Hostname: page-component-669899f699-2mbcq Total loading time: 0 Render date: 2025-04-28T07:32:54.891Z Has data issue: false hasContentIssue false
  • English
  • Français

The concept of service model fidelity in Talking Therapies

Published online by Cambridge University Press:  14 October 2024

Paul Cromarty Open the ORCID record for Paul Cromarty [Opens in a new window]
Paul Cromarty*
Affiliation:
University of Derby, Derby, UK CBT Institute, Adelaide, Australia
*
Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Abstract

The concept of Service Model Fidelity is considered as a parallel process to Treatment Fidelity in evidence-based psychological therapies. NHS Talking Therapies (formerly IAPT) aimed to increase access to an expanded, upskilled workforce on a national scale. This included systematic training, supervision and front-line service delivery, emphasising treatment fidelity to evidence-based interventions. A further feature of NHS Talking Therapies was modernising and restructuring of the health system that housed these trained practitioners. The term ‘service model fidelity’ (Cromarty, 2016) was coined to emphasise service modernisation aspects as a distinct entity. A definition of the latter is included. Examples of service model fidelity and of service model drift, are outlined to distinguish these from therapist drift. This links to past literature recommending changes in traditional mental health service design and emergent evidence from NHS Talking Therapies. The latter examines publicly available data identifying characteristics of service design, which appear to be predictors of enhanced clinical outcome. Challenges in modernising health systems are discussed and conclusions are made highlighting the crucial role of service model when delivering evidence-based therapies. Suggestions for further research into service configuration to improve experiences of service users are considered. This includes ongoing exploration of service design being more than a qualitative feature, and increasingly appearing as a key factor in enhanced clinical outcome.

Key learning aims

  1. (1) To identify service model fidelity as separate entity to treatment fidelity.

  2. (2) To provide a clear definition of service model fidelity.

  3. (3) To delineate therapist drift from service drift.

  4. (4) To further examine the role of service model in delivering evidence-based interventions.

Keywords

fidelityImproving Access to Psychological Therapies Programme (IAPT)NHS Talking Therapiesservice evaluationtreatment delivery preferences
Type
Service Models, Forms of Delivery and Cultural Adaptations of CBT
Information
the Cognitive Behaviour Therapist , Volume 17 , 2024 , e26
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of British Association for Behavioural and Cognitive Psychotherapies

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Further reading

Clark, D. M., Canvin, L., Green, J., Layard, R., Pilling, S., & Janecka, M. (2018). Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. The Lancet, 391, 679–686. https://doi.org/10.1016/S0140-6736(17)32133-5 CrossRefGoogle Scholar
Gyani, A., Shafran, R., Layard, R., & Clark, D. M. (2013). Enhancing recovery rates: lessons from year one of IAPT. Behaviour Research and Therapy, 51, 597–606. doi: 10.1016/j.brat.2013.06.004 CrossRefGoogle ScholarPubMed
Lovell, K., & Richards, D. (2000). Multiple Access Points and Levels of Entry (MAPLE): ensuring choice, accessibility and equity for CBT services. Behavioural and Cognitive Psychotherapy, 28, 379–391.CrossRefGoogle Scholar

