CBRT™– a case for NHS AdoptionProviding patients with structured relaxation support sessions

CBRT is a new innovation in mental healthcareNHS Change and transformation

CBRT (Colour Breathing Relaxation Technique) is a UK innovation which provides all users with a simple, yet very effective, mind - body awareness technique through structured and guided relaxation support sessions.

“Colour Breathing Relaxation Therapy is a vital tool that we use within our community to enable relaxation and stress management techniques, which focuses and calms the mind” Aidan Hamilton – CALM Programme Coordinator

The missing piece of the puzzle

• CBRT provides the NHS with a Value for Money, practical and unique system for physical health, mental health and wellbeing.

• CBRT provides a ‘safe care’ and ‘right care’ solution to the ever growing requirement for increased capacity within integrated care for patients with anxiety, mild to medium depression and long term conditions. This need was highlighted in the report, “How Mental Illness Loses Out in the NHS”, produced by a distinguished team of economists, psychologists, doctors and NHS managers convened by Professor Lord Layard of the LSE Centre for Economic Performance.

• CBRT can contribute to productive patient care and strengthen staff and patient communication skills; CBRT is empowering.

• CBRT is a high quality yet low cost product • A relaxation technique and therapeutic intervention - CBRT is a safe product. It is a CE

Class 1 Medical Device and is made of printed matter. • CBRT is a motivational, inclusive, non-pharmaceutical, non-invasive, non-denominational

and non-tactile intervention, for all ages and abilities..

Relaxation supports rehabilitationA positive outlook supports patients’ wellbeing

Aligns with IAPT Commissioning goals

An NHS Commissioner of Psychological Therapies has written the following about the CBRT™ NHS Training Initiative:

“The principles of building confidence and socialisation are good, as commissioners we understand how important this is for a patient’s recovery.”

“The proposal is very good and well presented, with a good evidence base and clinical outcomes.”

“On paper, the savings are good, a reduction in primary care presentations, and this is similar to IAPT where we also know there are reductions in referrals to secondary care.”

The case for adoption – a talking therapy Patients support at “Grass Roots” Level

• CBRT helps people with anxiety to learn how to relax naturally.

• The benefits of individual and group therapy are combined with a visually appealing and easy to learn Mindfulness technique.

• Patients receiving individual CBRT sessions are encouraged to talk about “how the colours make them feel” using the CBRT Initial Response Sheets© prior to receiving their relaxation session - this is a popular activity.

• CBRT can provide Patients with a structured relaxation intervention whilst waiting to join the IAPT Programme.

• CBRT sessions can be provided by staff from many disciplines including nursing, allied healthcare and social care, across primary and secondary care, occupational therapy, physiotherapy and in many clinics including obesity, insomnia, hypertension, substance misuse issues, smoking cessation, PTSD, trauma, bereavement, maternity.

CBRT Intervention Evidence Base “CBRT is an intelligent amalgamation of Evidence Based Interventions”

Here are the key components of CBRT and number of independent studies currently with NHS Evidence:

• Mind-Body Relaxation Technique (74)• breathing techniques (1,888)• Mindfulness approach (375)• positive thinking (7,383)• self-help and guided self-help (2,935)• MBSR (Mindfulness –based stress redu

ction) (24)

• Mind-body interventions (5,418)• creative visualisation (60)• Meditation (565)• group therapy (46,805)• Anxiety breathing techniques (971)

Interventions embraced with CBRT already with NICE approval include:• CBT • Guided relaxation• Mindfulness based stress reduction.

If CBRT was introduced with 8 NHS Trusts and CCGs it would very quickly - within 6 to 8 months - create c.17,000 independent case studies for NHS Evidence from the NHS staff post-training case studies.

CBRT Initiative for NHS Trusts and CCGs Taking the lead in Patient Care and Innovation

From 1st April 2013, CBRT will focus on working initially with 8 NHS Trusts and CCGs:• To train 28 staff per Trust/CCG (224 in total) • To “Train the Trainer” (40 in total) • Each NHS Trainer to train a further 20 staff (800 in total) • Evaluate Post Training assessment papers and case studies from each individual

NHS Trust and CCG group and provide these as case studies for NHS Evidence.• Work with partners to create an NHS quality database for Assessment Paper(s)

feedback; Case Studies Feedback; Patients/Users feedback.• Work with the RCN Accreditation Unit to complete the RCN CPD accreditation

process and similar process with COT (The College of Occupational Therapists.) • See contact details on last side if interested in being in this initial cohort

How CBRT Training is delivered in two days Training and Evaluation

Before training:

Learner skills and knowledge is assessed

During training: Short tests are conducted at regular intervals during activities and learning including:

CBRT “Initial response sheets”

Listening Exercise

Working as a group and in pairs

Techniques of evaluation used include:Observation

Questionnaires

Listening skills

Validating learning

Post Training Programme Paperwork:

40 question Assessment paper

10 case studies (2 groups of 5 users - twice, 2 individuals – twice.)

