COMPASSION FOCUSED THERAPY

How Compassion Focused Therapy is

SUPPORTING STAFF AND PATIENTS ALIKE

The use of Compassion Focused Therapy (CFT) in supporting staff with stress management and the ability to better support patients with challenging behaviour through CFTbased psychological formulation is being rolled out across The Disabilities Trust, following a successful pilot project.

Although CFT is most commonly used as a psychological intervention, through The Disabilities Trust’s innovative application of the therapy in supporting staff with stress, feelings and emotions - with the ability to also recognise this in patients - relationships with service users have been strengthened and staff are more confident in their skills and abilities. As well as happier and more confident staff, examples of patients reducing challenging behaviours by over 50 per cent have also been achieved in some cases, the CFTinformed formulations helping staff to understand the impact of their brain injury and emotional presentations.

The pilot at the Trust’s York House, led over several years by consultant clinical psychologist Dr Miles Rogish - who won a UKABIF Clinician of the Year Award in recognition of his work in this area - has seen such levels of success and engagement that it is now being introduced to care staff across its centres nationally. It was also trialled in a community setting in York to further gauge impact, which showed similar results with increased staff understanding of service user behaviours and emotional presentations, along with reduced anxiety in staff and staff becoming more likely to engage with service users and less likely to avoid behaviours that challenge. Dr Rogish used the relatively simple concept of three circles affect regulation system of CFT to create a formulation for staff to express themselves more effectively, to help them understand and manage their stress levels and reactions and protect against burnout, while better supporting patients and understanding their emotional experiences in the process. “Often within care settings, you can get situations where people want to downplay their own emotional responses, they say ‘I’m not scared, I can cope, I’m fine’, because staff don’t want to show they’re suffering in any way,” says Dr Rogish. “I tried to discourage that as much as possible, I want staff to communicate their feelings openly, honestly and effectively within an appropriate supervisory context. “For example, if you were helping someone with personal care and they slapped you when you were trying to help them, it's understandable to be angry and it’s OK to be scared when that situation occurs. “But what you have to then do is think about why it occurred, where was the service user in their emotional experience of the situation, and where were my (staff) emotions when that occurred. “Often you can find that if you can modulate your own emotions, so that you are as stabilising for the service user as possible, the probability of challenging behaviours occurring goes down. You then have a better interaction with the service user, you develop a better relationship and they progress better. “I’ve had staff come back to me and told me stories of working with service users, they told me that once they understood (through the formulation) that the patient was scared and not angry, they were able to empathise, be less anxious, and be a lot more compassionate and caring towards him. “And that made him less scared, which made the relationship a million times better. And now they feel safe working with him, and he feels safe working with them.” Dr Rogish has been working in CFT - a concept devised by Professor Paul Gilbert – since 2000, with its effectiveness in supporting people with treatment-resistant depression being supported by increasing evidence over the years. But keen to test its application in a wider field, Dr Rogish saw the potential to support care staff through the use of CFT, with high levels of stress and burnout being huge problems within social care. Through teaching staff a formulation based around the three circles affect regulation model - which comprise systems of threat, drive and soothing. The three circles are typically represented by three different colours - the ability of staff and service users to express themselves became a lot easier. “You can really boil the three systems model down to quite concrete ideas that a lot of people can really hold on to,” says Dr Rogish, also an associate lecturer at the University of York, whose MA students assisted in the research. “When you’re working with someone, you can tune into a shared language which can be as simple as ‘What circle are you in right now? Where is your red circle right now?’ “And as well as staff, where appropriate, you can quickly turn it into something that service users, even with some profound cognitive impairment, can get the gist of in a way that helps them understand what might be driving their emotional dysregulation. “Using the three circle system has been very effective. For example, if someone is very fearbased reactive, they have an overactive threat system. Staff then need to be then very aware of their own threat system, because if you are approaching someone who is very fear reactive, and you are showing fear or anxiety yourself, you will increase their fear. “You can then activate your soothing system, so that when you are approaching someone who is very threatened, you approach them with a very compassionate, soothing and caring perspective, so that none of your interaction should trigger their fear. “Through this, staff then understand how they can compensate for the dysregulation in the service user by adapting their own presentation.” This approach has been central to achieving significant progress in patients, including those with profound difficulties. “I started using CFT to individually formulate the service users. With psychological formulations, you typically share them with the service users, sometimes you do not, it would depend on the service user and their capacity to understand such things,” says Dr Rogish. “I used it with a particular service user with profound cognitive impairment and challenging behaviour. “He would not have had capacity to understand the formulation, or the need for a formulation, but it was really clear to me through my typical applied behavioural analysis-type interventions that most of his challenging behaviours were reactive and fear-based. “He was reacting from a fear based perspective, typically triggered by staff trying to support him. I formulated him using a CFT perspective, and what staff were able to get from the formulation was just that, that his aggressive behaviours were a fear-based reaction. “He was not an angry person - he was a scared person. And while that sounds really simple, how you approach an angry person and how you approach a scared person can be very different. “All it took was for some staff to just understand that ‘He's not angry at me, he’s scared of me’. And that really changed the whole situation. It allowed them to approach him with a lot more empathy and compassion for his feelings, and within a month, his challenging behaviours had reduced by well over 50 per cent.” The success of the project will now see staff of all levels across The Disabilities Trust receive basic training in CFT, with Dr Rogish creating online and face-to-face support for staff in its implementation. “At York House, we have integrated CFT into so many aspects of how we work here, it’s in our inductions, it’s in our psychology training, and it's in almost all of our formulations,” he says. “Staff in York House are very CFT-informed, so we are now targeting support workers outside of York House who may not have been exposed to CFT before to see if this training has as much of an impact with people who are naive to the model. “And I'm also going to be specifically targeting senior management with this training as well, because I'm interested to see the differences in perceptions of training between senior management and the people who are working with service users day-to-day, face to face. “I'm particularly interested in developing training that is clear, easy and effective for all staff, and through the research projects I hope to provide insight to senior leadership, so that we can understand whether our ideas are translating to everyone within the Disabilities Trust as well as they could.”

