Transferring new skills and knowledge to practice: a mixed methods case study of Improving Access to Psychological Therapy (IAPT) in a single English region

摘要

Background.udThis thesis examined facilitative and inhibitory issues in the transfer of newudskills and learning to support implementation of national policy for ImprovingudAccess to Psychological Therapy (IAPT) in primary care services within theudEnglish National Health Service (NHS). The policy for IAPT had two principaludimplementation strands; a) development of new services in primary care anduddevelopment of a new, national education and b) training programme toudsupport delivery of effective evidence based psychological treatments for audspecified range of common mental disorders; particularly depression andudanxiety.udThere is a paucity of research on transfer of skills and learning from formaludeducation programmes to application in healthcare practice.udMethodology.udA mixed methods case study design was developed to obtain quantitative andudqualitative data on the experiences of IAPT therapists prior to commencingudtheir training programme; on completion of their educational programme andudagain at a follow-up period. In-depth interviews were held with key policyudleads that devised, developed and implemented the IAPT initiative to examineudtheir expectations and reflections on the programme. Formal interviews wereudheld with IAPT therapists; their managers and clinical supervisors from audsingle education cohort in an English region. Focus groups were also heldudwith other IAPT therapists to examine emerging findings from the data. udResults udA number of themes emerged from the merged quantitative and qualitativeuddata. Motivation to maintain fidelity to the work of being an IAPT therapistudwas seen as crucial. This motivation was highly related to the self-reportedudforce of external pressures to adapt IAPT practice in line with changed NHSudcommissioning requirements. System feedback was seen as a unique featureudof the programme and part of this feedback process centred on the role ofudclinical supervision in supporting the transfer of learning and continuousuddevelopment of practice.udEducational programmes were based on a prescribed competency modeludwhich was designed to provide core knowledge and skills to support newudworkers in new roles in new service providers within Primary Care. However,udrespondents reported high degrees of complexity, practice isolation andudpolitical and economic stressors that were not reflected in the curriculum.udTherefore the role of the curriculum as a front end model to prepareudpractitioners for practice was questioned.udDespite this, evidence existed of high levels of confidence and capability ofudIAPT therapists in the extension of their core educational skills. This transferudbehaviour was a feature of practice when set within the context of supportedudsupervision.udDiscussion on the implications from this researchudImplementation of new services and a new workforce (such as IAPT) withinudthe NHS remains challenging with few significant successes. The IAPTudprogramme has a number of unique features, such as a focus on feedbackudprocesses and clinical supervision. These enabling forces particularly thoseudof supervision, were considered to be under threat from cost saving initiatives.udSuch financial pressures appear to have the potential to destabilise one of theudmajor enabling building blocks of learning transfer.udThis thesis adds to the body of knowledge in workforce development andudeducation and training in the NHS by offering a detailed case study analysis ofuda range of factors that can inhibit or enable transfer of learning and promoteudchange in professional practice. There is little research in the mental healthudliterature on the transfer of learning that takes such a comprehensive wholeudsystems and long term perspective on this issue.