Evaluating feedback - After training:Learner provides course feedback.

CBRT provides course assessment feedback to the learner.

Actual outcomes - see slides 24 – 28 examples.

Follow up:

- Transfer of learning to the workplace

- Patient feedback

- Results and impact on organisation

- Return of investment study

- CBRT intend to provide NHS Trainers with ½ day refresher training every 12 – 18 months.

NHS Trust – a strong case for adoption – QiPPMeeting challenges whilst serving a need

• The purpose of CBRT is to improve quality, and safety and provide value for money in the NHS through the provision of structured and guided relaxation support sessions for patients.

• Designed to support NHS savings targets.• An “invest to save” programme.• An Innovation that supports mental health

and wellbeing - national NHS priorities.• Enhances both Productivity and Prevention• Helps address the demand for anti-

depressants which is growing annually.

• CBRT can be used in conjunction with programmes associated with reducing the use of antipsychotic drugs particularly with dementia sufferers.

• Person centred care is provided though guided group support sessions.

• CBRT is a very flexible relaxation intervention - so is not “just about group therapy” - it can easily be used as a “one off” intervention for the anxious ward patient for example.

• > 12,000 patients in a single Trust could benefit each year, including a reduction in primary care referrals and secondary care.

• CBRT is a unique innovation and system.

• Commissioners may note that Regulation 5 provides for commissioners to award a new contract without a competition where there is only one capable provider.

5 Case Model – Improving Patient Care

• The Strategic Case - CBRT provides a response to ‘Francis’ empowering patients and staff. As an IAPT technique evidence would suggest it can reduce prescribing and dependency on other services. It is a quality health improvement and modernisation programme through training staff. It addresses the call for ‘Compassion in Practice’ 6C’s.

• The Economic Case – CBRT optimises Value for Money –A ‘compelling case’ for innovation supporting mental health as an NHS priority. The Health and Care Act highlights the importance of integration and a mind and body approach to care

• The Commercial Case – CBRT requires a modest initial investment and is commercially viable. In May 2012, CBRT scored 92.53% with the NHS National Innovation Technology Scorecard process. As a non-referral baseline activity, help to reduce unnecessary admissions and length of stay targets. Pre-admission clinics and prevention strategy.

• The Financial Case – Improve your local public services and integrated self care programmes. CBRT is financially affordable and provides a demonstrable improvement in care and a demonstrable return on investment

• The Management Case – CBRT is all inclusive and can be taught to and delivered by all nursing and allied healthcare staff.

“I have no idea why healthcare providers do not offer relaxation

classes to Patients suffering from long term conditions. Following an

accident, I now live with chronic pain syndrome and bouts of depression...

I am not surprised so many people suffer with depression. Group

contact and regular support is far more important than a packet of

tablets.”

Mrs P. NHS Patient, South of England

The case for adoption – Staff Skills,CPD Training

• The CBRT programme provides staff with skills transferable to many different clinical scenarios.

• It offers a Team building opportunity.• Smaller CCGs can be provided the two day

CBRT Training Programme for 12 - 20 staff .• CBRT provides Performance Measured

Training (PMT) . Upon completion of two day training programme, staff are required to complete an online 40 question Assessment paper and 10 templates for their CBRT user case studies – (3 groups of five people twice and two individuals twice.)

• Upon successful completion and marking of papers, staff receive assessment grade and a certificate is issued (within 8 -10 weeks of training.* Staff are then allowed to provide CBRT Relaxation Support Sessions to patients. (*Based on staff completing paperwork to agreed schedule.)

“Training and education should be an integral part of any proposed service if it is to be of high quality and sustainable.”

NHS Confederation – “Clinical responses to the downturn.”

