IAPT and BABCP Accreditation and Supervision: October 2009 Update.

11 October 2009
IAPT Admin

Introduction

During the course of recent IAPT/BABCP accreditation visits to courses, several questions have emerged about the nature of the course accreditation process, the relationship between requirements of BABCP accreditation and the IAPT National Curriculum, and the criteria for who is eligible to supervise a high intensity IAPT trainee. Following discussions between IAPT and BABCP, together with a recent Oversight Group for Accreditation of IAPT Training (OGAIT) meeting, the following clarification and guidance has been agreed:

Who is eligible to supervise a high intensity IAPT trainee?

There has been some confusion about whether all supervisors of High Intensity IAPT trainees need to be BABCP accredited practitioner. The IAPT National Curriculum requires 70 hours of supervision and 8 cases to be supervised by “a CBT accredited therapist” familiar with the Hi Intensity curriculum and its interventions. Unfortunately, it has not been easy to ensure that all trainees are guaranteed to receive such a high standard of supervision in the first year of the programme since:

Not all supervisors have sought BABCP accreditation.
Some supervisors have applied but their application has yet to be confirmed.
Some supervisors may not be currently accreditable and would require further top up training.
Even some BABCP accredited practitioners may not be familiar with the IAPT curriculum, especially if they trained to specialise in CBT for psychosis or children.
Not all SHAs have arranged IAPT consistent supervisor training this year.

Due to the above problems, to rigidly adhere to this standard may mean that some courses would not be accredited this year, and trainees would therefore not be eligible for individual accreditation with BABCP. This would introduce a serious capacity problem into the programme.

Notwithstanding the above, the IAPT Supervision guidance has consistently made it clear that eligible supervisors had to be familiar and competent in the delivery of therapy that they were supervising. Hence, courses and services must assure themselves that IAPT supervisors are familiar with and have practiced CBT. BABCP accreditation, as an individual practitioner, is currently the only accreditation standard that courses and services can reliably apply, to ensure that supervisors have achieved a required standard in CBT. However, we are currently exploring with other professional bodies (e.g. BACP, BPS) other possible accreditation routes for practitioners. Moreover, the IAPT Supervision Good Practice guidance (http://www.iapt.nhs.uk/2008/12/17/iapt-supervision-guidance/) also recommended a minimum of 1 hour a week (i.e. 44 hours p.a.) for individual supervision, or longer if in groups, from within the service for all IAPT therapists irrespective of whether they were qualified or trainees.

What are the accreditation criteria for Courses?

BABCP requires that Courses should only use supervisors that are BABCP accredited and that individual trainees should acquire 40 hours of individual supervision or the equivalent if provided as group supervision according to the BABCP formula. However, when the national curriculum was agreed for IAPT high intensity trainees, given that these new courses were essentially twice the duration of existing CBT courses, it was decided that it would be desirable and reasonable to expect a minimum of 70 hours of supervision by a CBT experienced supervisor who is either BABCP accredited or eligible for accreditation.

The additional requirement for IAPT CBT courses, together with the issues described above concerning accrediting supervisors’ CBT competence, has posed some challenges for some courses and services, which have been recently identified within accreditation visits. Hence we would like to clarify how BABCP/IAPT will judge course accreditation over the next two years and also provide some good practice advice as to how courses and services can meet these criteria.

Accreditation requirements for year 1 and beyond:

For year one and subsequent years, trainees need to have at least 40 hours of supervision by accredited CBT therapists (at the moment that means BABCP). Hours are calculated on the BABCP formula, which takes into account differences between individual and group supervision. Hours count as long as the supervisor has successfully applied for accreditation by the time the student is awarded the PGDip. This is the BABCP minimum criterion and the organization is understandably unable to lower the standard for IAPT.

In year one any extra hours that are required to make up the 70 required by the IAPT national curriculum must be provided by a suitably qualified CBT therapist. Normally this means the person is BABCP accredited. However, in year one we will also accept any extra hours (above the BABCP 40) that are provided by individuals whom the course has satisfied itself are suitably qualified in CBT (e.g. a PGDip or other specific training).

For year two, all 70 hours specified in the national curriculum need to be provided by a CBT accredited therapist. It is recognized that some supervisors in some sites will not have applied for CBT accreditation at the start of year two. However, they need to do so during year two as their hours of supervision will only count if they are accredited by the time their students submit their practice portfolio at the end of year two (September 2010 or later).   So, hours count as long as the supervisor’s accreditation is in place by the time the student graduates.

Ideally, all 70 hours in year two ought to be delivered according to the BABCP formula but we recognize that there may still be some difficulties in achieving this. Even so, the IAPT Supervision Good Practice Guide does recommend at least an hour a week supervision to be provided within the service and strongly recommends that supervision groups should not exceed 3 members, together with other examples of good practice in organising both in-service and University supervision. (see IAPT Supervision Guidance).

In summary, courses in year 1 will have to have demonstrated that they meet the minimum BABCP accreditation requirements of 40 hours from a BABCP accredited therapist. For many courses this year, this may mean that they might need to delay the submission of student practice portfolios (see below) in order to ensure that services and the course, help students to accumulate these hours. For year two and subsequent cohorts, courses will need to demonstrate an action plan as to how they can achieve the IAPT/BABCP 70 hours criterion with CBT accredited therapists (i.e. BABCP or equivalent professional accreditation specifically in CBT).