ABI Strategy Update UKABIF Awards 2022 are open THE annual UKABIF awards are back for 2022 celebrating people’s work and creativity in the field of acquired brain injury.

It was a pleasure to join Chris Bryant MP on visits to three very different facilities offering neurorehabilitation services across the country to gather information for the new Government wide Acquired Brain Injury (ABI) Strategy.

We visited facilities in Newcastle, Sheffield and Birmingham to speak to staff, patients and families in order to hear what they think is needed to improve the lives of those living with acquired brain injuries. Chris Bryant MP said: "These visits have been hugely helpful as we look to gather information and first hand views from people working in ABI neurorehabilitation. If the ABI Strategy is to be fit for purpose we need to know what is currently working but perhaps more importantly what isn't working in order to ensure the needs of people with an ABI are properly addressed. "I want to say a huge thank you to everyone we met for sharing their experiences for us to consider as we take the Strategy forward." The four awards, sponsored by Elysium Neurological are: > The Mike Barnes Award for Innovation > The Stephen McAleese Award for Inspiration > The UKABIF Film Award > The UKABIF Poster Award

The awards are one of the ways we can recognise and celebrate the wonderful work of unsung heroes across the country. In the past we have received some incredible nominations and we look forward to hearing about the inspiring and innovative efforts being carried out. The deadline for entering the awards is 30 September and you can email your entry to info@ukabif.org.uk

ABI Strategy secondment opportunity: Applications open The Department for Health and Social Care has a secondment vacancy for a Stakeholder Liaison Lead in the Long-Term Conditions Team, working specifically on the ABI Strategy. The Stakeholder Liaison Lead will support the development of policy proposals for inclusion in the Strategy and ensure that the views of patients, carers, families and professionals are fully taken into account in the policy development. The role will involve building and maintaining strong working relationships with key stakeholders, particularly voluntary sector organisations working with people with an ABI. This is a hybrid part time role for a six-month period. www.bit.ly/3Ocy08K for full details closes 26 June. The winners will be presented with their awards at the UKABIF Time for Change Summit in Manchester on Monday, 7 November.