References

Bickman, L. (1999). Practice makes perfect and other myths about mental health services. American Psychologist, 54, 965.CrossRefGoogle Scholar
Bower, P., & Gilbody, S. (2005). Stepped care in psychological therapies: access, effectiveness and efficiency. Narrative literature review. British Journal of Psychiatry, 186, 11–17.CrossRefGoogle ScholarPubMed
Chellingsworth, M., Davies, S., & Laidlaw, K. (2016). The National Curriculum for CBT with Older People (2nd edn). Department of Health.Google Scholar
Clark, D. (2018). Realizing the mass public benefit of evidence-based psychological therapies: the IAPT program. Annual Review of Clinical Psychology, 7, 159–183. https://doi.org/10.1146/annurev-clinpsy-050817-084833 CrossRefGoogle Scholar
Clark, D. M., Canvin, L., Green, J., Layard, R., Pilling, S., & Janecka, M. (2018). Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. The Lancet, 391, 679–686. https://doi.org/10.1016/S0140-6736(17)32133-5 CrossRefGoogle ScholarPubMed
Clark, D. M., Layard, R., Smithies, R., Richards, D. A., Suckling, R., & Wright, B. (2009). Improving access to psychological therapy: initial evaluation of two UK demonstration sites. Behaviour Research and Therapy, 47, 910–920.CrossRefGoogle ScholarPubMed
Cromarty, P. (2016). Improving Access to Psychological Therapies (IAPT) in Australia: Evidence-based CBT Interventions for Anxiety, Depression and Gambling Addiction. Innovations and Future Directions in the Behavioural and Cognitive Therapies, ed. Menzies, R., Kyrios, M. & Kazantis, N.. Australian Academic Press Google Scholar
Cromarty, P., & Gallagher, D. (2023). What guides guided self-help? Recognising the role of formulation in Low Intensity CBT. Mental Health Science, 1, 48–54. https://doi.org/10.1002/mhs2.15 CrossRefGoogle Scholar
Cromarty, P., Drummond, A., Francis, T., Watson, J. & Battersby, M. (2016). NewAccess for Depression and Anxiety: Adapting the UK Improving Access to Psychological Therapies Program across Australia. Australasian Psychiatry.CrossRefGoogle Scholar
Cromarty, P., Price, K., & Freeston, M. (2008) Starting from Scratch: Capacity Building of Training to Produce CBT Practitioners. Presented in Current Issues and Approaches in CBT Training at 36th BABCP Annual Conference, Edinburgh.Google Scholar
Freeston, M. H. (2008) Clinical Art and Clinical Science In CBT: Challenges for Dissemination, Education, Training and Supervision; Keynote at 36th BABCP Annual Conference, Edinburgh.Google Scholar
Gyani, A., Shafran, R., Layard, R., & Clark, D. M. (2013). Enhancing recovery rates: lessons from year one of IAPT. Behaviour Research and Therapy, 51, 597–606. doi: 10.1016/j.brat.2013.06.004 CrossRefGoogle ScholarPubMed
Knapstad, M., Nordgreen, T., & Smith, O.R.F. (2018). Prompt mental health care, the Norwegian version of IAPT: clinical outcomes and predictors of change in a multicenter cohort study. BMC Psychiatry, 18. https://doi.org/10.1186/s12888-018-1838-0.CrossRefGoogle Scholar
Layard, R. (2006). The Depression Report: A New Deal for Depression and Anxiety Disorders (No. 15). Centre for Economic Performance, LSE.Google Scholar
Lillienfield, S., Ritschelb, L., Lynnc, S., Cautind, R., & Latzmane, R. (2013). Why many clinical psychologists are resistant to evidence-based practice: root causes and constructive remedies. Clinical Psychology Review, 33, 883–900.CrossRefGoogle Scholar
Lovell, K., & Richards, D. (2000). Multiple Access Points and Levels of Entry (MAPLE): ensuring choice, accessibility and equity for CBT services. Behavioural and Cognitive Psychotherapy, 28, 379–391.CrossRefGoogle Scholar
NHS England (2023). https://www.england.nhs.uk/blog/whats-in-a-name-nhs-talking-therapies-for-anxiety-and-depression-the-new-name-for-iapt-services/ Google Scholar
NHS England (2024). https://www.england.nhs.uk/publication/the-improving-access-to-psychological-therapies-manual Google Scholar
Robb, S., Burns, D., Docherty, S., & Haase, J. (2011). Ensuring treatment fidelity in a multi-site behavioral intervention study: implementing NIH behavior change consortium recommendations in the SMART trial. Psychooncology, 20, 1193–1201.CrossRefGoogle Scholar
Saunders, R., Cape, J., Leibowitz, J., Aguirre, E., Jena, R., Cirkovic, M., Wheatley, J., Main, N., Pilling, S., & Buckman, J. (2020). Improvement in IAPT outcomes over time: are they driven by changes in clinical practice? the Cognitive Behaviour Therapist, 13, E16. doi: 10.1017/S1754470X20000173 CrossRefGoogle ScholarPubMed
Shafran, R., Clark, D. M., Fairburn, C. G., Arntz, A., Barlowe, D. H., Ehlers, A., Freeston, M. H., Garety, P. A., Hollon, S. D., Ost, L.G., Salkovskis, P.M., Williams, J.M.G., & Wilson, G.T. (2009). Mind the gap: improving the dissemination of CBT. Behaviour Research and Therapy, 47, 902–909.CrossRefGoogle Scholar
Townend, M., Iannetta, L., & Freeston, M. H. (2002). Clinical supervision in practice: a survey of UK cognitive behavioural psychotherapists accredited by the BABCP. Behavioural and Cognitive Psychotherapy, 30, 485–500. https://doi.org/10.1017/S1352465802004095 CrossRefGoogle Scholar
Waller, G., & Turner, H. (2016). Therapist drift redux: why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behaviour Research and Therapy, 77, 129–137.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.