Guided Self Help Service (Guidelines)

The aim of the service is to provide a short-term (up to 3 to 4 hours maximum) self help intervention for adults aged 16 years and over, unless still at school, with recent onset mild to moderate psychological difficulties, unless still at school.
The service aims to offer an appointment within four weeks from point of referral.

Who can refer to the GSH Service?
The service will consider referrals from any General Practitioner (GP) in the Highlands and Argyll & Bute, as well as from the Psychology Service, Community Mental Health Teams (CMHT), Health Visitors (via the GP) and Practice Nurses. Only electronic referrals sent via SCi Gateway will be accepted from GP’s, Health Visitors and Practice Nurses. The service does not accept self referrals.

Urgent/priority referrals
The Guided Self Help Service is not a crisis response service and therefore sees clients routinely. If the referrer feels that a person may need immediate attention, they may refer to one of the other local Mental Health services for assessment.

In line with Government policy, we will prioritise referrals for veterans of the Armed Services if the presenting issues are related to their time in the Forces.

Inappropriate referrals
All GSHWs as with all clinical staff working in the Psychological Therapies Service need to adhere to the professional guidelines of the Psychology Therapies Service and NHS Highland. 

Within the Psychology Therapies Service and NHS Highland guidelines Guided Self Help Workers are required to work within the strict remit of the Guided Self Help Service and therefore to only work with people they are trained and resourced to deal with (ie within the bounds of their competence).

As the remit of the Guided Self Help Service is to provide a time-limited focussed intervention for a specific client group there are very clear exclusion criteria to ensure we meet these aims and that staff and clients are protected by not working out with their clinical competencies. Guided Self Help Workers are trained in delivering cognitive behavioural therapy principles using self help materials and they do not hold a professional qualification.

When a referral is deemed inappropriate the service will consider whether the client’s needs may be better met by another service within mental health and will liaise with other mental health services to pass the referral on when deemed appropriate to do so.

The list of service exclusion criteria are outlined below:

• Patients with previous contact with CMHT or Psychiatry (unless referred by the CMHT who determine suitable for GSHS)
• Patients with more than one course of treatment in Psychiatry (unless referred by the CMHT who determine suitable for GSHS)
• Admitting to suicidal ideation / self harm/suicide attempt within last 3 months (unless referred by the CMHT who determine risk level suitable for GSHS)
• When the primary difficulty is sexual abuse or other ongoing  forms of abuse
• Substance, including alcohol, addiction/abuse
• Couples
• Families with social work involvement (unless referred by the CMHT who determine suitable for GSHS)
• Longstanding physical health problems/adjustment to physical health concerns
• People on charges or awaiting court appearances or with a serious forensic criminal record (unless referred by the CMHT who determine suitable for GSHS)

These exclusion criteria are to reduce any potential for more complex referrals than would be appropriate for the GSHS being made.

The GSHS will not be used to test out a person’s motivation to engage in psychological intervention.

Allocation of referrals
When a referral is received into the Guided Self Help Service it will be registered on our IT system and given to the Guided Self Help Worker covering the GP surgery and geographical area. The Guided Self Help Worker will ensure that the referral meets the service criteria and if in doubt will seek further information from the referral agent or client, from old clinical records or other professionals involved, their supervisor or line manager.

Opt-In system
An opt-in system may be employed when a large number of referrals accumulate for one particular area. This may occur as a result of staff sickness, staff absence or due to receiving a larger than normal number of referrals. In this instance clients referred will receive an opt-in letter asking them to contact the department if they wish to be seen. 

If there is no contact from the person within a designated time period, we will assume they no longer require input and they will be discharged from the service and the referral agent will be informed.

Notification of first appointment
When the referral has been accepted the Guided Self Help Worker will then aim to contact the client (through written communication) within two weeks. The service aims to offer clients an appointment within four weeks from referral however this may vary at times of staff shortages, sickness or holidays. An appointment letter confirming the date, time and place for the first appointment will be sent to the referred person and copied to the referral agent and any other relevant professionals involved.

Cancellation/attendance policy
The service has a clear attendance and cancellation policy with the aim of maintaining service efficiency by trying to ensure clients are seen within four weeks from referral and to prevent waiting lists. If clients do not attend their first appointment, (DNA), they will be sent a letter telling them that they have missed an appointment and they will be asked to make contact with the service within two weeks to arrange another if they wish. They are informed that if they do not respond within that timeframe they will be discharged and referred back to the GP.

With regards to cancellation we are aware that clients may have to cancel an appointment due to unforeseen circumstances however if two or more consecutive cancellations are made (given the limited number of sessions offered in this service) it would suggest that they may be having difficulties engaging with the intervention and attendance. An opt-in letter will be sent and the client asked to respond within two weeks. If they do not make contact with the GSHW or the service within that time they will be discharged back to their GP.