Dementia and the joy of being outdoors

Former carer Beth Britton writes about how getting outside was a great tonic for her and her dad during his years in care homes with dementia

So many of my happiest memories of my dad’s latter years with dementia revolve around being outdoors with him. We were lucky that the care home he spent the majority of his last nine years in was in a rural location, with a big garden and footpaths beyond the home for taking dad out in his wheelchair. My dad was very much an outside person. He’d spent his life as a farmer and his main hobby was gardening, not just at home but through maintaining huge allotments to grow vegetables throughout my young childhood. For dad, being indoors wasn’t his preferred environment, but the staff in his care home often found it difficult to find time to get my dad (and other residents who wanted to be outside) into the garden. Countless times we’d go to visit and would need to find dad a wheelchair, help him to get an extra jumper on, and get some help to move dad into his wheelchair. Other residents without visiting families often looked on, and I can only imagine that they were perhaps wishing to be outside too. Whilst summertime was when we went outside with dad the most (we’d sit in the garden, dad with his Panama hat on, having tea and relaxing) we would go outside in cooler weather too. So long as dad was well it just meant wearing more layers, and us pushing his wheelchair around to keep us all on the move and warmer. The care home would sometime arrange outings – I recall visits to a model village and a working farm amongst them – but whilst my dad enjoyed these I’m not sure they were preferred to quiet time in the garden. Outings, especially in these post-COVIDlockdown times, can sometimes be a sensory overload of crowds, movement and noise. Many people living in care homes have become conditioned to being within the care home building or grounds due to lockdown, and whilst some residents may welcome the chance to go on trips to attractions or shops there are definitely some people who will feel anxious and uncomfortable too. Even in my dad’s care home, long before any of us had heard of COVID (my dad died in April 2012), there were residents who would never go into the garden, even when the staff had set up lunch or tea outside. For these individuals their dementia had made them very fearful of larger spaces, and they only felt comfortable in the confines of their room or the lounge/dining area. My advice to families, whether your loved one likes to be outside or not, would be to think about how to enjoy nature together – all year round – in ways your loved one feels most comfortable with. Plants can be enjoyed inside or outside, gardening can be done inside or outside (think table-top planting and potting), different textures (leaves/stones/sand/soil etc) and smells (think aromatherapy) can be explored inside or outside, and watching birds or wildlife is often as easily done from a window as it is outside. Try not to see boundaries, but instead see possibilities and be as creative as possible. Why? Because nature is fantastic for helping us to ‘Take notice’, which is one of the 5 Ways to Wellbeing , and overall embracing nature in all its forms is heavily linked to improved mental health. On an anecdotal personal level, I know from the time I spent in nature with my dad that there is something very calming about that environment. I’d often sit in the garden with my dad holding hands as he napped in his panama hat, close my eyes myself, and almost forget dad had dementia for a while. We were just enjoying the moment, with the warmth of the sun on our faces and only birdsong and the rustle of the trees to listen to. That – more than any other experience – was priceless for me, and now my dad’s gone they are very precious memories. As I said in my blog, ‘The sun is out’

Beth Britton is an award-winning content creator, consultant, trainer, mentor, campaigner and speaker who is an expert in ageing, health and social care www.bethbritton.com.

