CBRT™– the case for NHS Adoption

Providing 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

A 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 patients’ rehabilitationA positive outlook to aid patients’ wellbeing

Aligning with IAPT Commissioning goalsFeedback from an NHS Commissioner of Psychological Therapies

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.”

NICE Quality Standards ProgrammeQS for Depression in adults

In March 2013, the CBRT Initiative was supported by the Innovation

Promotion Manager of NHS South of England. It was suggested that the

paper “NICE – Quality Standards Programme – Cost impact and

commissioning assessment: quality standard for depression in adults -

March 2011” should be provided as an example of potential cost savings

for the CBRT Initiative as it states on pages 8 and 9 that the total expected

saving per IAPT patient rounded as being £340.00 in a two year period.

http://www.nice.org.uk/media/01D/C3/DepressionQSCostAssessment.pdf

125 staff trained in CBRT would therefore only need to support a

minimum of 264 Patients in Year One (less than one per day)

to recoup the initial investment in the whole CBRT Training Initiative.

(2.11 Patients per trained staff member.)

Supporting more patients would, the NICE

paper suggests, result in a saving to the

organisation as well as enhanced quality

of care and experience for the patient.

The case for adoption – a talking therapy “Grass roots” level patients support

• CBRT helps people with anxiety to learn a

simple technique and how to relax themselves

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“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

reduction) (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.

When CBRT is introduced into 8 NHS

CCGs /Trusts it will very quickly support

patients across the board and within 6 to 8

months, create c.17,000 CBRT NHS case

studies for NHS Evidence from the NHS

staff post-training case studies alone.

CBRT Initiative for NHS Trusts and CCGsTaking 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

CBRT Training is delivered in two daysTraining 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 Now

• 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

Compassion in Care.

• To deliver cash releasing savings.

• To provide independent NHS led

evidence to work towards NICE

approval as a relaxation intervention

and technology.

• 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 & Flexible Intervention

• 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 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 which

affirmations they choose to use each day. This will provide

NHS staff with improved communication and regular

weekly feedback from Patients in a simple format.

Adoption of CBRT – long term conditionsAs 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 does CBRT support NHS staff?CBRT training to strengthen communication skills & team building

• CBRT offers Quality Improvement - made

simple.

• Team building and Engagement to Mobilise.

Nurses, Allied healthcare and Social Care

Teams have the opportunity to train 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.

• CBRT Relaxation Support Sessions could

also be provided to support NHS staff.

• 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...

Sustainable model – NHS ongoing 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 CCGs and Trusts

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.

nationalhealth@colourbreathing.com

Supporting “Compassion In Practice and Innovation Health and Wealth” Updated 05.04.13

CBRT has a key NHS pilot initiative programme ready to

action now and benefit 45,000 NHS patients.