Transferring new skills and knowledge to practice: a mixed methods case study of Improving Access to Psychological Therapy (IAPT) in a single English region
Creators: name: Mcgonagle, Ian
Publisher: name: University of Lincoln
Year: 2023
Subjects: C800 - Psychology

description: Background.This thesis examined facilitative and inhibitory issues in the transfer of newskills and learning to support implementation of national policy for ImprovingAccess to Psychological Therapy (IAPT) in primary care services within theEnglish National Health Service (NHS). The policy for IAPT had two principalimplementation strands; a) development of new services in primary care anddevelopment of a new, national education and b) training programme tosupport delivery of effective evidence based psychological treatments for aspecified range of common mental disorders; particularly depression andanxiety.There is a paucity of research on transfer of skills and learning from formaleducation programmes to application in healthcare practice.Methodology.A mixed methods case study design was developed to obtain quantitative andqualitative data on the experiences of IAPT therapists prior to commencingtheir training programme; on completion of their educational programme andagain at a follow-up period. In-depth interviews were held with key policyleads that devised, developed and implemented the IAPT initiative to examinetheir expectations and reflections on the programme. Formal interviews wereheld with IAPT therapists; their managers and clinical supervisors from asingle education cohort in an English region. Focus groups were also heldwith other IAPT therapists to examine emerging findings from the data. Results A number of themes emerged from the merged quantitative and qualitativedata. Motivation to maintain fidelity to the work of being an IAPT therapistwas seen as crucial. This motivation was highly related to the self-reportedforce of external pressures to adapt IAPT practice in line with changed NHScommissioning requirements. System feedback was seen as a unique featureof the programme and part of this feedback process centred on the role ofclinical supervision in supporting the transfer of learning and continuousdevelopment of practice.Educational programmes were based on a prescribed competency modelwhich was designed to provide core knowledge and skills to support newworkers in new roles in new service providers within Primary Care. However,respondents reported high degrees of complexity, practice isolation andpolitical and economic stressors that were not reflected in the curriculum.Therefore the role of the curriculum as a front end model to preparepractitioners for practice was questioned.Despite this, evidence existed of high levels of confidence and capability ofIAPT therapists in the extension of their core educational skills. This transferbehaviour was a feature of practice when set within the context of supportedsupervision.Discussion on the implications from this researchImplementation of new services and a new workforce (such as IAPT) withinthe NHS remains challenging with few significant successes. The IAPTprogramme has a number of unique features, such as a focus on feedbackprocesses and clinical supervision. These enabling forces particularly thoseof supervision, were considered to be under threat from cost saving initiatives.Such financial pressures appear to have the potential to destabilise one of themajor enabling building blocks of learning transfer.This thesis adds to the body of knowledge in workforce development andeducation and training in the NHS by offering a detailed case study analysis ofa range of factors that can inhibit or enable transfer of learning and promotechange in professional practice. There is little research in the mental healthliterature on the transfer of learning that takes such a comprehensive wholesystems and long term perspective on this issue.