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Psychology

Implementation and Governance Standards for Delivery of Survive and Thrive

This document has been produced in partnership with the ‘Survive and Thrive’ National Reference Group in relation to the best evidence available.

Basic Principles

‘Survive and Thrive’ is not designed as a standalone intervention but as part of a planned treatment approach for survivors of complex trauma in line with the Matrix (2015). This should be embedded in a service where there is trauma awareness; training and staff support should be available to support this.

‘Survive and Thrive’ should be part of a phase 1 treatment and may not be necessary or sufficient to ensure the needs of this stage of treatment is met. The acquisition of skills and knowledge of service users should be assessed individually and supplemented with the use of psychometric measures.

However, for some service users’ attendance at a ‘Survive and Thrive’ will be sufficient or all that is required at the moment. However service users should be reassessed following the course to ensure that the best service is being offered.  It is possible to offer attendance on the course, whilst someone is  waiting for or in conjunction with another psychological therapy.

Service users must be assessed with a view to their safety and the safety of the other participants in the course. Should safety concerns, in terms of suicide risk and harm to others be identified, this must be (as ever) the principle concern and services should have protocols available to follow in these circumstances. On principle, participants should be involved as much as possible in these discussions and decisions.

Facilitator of a ‘Survive and Thrive’ course- checklist

Although, the course material is designed to be delivered with a degree of flexibility it is essential that through the training and supervision that the course is delivered in line with the way the material was delivered in the research studies.

Pre-course checklist for facilitators

 

Referrals screened against referral criteria (see below)

 

Suitable venue which is safe and confidential, ideally with breakout space and access to facilities for tea and coffee making.

 

Access to laptop and projectors.

 

Access to weekly slides.

 

Weekly handouts prepared (if necessary).

 

Psychometric assessment available – see table below for recommendations.

 

Feedback forms or methods in place.

 

Supervision is in place with an appropriately qualified supervisor.

 

Recommended

 

Service users have a named link person or contact person who they can access for additional support during the course and who may have responsibility for end of course assessment.

Client/service user referral criteria

Referral criteria

 

Survivor of complex trauma, where an assessment indicates that they are experiencing the impact of this in terms of affect dysregulation and interpersonal difficulties.

 

Phase 2 (direct work on trauma memories) is not currently the primary need.  Although there may be situations where this is the primary need but that the client has agreed to attend ‘Survive and Thrive’ explicitly as a preparation for this work.

 

Although not an exclusion criteria, clients who have a known history of perpetrating abuse need to be given very careful consideration. It may be unsafe were they to disclose their involvement and some of the material is not explicitly designed to meet the needs of this group.

Exclusion criteria

 

A service user  should not be offered ‘Survive and Thrive’ if another evidence based treatment is likely to be more beneficial e.g. if depression is the primary presentation then the evidence base for this should be followed.

 

A service user should not be offered’ Survive and Thrive’ is there is acute or significant risk, either from self or others at the point of commencement. Work with the service users to manage this prior to engaging in the course.

 

Some service users may not be able to tolerate a group based intervention, this should be considered when offering ‘ Survive and Thrive’.

Recommended psychometric tools

Psychometric tools as agreed by the local services should be provided weekly and fedback initially to the supervisor and then to the service and wider ‘Survive and Thrive’ network as part of the ongoing audit and research effort.

Psychometric tools which allow client safety to be assessed should be used (weekly CORE 10 is recommended). However, this must always be supplemented with individual assessment and risk assessment; decisions should never be made based only on psychometric assessment.

Literacy and language difficulties need to be taken into account. Information on this should be gained prior to attending the course and adaptations must be developed (for instance asking people to attend 10 minutes earlier to get support in completing psychometrics).

Psychometric data should be available for review at all ‘Survive and Thrive’ supervision meetings and anonymous data should be shared with NES as part of the quality assurance and fidelity checks.

With a view to ensuring quality and safety in addition to allowing ongoing data collection and audit of the effectiveness of Survive and Thrive delivery the following psychometrics are recommended as a minimum.

Recommendations for use of psychometrics

Week one

 

Post Traumatic Stress Disorder Checklist- Civilian Version (PCL-C) Blanchard et al 1996

Generalised Anxiety Disorder Assessment (GAD 7) Spitzer et al 2006

Patients Health Questionnaire 9 (PHQ 9) Kroenke et al 2001

CORE 10

Additional assessments which should be considered:

COPE Inventory (Carver et al 1989)

Brief COPE (Carver et al 1997)

Difficulties in Emotion Regulation Scale (DER-S) Gratz and Roemer (2004)

Week two

 

CORE goal attainment scale

CORE 10

Weekly

 

CORE 10

Methods of gaining participant feedback should be incorporated throughout the course; this can be formal feedback forms or asking participants to leave ‘post its’ etc with brief feedback on.

Week 10

 

Post Traumatic Stress Disorder Checklist- Civilian Version (PCL-C) Blanchard et al 1996

Generalised Anxiety Disorder Assessment (GAD 7) Spitzer et al 2006

Patients Health Questionnaire 9 (PHQ 9) Kroenke et al 2001

CORE 10

Review CORE goal attainment as part of assessment  of ongoing needs

Additional assessments which should be considered( repeated depending on what was used week 1)

COPE Inventory (Carver et al 1989)

Brief COPE (Carver et al 1997)

Difficulties in Emotion Regulation Scale (DER-S) Gratz and Roemer (2004)

Supervisor checklist

In line with The Matrix (2015) ‘Survive and Thrive’ must be provided under adequate supervision

Recommendations for supervision

 

The supervisor of ‘Survive and Thrive’ should ideally be an applied psychologist and who has experience and expertise in working with survivors of complex or interpersonal trauma.

 

They should be knowledgeable and experienced in the delivery of ‘Survive and Thrive’ but also the wider evidence base around the holistic phased interventions for survivors of complex or interpersonal trauma.

 

They should have, as a minimum, completed the NES Generic Supervision Competency training.

 

The supervisor should be able to support the interpretation of psychometric data. Weekly routine data should be reviewed in partnership with the facilitators to ensure safety issues are understood and examined. Risk assessment and management should be central to this.

 

It is highly recommended that a minimum of one tape/DVD is provided to supervisors to review over a delivery of a course. Policies and procedures for data protection must be adhered to within this.

 

All clients attending the course should be reviewed regularly, with reference to safety, engagement and ongoing needs.

 

The supervisor and supervisee should have a supervision contract in place.

 

Supervision could be delivered in a group format.

 

Supervision frequency should, as a minimum, meet the standards recommended of the professional body but 3 weekly minimum frequency is highly recommended.

If you have any additional questions, please do not hesitate to contact Dr Sandra Ferguson, NHS Education for Scotland 

Sandra.ferguson@nes.scot.nhs.uk

Survive and Thrive- under 18s