Measurable outcomes – All CBRT case study templates contain recognised health and wellbeing statements

CBRT as a Service ImprovementHelping your Trust respond to “The Francis Report”

• CBRT provides a unique product, service and results - with measurable outcomes.• Integrated healthcare for “whole patient” and self care pathway. Greater commitment

and ownership Designed for easy large scale change and adoption.• Embedding Equality, Diversity and Inclusion.• The CBRT Initiative is a Project with a Value Stream – to quickly provide professional,

structured, relaxation support sessions for all patients. A robust, quick diffusion model.• CBRT supports NHS staff training and resources appropriately, in the most serious

period of financial constraint ever faced.• Meeting national policies – long term conditions, mental

health, health prevention, innovation, QiPP.• Innovation procurement to meet local strategic needs.• Extends patient choice prior to IAPT Programme.• Designed for easy large scale change and adoption.

CBRT Initiative Goals“Any project worth doing is worth doing fast and right.”

CBRT Initiative Project Goals:

• Improve Quality - Patient experience, mental health and wellbeing provision . Staff make shared time with patients “Make Time to Save Time.”

• Meet RCN and COT CPD Training standards and requirements.

• Reduce waiting times of IAPT interventions, through Innovation and practical application of this new technology.

• Reduce Total Costs – examples include: Group relaxation support provision, Length of stay – reducing length of stay.

• Improves patient choice and experience. Learn how to relax before starting a medication pathway. A tool kit to help reduce boredom on the ward.

• NHS Staff and Trainers to complete training paperwork to agreed time

Long term goals:

• To contribute to improving Patient experience through innovation led Compassionate Care.

• To deliver cash releasing savings• To provide independent NHS led

evidence to work towards NICE approval as a relaxation intervention.

• The NHS Change model includes need for “Rigorous Delivery.”

• Each member of staff trained will aim to support 10 patients per week.

• NHS Staff and Trainers to complete training paperwork to agreed time.

• NHS Trainers to attend a ½ day CBRT “Refresher” Training programme every 2 years.

CBRT Technique - a Safe and Flexible Approach

• Individual and groups of patients - of all ages and abilities, including children. • Correct breathing pattern. Mindfulness, focus, concentration, positive thinking .• Guided group relaxation sessions found to be supportive; individual or groups of up to 20

patients• Focused breathing on one colour also effective - in just 5 – 10 mins.• Once a Patient has learnt how to use CBRT it can be self-delivered – a form of self-

therapy.• Most effective sessions last between 30 – 50 mins. A practical, visual tool – easy to use.• Patients participation in relaxation process empowers them as individuals.• Patients select their own Affirmation Cards for focus – able to express “how they feel.”• “CBRT Initial Response Sheets©” - form of ‘talking therapy’ - used with individual patients.

Responding to Our Patients’ NeedsHelping your Trust respond to “The Francis Report”

Compassion in Practice and the 6 C’s :• Care quality/safety• Compassion• Commitment• Communication - understanding• Courage – change, adopting innovations• Competency

Patients also need: • To have a vehicle to express their

thoughts and needs• To feel they are being heard• Feel respected• Experience calm• Learn relaxation skills• Positive thinking• Develop self – care tendencies• Feel involved and cared for• Interconnection.

An easy to use, ongoing self-care programme

• CBRT provides Patients with a non-pharmaceutical intervention choice. • Patients are able to continue self directed Colour Breathing Technique everyday as the

CBRT Kit is safe and suitable for home use.• CBRT encourages patients to become proactive in self-care.• Each CBRT Kit comprises: full colour book, set of seven

Colour Breathing Disks easel set, Audio CD. • The new 2013 “Daily Observations Diary” will enable

users to record their feelings and moods and whichaffirmations they choose to use each day. This will provideNHS staff with improved communication and regular weekly feedback from Patients in a simple format.

Adoption of CBRT As part of Patients’ Care Pathways CBRT may deliver many benefits

• Relaxation awareness• Mindfulness, focus • Inner calm • Breathing improvement, awareness • Positive thinking • Group support • Quality time with nursing staff • Self-help in action • Group participation

As part of a whole pathway holistic approach CBRT can contribute to:• Cardiac and stroke prevention• Respiratory Smoking cessation • Long term conditions support • Mild – medium depression • Anxiety, Insomnia toolkit • Mild dementia , easy to use technique• Antenatal, Postnatal skills • Rehabilitation pathway tool • Medication reduction support

The Colour Breathing book is very easy to read and printed in full colour

How will CBRT help our staff?CBRT includes staff training in communication skills

• CBRT offers Quality improvement made simple.

• Team building and Engagement to mobilise. Nurses, Allied healthcare and Social Care Teams have the opportunity of training together, attending a two day CBRT Training Programme.

• Through interaction and learning how to use CBRT with both individuals and groups of patients, staff enhance their natural communication skills of listening, focus, timing, patience and awareness.

