emphasize this in the Guide?
•How will Competencies be used? Support for CPD accreditation? Assess readiness for solo facilitation?
•Improved Facilitator Guide was well received, Competencies were less useful.
•Trainees valued the graduated co-facilitation process to gain experience and confidence, in particular with managing interpersonal dynamics and responding to questions.
•A series of three rounds of observing/co-facilitating the CBT Skills program was deemed the minimum to attain competency. A “booster” training series after solo facilitating should be explored.
•Facilitators would like the opportunity to connect with other facilitators to share experiences and reflect on challenging scenarios.
•Low rate of return of outcome measures; electronic surveys are recommended for future QI initiatives.
Lessons Learned
•CPD accreditation granted for family physicians, 156 Group Learning Mainpro+ credits.
•On-going Group Medical Visit fee codes for psychiatrists as important factor for current training model.
•Victoria facilitators started on-going peer-led faculty development sessions every 3 months.
•Shared Care exploring provincial spread of the program with UBC-CPD as central administration for training and development.
Sustainability and Spread
Develop a spreadable training program for physician facilitators of CBT Skills groups in BC; pilot this in Victoria and Vancouver between 2017 and 2018
Effects of Change
Strategy for Change
Survey current facilitators for feedback (in Victoria 7 family physicians and 5 psychiatrists) Use expert opinion to revise the Facilitator’s Guide and draft Competencies Field test new Facilitator’s Guide format and content with indexing to new Patient Workbook Field test Competencies at different time points of the Facilitator Training Program Develop and implement evaluation tools:
GP Facilitator Needs Assessment (self and psychiatrist report) Satisfaction Survey
Facilitator Training Program
“All excellent! The content was completely relevant. The Facilitator’s guide was comprehensive. I found the debriefing sessions invaluable for learning and gaining confidence with the immediate feedback.”
“Wonderfully drafted, recipe cards really target the important aspects and the comprehensive guides have fantastic detail. I appreciated the quotes woven in as well.”
“Facilitator Competencies - glad to see these, useful to realize how many competencies there were - no wonder it seemed overwhelming at first!”
Selected Feedback from Facilitators
ProblemNew communities are interested in the program, but spread requires that family physicians train to facilitate groups. The training program needs to be mapped, evaluated and improved.
Self-Reported Skills and Knowledge of Facilitator Trainees Over Course of Training
(n=4, scores averaged)
guided by electronic Facilitator’s Guide
