This post is the second in a series. The first is Cannon Fodder: a Story of Vicarious Trauma which you can find here.
Dr Sarah Watts is the author of today’s post and is the Clinical Lead and Consultant Clinical Psychologist for the Staffordshire and Stoke on Trent Wellbeing Service (IAPT), NHSE/I Clinical Lead for IAPT in the West Midlands and the Joint Programme Director for the Post Graduate Diploma in CBT at Staffordshire University.
I don’t know what it’s like to be a PWP because I’ve never been one. I do, however, have the privilege of leading a team of currently around 200 staff with 40 amazing PWPs and Senior PWPs as part of our IAPT service in South Staffordshire. I have always strongly believed that if step 2 is not working well, your whole service will have problems. PWPs are among the most organised, efficient, team playing and innovative people in our workforce and I am delighted to have the opportunity to write this post as a Clinical Lead within IAPT, and share some of the ways we try to ensure our PWPs have the support, the resources and the freedom to do their job in the best way they can. I am by no means claiming to be an expert and I know that there are still areas we can make improvements in. There are also times when we get it wrong and when that happens, we do our best to listen and try to do better next time.
I hope that there are some ideas here for you as leaders, supervisors, managers and mentors in your own service that you can use, adapt or make your own and I’d love to hear about what you are doing to help your PWPs to thrive.
In recent months, I have been asked to deliver several training sessions around compassionate leadership. I’ve found this diagram very helpful in explaining how I see it (based on Northouse, 2013):
How do teams work best? When they communicate well, when they are connected, when shared goals are clear, when leadership is consistent and when everyone has compassion for each other. We all know that, working in IAPT, we have to work harder than many services to maintain these things at times. It can be easy to fire off an email on a particularly busy day, when a conversation would be gentler or less ambiguous. We can fall into the trap of assuming everyone knows the team targets when new staff may never have come across local directives before. Remote working can lead to us working in isolated ways and we have to work harder than ever to keep people talking and connected – and ready for the day that we can return to working as teams in the same buildings again. (I for one can’t wait for the proper return of the kitchen conversation and team lunches!) All of these factors indicate that services need leaders who can hold the team – and all of the individuals in it – in mind and balance service delivery with compassion and clarity.
I’ve been thinking about the key aspects of compassionate leadership in action in relation to supporting our PWPs to thrive and the three themes I kept returning to were wellbeing, development and teamwork.
This is the big one. PWPs work supremely hard and always go above and beyond for their patients and their colleagues. What tends to get left out is themselves as they juggle competing demands and try to fit everything into an already full diary.
Pro tip for leaders – just because your PWPs can do it doesn’t mean you should ask them to – or that they are finding it easy.
Yes part of our job is to ensure the service runs efficiently but there is nothing efficient about a struggling and burnt out workforce. Sometimes our job is to notice when PWPs are doing too much and slow them down. Sometimes we need to ask staff if they are OK, twice to make sure, and really listen to the response. Sometimes our job is to push back and say that no we can’t take on that new prevalence target with current staffing as it is, as step 2 are already working at capacity. We need to protect our staff as our most vital asset. We need to provide opportunities for regular team wellbeing sessions, step 2 peer discussions and learning alongside supervision and meetings. We must keep working hard to create an environment of psychological safety where people know that it is OK to say they need help or have made a mistake – including noticing and owning our own mistakes as leaders.
Clinically, very often PWPs are frontline as they tend to carry out more assessments than other staff in IAPT. Facilitating that first clinical contact with a new patient is hard – it needs high levels of interpersonal skill to contain their anxiety, ensure the correct information is gained in a set time and most of all, instil hope and trust. There needs to be a limit to the number of assessments staff are asked to complete and an offer of time to go through assessments in supervision – not just to make decisions re next steps but to debrief if they have heard a particularly difficult story. Vicarious trauma is real and staff need to feel supported in managing this.
Possibly most importantly of all, we need to notice what people are doing, and say thank you and well done. We’ve recently introduced a quarterly Celebration meeting where we come together to notice the good things. Everyone is invited to mention something they have done well or have noticed someone else doing or achieving. It’s a very affirming meeting to attend and really boosts team morale. As the saying goes, you can’t pour from an empty cup.
PWPs are specialists in their field. I know I couldn’t do their job and I admire them greatly for what they do. I can only imagine how frustrating it would be if you qualified as a PWP and there were no development opportunities available to you beyond that. This may in part be fuelling the number of people leaving the profession to train in other fields in order to develop and progress. Leaders need to know their staff in order to know their strengths and help people develop them as there are so many options available:
- Some people are great champions and advocates for different groups of our local community
- Some make excellent supervisors and buddies/mentors for new colleagues and trainees.