First and subsequent appointments
At the first appointment the Guided Self Help Worker will explain the boundaries of confidentiality and will ask the client to read and sign an information sharing consent form. If the client does not wish to sign the consent form and or disagrees with the service’s (Board’s policy) policy regarding information sharing and confidentiality we will be unable to deliver a guided self help intervention as it would not be safe to practice in these circumstances. In addition at the initial appointment Guided Self Help Workers will ask the client to complete the CORE (Clinical Outcome Routine Evaluation) questionnaire which is one of the measures the service (and department) uses to evaluate its effectiveness. The CORE also highlights if there are risk concerns and is used as part of the Guided Self Help screening questions asked at the first appointment to ascertain possible risk. The risk screening questions also help to highlight if the client is appropriate to be seen within the Guided Self Help service or if another service would be more appropriate to meet the client’s needs (ie to assess any highlighted risk further, for longer-term intervention) or if they are not ready to engage in any form of psychological intervention at present.

The Guided Self Help Worker will also complete all demographic information as required for NHS Highland statistical data collection entered into TRAK. The Guided Self Help Worker may also ask the client to complete other questionnaires or rating scales as appropriate to the presenting issues.

If risk concerns are highlighted at the first appointment the Guided Self Help Worker is required to seek supervision with their clinical supervisor, or advice from their Line Manager. The Guided Self Help Worker would then be responsible for communicating any risk concerns to the client’s GP and any other professionals involved in their care and to refer them onto another service to assess their risk further if this is deemed appropriate.

If the client is deemed to be appropriate for the Guided Self Help Service a number of key questions will be asked to establish the reason for referral (to find a focus for sessions) and a very brief history will be gathered.  With this information a collaborative understanding of what has brought the person to the Guided Self Help Service will be reached and possible ways of resolving the problems or reducing their negative effects discussed.

At the final session the client will be asked to complete the CORE again.  These figures will be added to a data set which represents the service’s outcomes.

Clients referred to The Guided Self Help Service can be offered a maximum of 3 or 4 hours however they may not require all of these sessions and therefore the Guided Self Help worker will agree an end point for the intervention.

Communication with referral agents
All Guided Self Help workers adhere to the Psychological Therapies Service and NHS Board’s Code of Conduct with regards to confidentiality. Guided Self Help Workers discuss boundaries of confidentiality and the sharing of information with people at the first appointment. It is normal practice to write to the referral agent. A discharge letter will be sent to the referring agent including the GP if they did not refer the client. This will be sent when the client has completed their final session or when no further sessions will be offered. Other professionals involved in a person’s care may also be copied into these letters.

Within the Guided Self Help Service we offer a time-limited face-to-face self help intervention undertaken in various clinical settings across the region (ie GP surgeries, Health Centres, Hospitals, Community Mental Health Centres,  and within the Psychological Therapies Department). We do not carry out home visits. The GSHS is largely for tier one referrals and offers a short-term self help intervention (up to 3 to 4 hours maximum).

The Guided Self Help Service seeks to offer an evidence-based, self help intervention delivered by Guided Self Help Workers with the relevant training within a welcoming, safe environment in which to address psychological and emotional difficulties.

Management and supervision
Within the Guided Self Help Service there is a clear line management structure. We require every Guided Self Help Worker to:

• Complete outcome measures to monitor effectiveness of the guided self help intervention being delivered.
• Complete activity records which are inputted to our IT system allowing monitoring of referrals and staff’s capacity.
• Complete electronic diaries.
• Participate in audits that are conducted from time-to-time (eg ensuring letters/reports are written timeously, notes are kept up to date and risk concerns are communicated via written letters and distributed as appropriate).
• Attend Departmental meetings every two months; Pan Highland Psychological Therapies Service meetings twice a year, regular CMHT meetings, AMH monthly meetings,  business meetings, CPD events as appropriate.
• Attend a minimum of monthly supervision sessions as arranged and to seek out supervision to discuss risk issues when they arise.
• Keep up-to-date with all mandatory training requirements
• Have an Annual Development Review/appraisal with their Line Manager, and Team Lead as requested and to seek out professional guidance as needed from their Line Manager and/or the Professional Lead for Psychological Therapies Services.

All Guided Self Help Workers are required to attend for clinical and managerial supervision (as outlined above) in line with the Psychological Therapies Service ‘Supervision Policy’.

Continuing professional development
All Guided Self Help staff are advised to undertake continued professional development (CPD) in order to maintain and develop their clinical skills within a self help model. This includes attending Guided Self Help workshops, CPD within the Psychological Therapies Service and the NHS Board, further relevant teaching and training courses. It is also required that staff attend the Adult Mental Health meetings on a regular basis for continuing professional service development and to keep up to date with developments within the Adult Mental Health (AMH) and the wider Psychological Therapies Service. Staff are also advised to continue to take time for reading self help materials, books and journals in order to remain up-to-date with the latest developments and research. Staff will complete Personal Development Plans (PDPs) as part of their Annual Development Review/Appraisal which is conducted with their Line Manager and Team Lead.

Research/audits
From time-to-time, staff may be required to become involved in a service audit to examine the effectiveness of the service. All audits adhere to Health Board, national and professional codes of ethics.  We seek to ensure that all research and audits adhere to the Health Board’s research governance policies and professional codes of ethics.

• Patient information: Guideline self help service