• Staff may feel more valued by management when given the opportunity to undertake additional training.

• Structured CBRT Relaxation Support Sessions – whether patients experience this as a ‘once-only experience’ or in a series of 8 – 10 sessions, provides time and space for positive, uplifting, calming dialogue between staff and patients, contributing to overall staff and patients’ wellbeing.

• CBRT is a vehicle for engaging with Patients with Care and Compassion.

• In the community, clinics, wards, rest rooms...CBRT is a flexible tool and efficient way to deliver a relaxation intervention in a group setting.

CBRT™ Relaxation Support Sessions are a productive model and an efficient way of

delivering group therapy. An established method, CBRT requires :

• A trained member of staff.

• 20 – 45 minutes of uninterrupted time.

• A suitable, well ventilated room.

• Comfortable seating, with table space, if possible.

• Colour Breathing Disks – 1 set per user.

• Colour Breathing Affirmation Cards – 1 set per group.

• Initial Response Sheets (Individual use only)

How CBRT is delivered...

Sustainability for ongoing NHS cost savings

Each Initiative comprises of Two days CBRT Training Programme for 28 staff + two days "Train the Trainer” for 5 staff + 100 Training Kits.

• The Training Initiative provides ongoing sustainability to every NHS Trust and CCG, allowing greater flexibility with local training provision.

• Stage 1 is an initial two day CBRT Training Programme for 28 nursing, allied healthcare and social care staff.

• 8 weeks later a two day “Train the Trainer” regional Training Programme is provided for 5 members of staff.

• Stage 2, The NHS Trust is now self-sufficient and receive their allocation of 100 CBRT Training Programme Kits and additional Colour Breathing Disk sets. Future Training Programme Kits will be available to purchase in sets of twenty as required.

Users feedback of “CALM Programme”

Participants of the CALM Programme were asked about their experience of CBRT training: their responses included:

• Meeting new people that they can learn from, both other participants and the trainer;

• Learning new skills that they can apply and building self-confidence;

• A positive environment to come to and bring them out of their shell where they need to;

• Promoting positive mental health and reducing suicide;

• The way it has been delivered and the interaction between the group;

• The CBRT is a valuable resource they now have available to them.

“Colour Breathing Relaxation Therapy is a vital tool that we use within our community to enable relaxation and stress management techniques, which focuses and calms the mind” Aidan Hamilton – CALM Programme Coordinator

The next 5 slides demonstrate actual feedback received from 85 CBRT Users

who received CBRT sessions from 5 newly trained practitioners

85 Users - Overall improvement after 2 CBRT sessionsQuestions - Physical health & Mental Health

85 Users - Overall improvement after 2 CBRT sessions Questions : enjoyment of life and optimism

85 Users - Overall improvement after 2 CBRT sessions Questions : feeling useful and feeling relaxed

85 Users - Overall improvement after 2 CBRT sessions Questions: dealing with problems, thinking clearly

85 Users - Overall improvement after 2 CBRT sessions Questions: Feeling close to other people, able to make up own mind

CBRT creating a flexible solutionFor NHS Trusts & CCGs

CBRT NHS bespoke versions

All products are printed in full colour and to a high quality.

As CBRT is also an independent publishing house, there is great flexibility and capacity to create bespoke localised versions of all CBRT products for NHS Trusts and CCGs as requested. E.g. The CBRT Book Kit can be produced to include up to 10 pages of relevant NHS Trust /CCG local information in full colour for their patients, with the minimum print run being only 3,000 units per product. CBRT can also create CBRT products and information leaflets: • In different language editions* : • Braille• Larger font• All formats - special needs.

CBRT future products

• CBRT are to create additional sets of boxed Affirmation Cards to provide positive thoughts and a low cost solution to further support and address specific conditions and life such as:

• Hypertension, Anxiety, Stress, Insomnia

• Mild to medium depression• Long term conditions• Obesity, healthy weight• Substance misuse conditions• Bereavement, Dementia.

Work with us! CBRT is affordable for all budgets. The CBRT NHS Training Initiative for Trusts and larger CCGs (125 staff & 5 Trainers) is payable in three stages across a period of three months. Deposit on booking £5,000, Phase 1 £18,826, Phase 2 £23,009 (+ VAT) and/or

Local training programme for 12-28 staff @ £600 each + National Trainer travel costs, accommodation allowance + VAT. Supporting “Innovation Health and Wealth” nationalhealth@colourbreathing.com