- The Long Term Conditions top up training has added another branch to clinical delivery.
- Good teams will be regularly evaluating and developing their service offer and PWPs are, in my experience, great at this due to their attention to detail and clear written communication.
- PWPs with aspirations of becoming Senior PWPs need to be nurtured and offered opportunities to support leadership and management roles so there is a smooth transition for them when the time is right.
- Learning is key and we have set up a bi-annual PWP Forum within the service where step 2 staff get together focussing on clinical and delivery issues, with the agenda set and led by them. Sometimes I will be invited and sometimes not. I know that I do not need to be there for the ideas and discussions to flow and I know that I will hear all about it afterwards as we plan for the next steps together.
- Senior PWPs also need to develop and we encourage them to attend CPD and Trust and regional level meetings to share learning and innovation and to take on service wide responsibilities when they are ready.
- PWPs are innovators – ask them how things could be better, better still, ask them to design a solution. Service development is for everyone in the team and the best people to look at alternatives are the ones working within the system every day.
We all need to feel we are valued and achieving something when we go to work and if PWPs feel stagnant in their role it is not surprising that they start to look elsewhere for those opportunities. Sometimes I hear of people who are assigned additional roles with no time to do them in and that can simply lead to resentment. Leaders need to create the right environment and space for PWPs to succeed in what they are doing and based on my experience, PWPs will always deliver more than I expected!
Our people are our biggest asset and we work better together. There are obviously lines of supervision and reporting within services but when it comes to ideas and improvements, there should be no hierarchy and everyone’s view is as valid as another’s within the team. Clinically, I work by the rule that when people are training, I don’t assume they know things until they have told me they understand. When they are qualified, I assume they know things unless they tell me otherwise – this to me is basic respect from one clinician to another. When things don’t go to plan or someone makes a mistake, I tend to believe that staff have done what they have done with good intentions unless there is evidence to the contrary. We do a difficult job and we need to trust each other as a team in the tricky moments as well as the celebratory ones. I would love to see BABCP reintroduce an accreditation process for PWPs to enable them to feel valued as a profession in their own right
Diversity within our workforce is key to providing the best services we can. I am watching with baited breath the developments around the apprenticeship scheme as I think this will support people who currently cannot access the training route to join the workforce. As leaders, when we recruit we must hold in mind the goal of a truly diverse workforce that represents the entire community we work in. If we do what we have always done we will get what we have always got – and that’s not always been a good thing. We need to open our eyes to the value difference and diversity brings and celebrate it.
Connection in the time of coronavirus is undoubtedly a challenge but there will come a time when services are restored and we need to learn to be teams together in the office again. Communicating clearly and carefully via email, MS Teams or phone is such an important part of this as without the non-verbal communication we would have if we were together in the office, messages can get misunderstood. Making every effort we can to keep people connected and ‘together’ now will make that process easier next year and I am so proud of how our step 2 colleagues have continued to work together and support each other during this period – they are, after all, the experts in working via phone and video consultation.
I make no apology that this blog is focussed on the positives and the potential of working at step 2. This year has been so so difficult for all of us in different ways and I am sure we have all felt exhausted, overwhelmed and isolated at times in ways we may never have felt before. I am not ignoring the challenges or the criticisms of IAPT which are rightly raised in other forums and blogs in this series and these issues of course need to be addressed fully and thoughtfully. I am also not saying that our service has everything right as I know there are still areas we can work on to improve things further. For this blog, I wanted to write a piece that someone thinking of becoming a PWP might read and think ‘you know that sounds like an amazing career, I’d like to do that!’ There are so many good things happening at step 2 in IAPT and that is down to the people who work here – as I keep saying, our greatest asset.
I’d like to end with a personal story. Over twenty years ago, when I was starting out in my career in mental health, I was having a tough time at work. Just when it felt like it couldn’t get any worse, my head of department asked to meet with me. I never even saw him as a rule. I was beside myself with worry. He called me in, made me coffee and said ‘This work is hard. The trick is to see it as a marathon, not a sprint – you must look after yourself. You’re good at this and one day I know you’ll be here in my job or doing something just like it. Let’s make a plan and you tell me what we need to change and what I can do to help you now’. Wow! I felt seen and supported by someone I didn’t even realise knew my name and the effect was life changing. That one conversation probably kept me in a profession I was considering leaving and even now, all these years later, it still sustains me on a bad day and gives me hope that by working together, we can always find a way.
But this story is not about me, it is about what we as leaders need to pay forward to our PWPs now. IAPT leaders – please please, be that manager for your step 2 workforce. See them, listen to them, encourage them, thank them and make sure they have what they need – and everything else will follow.