Lessons in Learning for a Curious Case Manager

Before the conference

Knowing this edition would contain a report of the BABICM annual conference on June 15th and 16th I decided to write half of this article before the event and half afterward, I will leave it with the reader to decide whether that’s been a good idea… I am excited about the programme and the learning opportunities it provides. Many months ago the conference planning group put on their thinking caps aiming for an inspiring and fresh programme and aspiring to line up fantastic speakers who could share valuable their expertise, their learning and their wisdom. We have 2 themes which intertwine to an extent but which also allow for a deep dive into one topic – sporting concussion / mTBI and the opportunity to explore broader themes of safeguarding, regulation and protection with all the messy complexity that often entails. I have been involved in organising many events. I can’t think of any that have bombed, in fact the majority have gathered extremely positive feedback. Nevertheless there is always anxiety as to whether the content will land well with the audience and a secondary fear that speakers may drop out (I did once have responsibility for a conference where six out of seven speakers had to cancel in the weeks leading up to the event, we managed to replace 5 of the 6 and still run a well-received day!). My third fear is something practical going wrong - IT failure, someone falling off the stage, discovering the timings are not correct….. But that is about me and of course the conference is actually about giving a platform to wise, learned, experienced voices, who give their time and share their expertise generously. It is about an enthusiastic audience keen to learn from our speakers, exhibitors and each other. It is about a varied range of exhibitors updating delegates on their services and products. Learning, learning, learning – the conference is a platform and facilitator for curious and open minds. So case packed, car fuelled up, introductory notes written, feeling curious and open I am ready to set off. By Thursday evening I shall be home again and it will be done, so let’s see what I think when I come back….

After the conference

It’s Friday and I am back in the office after a packed and thoroughly enjoyable conference. Of course I need not have worried – which I am sure you have already surmised. No one fell off the stage, no speakers forgot to turn up and the after dinner comedian was very funny. There are many highlights. I am particularly proud that we have supported research students from Plymouth University to attend and present their case-management related work. We heard several times that the BABICM research group can develop research questions, members have lots of data and students – like those we heard from – are willing and able to carry out analysis and write up their work with the support of their supervisors. That’s a win-win surely? There is a very real sense of momentum developing across case management to contribute to the evidence base and BABICM is committed to building on this. So curious and open minded what did I learn? What have I brought back home with me?

Change - I reflect on the idea that change is never far away. I anticipate case managers should expect to see litigated sporting mTBI / concussive injuries in the coming years. Alongside this changes in diagnosis and imaging mean there will be better opportunities to demonstrate the existence of neural damage and its consequences. Also importantly that it may be more helpful to refer to Persistent Post Concussive Symptoms (PPCS) - another acronym to get familiar with – but language matters. ‘Mild’ is not a particularly helpful term for lasting cognitive changes that are resistant to change.

Impact - I felt strongly the impact of colleagues who are making a difference beyond the clients they directly work with. On day 2 there was a moment when Dr Mark Holloway received applause during his presentation in recognition for his work and determination to highlight serious failings in his local area, which contributed to the death of a brain-injured individual. The story he told demonstrated how coming forward and taking action from a place of on-theground knowledge alongside highlighting published evidence can bring about change – in this case a local authority implementing organisation-wide brain injury training. I can’t have been the only one thinking “I should do that too”. Core team members from The Open Justice Court of Protection Project described how the project is challenging the Court to deliver on its promise of transparency, and providing and supporting impactful learning across a range of professionals in this extremely important area.

Lived experience - Three inspiring presentations made me stop and ponder anew on lived experiences as Dawn Astle, Laura Collett and Lorraine Currie all offered a different window into life, living and achieving before and after injury. For me these presentations sat interestingly alongside storytelling from professional deputies from EMG Solicitors, who must see when to act in best interests but also when to give way to capacitous yet sometimes unwise decision making. Understanding the fine-grain details and priorities of each individual life are crucially important to the work we all do with injury survivors and their families.

I could go on, there was so much and each of us attending will have no doubt brought back our own particular learning points and highlights. I guess the most crucial thing is always to keep an open mind, to be prepared to be challenged and to look for opportunities to add to our knowledge and experience and I think I can honestly say (whilst admitting a certain level of bias but also having received all the feedback) that the BABICM 2022 conference delivered once again. So now a bit of annual leave for me and then back to join the BABICM 2023 Conference Planning Group. See you in Coventry next June!

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