What if we are unable to meet these requirements?

We anticipate that some courses will have difficulties achieving these requirements due to the nature of staffing and supervision within some services in the first year. We strongly recommend that such courses delay submission of the relevant students’ practice portfolio and work with services, to ensure that their students will be able to meet the year one minimum standards specified above before submission. Steps that can be taken are outlined below.

Buying in supplementary expert CBT supervision from neighbouring services or local practitioners
Carefully scrutinising  the accreditation of supervisors and how they are allocated across the trainee cohorts.
Encouraging and supporting (e.g. financial in some cases) supervisors becoming BABCP accredited. BABCP offer a fast-track process for IAPT services.
Using smaller group supervision groups (i.e. 3 trainees).
Extending the acceptable period of HEI registration on the course beyond 12 months (i.e. up to 24 months), so as to allow delayed examination of portfolios.

However, we recognize that the passing of the practice portfolio may be possible within the university regulations of some courses, without students meeting minimum year one criteria laid out above. In such instances, the BABCP would not be able initially to accredit the course and any graduates would need to document that they individually meet the BABCP minimum training standards when subsequently applying for individual accreditation with BABCP. (Students who have passed an IAPT/BABCP accredited course do not need to do this, as many of the BABCP minimum training standards are accepted as met, because the person has passed an accredited course).

Accreditation outcomes

For High Intensity IAPT courses, either they will be given full accreditation or provisional accreditation depending upon the extent that the course meets course accreditation criteria and the number of recommendations for change made within the final report.

Normally full accreditation will be given for a period of up to 5 years.  However, given that these are new courses and reliant on the quality of the individual IAPT services within which the training is delivered, we have decided in the first instance, only to accredit courses for two cohorts and that subsequent accreditation will be subject to a report of satisfactory progress and assurances that the services used for training meet minimum quality standards. If progress is satisfactory and the services within which training is taking place meet minimum training standards, accreditation will be extended to include the full five cohorts of trainees.

Where progress has not been satisfactory or where there have been major changes to a course (e.g. departure of Course Director), IAPT/BABCP may choose to arrange a further accreditation visit. Courses are required to inform IAPT and their relevant SHA of any major changes in course staff/ organization or service providers for training.

Some courses may only receive provisional accreditation and this will usually refer to only one student intake. A provisionally accredited course would need to submit a report within a specified time period (usually 9 months) describing and evidencing how it has met the recommendations/conditions made in the accreditation report. IAPT/BABCP may choose to arrange a further accreditation visit if the documentation is not sufficiently clear or the issues need to be reviewed in person. Where a course is failing to deliver the High Intensity IAPT curriculum or meeting BABCP criteria, despite significant advice and support through the accreditation process, accreditation will not be given.

Will accreditation criteria impact on the assessment of individual trainees?

Generally, HEI assessment regulations need to reflect the accreditation requirements of IAPT/BABCP. Depending upon HEI requirements, trainees may also have difficulties in passing their practice portfolios. However, it is uncertain the degree to which HEIs may have required BABCP accredited supervisors within their assessment regulations? Clearly supervisors used by the course should meet minimum standards as specified by the course itself and that the standard of trainee’s work must meet the minimum academic standards. However, some examination boards may need to use an element of discretion, particularly with the commencement of a new course. If the approval of supervisors is an issue, we would suggest exploring this with the course’s external examiner in the first instance, following discussion of this document.

When will my course receive its accreditation report?

Accreditation visits follow the agreed guidance (http://www.babcp.com/training/iapt-course-accreditation/) between IAPT and BABCP which is available on each website. Following a visit, a course accreditation report is drafted and courses will be asked to comment on the draft for factual accuracy. The final report will then be scrutinized and agreed by the BABCP Course Accreditation committee, together with two IAPT representatives present. This later process is to ensure consistency across BABCP and IAPT requirements, and also to ensure consistency across all visiting teams and reports.

Copies of the report will also be sent to the SHA, and the IAPT Regional Lead and Clinical Advisors. Courses are encouraged to share the reports with all stakeholders including students, services, supervisors, commissioners and user groups. A copy will also be made available to OGAIT.

Where the accreditation status of a course has been compromised due to either delays or deficiencies in service provision, it will be essential that a joint action plan is agreed between the course and its associated IAPT services as to how these difficulties might be remedied. In such circumstances, it would be expected that the IAPT Regional Advisor and the relevant SHA leads would follow up any recommendations for service improvement following the accreditation visit and the publication of the report.

We hope this briefing answers some of the questions regarding both course and individual accreditation that have been raised within the first year of IAPT High Intensity Training implementation. We have also just finalized the accreditation criteria and processes for Psychological Wellbeing Practitioner courses delivering low intensity IAPT interventions. We will shortly be writing to these courses with details of the programme of accreditation visits and initial scrutiny reports, and a copy of the Accreditation Handbook. Finally, IAPT and BABCP through OGAIT will continue to work with other professional bodies to encourage their members to seek some form of CBT/IAPT accreditation.

IAPT National Team/ BABCP