What is the CBT Skills Group program?
The Cognitive Behavioural Therapy (CBT) Skills Group program is an eight-week group medical visit for adult patients (17.5-75 years old) who want to learn practical tools to improve their mental health. The CBT Skills Group program is a transdiagnostic course that integrates basic neuroscience concepts with introductory mindfulness and cognitive behavioural therapy skills and teaching.
It is delivered as an eight-week series of 90-minute group medical visits, with 15 patients per group. Patients learn practical tools to recognize, understand and manage patterns of feeling, thinking and behaving. They learn to be conscious of their choices as they respond to life stressors, and explore options for living a fuller, richer life, more aligned with what they value most.
The group is part of a project that fosters collaboration between family medicine and psychiatry, and enables people to access an intervention covered by MSP. The implementation of CBT Skills Groups has opened up a new accessible, time-efficient alternative for patients with mild-to-moderate depression, anxiety and other mental health concerns.
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What is the cost of the program for patients?
In Victoria, there is an upfront cost of $75 that is required at the time patients register for the program. To encourage their participation and sustain this service, $40 of this $75 is held and returned to patients if they attend 7 or more sessions. If they miss two or more sessions for any reason, the $40 deposit is not returned. The remaining $35 covers the cost of the workbook. If patients already own a workbook, they can request a coupon to forego this fee. If the initial $75 cost is a financial hardship for the patient, they can contact the administrator.
The group sessions are covered by MSP and billed as a Group Medical Visit (Psychiatrists: insert code; Family physicians: insert code) so there is no direct cost to the patient.
What are the evaluation results of the CBT Skills Group Program?
In an evaluation of the Victoria program, 63% of those enrolled in the program, completed it (i.e. attended 6/8 sessions) (n=1848). Those who completed the program reported 94% satisfaction, and nearly all participants would recommend the program to others. Self-efficacy was markedly improved, with 93% of completers reporting confidence in their ability to manage their mental health symptoms. Quantitative measurements of symptom severity showed statistically and clinically significant improvements, with large to very large effect sizes for completers. Referring family physicians ranked the value of the program at 4.7/5, indicating that the program had a positive impact on their patients’ mental health, increased access to mental health care, and somewhat reduced the need to refer to specialist services. Providers of the groups, both psychiatrists and family physicians, reported high levels of satisfaction and acceptability.
Referring to the program
How do I refer to the program?
All referrals require a recent PHQ9 score and a completed referral form.
When submitting the referral form please ensure you have filled out all portions including: the patient’s email address, identified the MRP or indicated that you are the MRP, the PHQ9 score, and diagnostic code.
To refer to the program in your area please contact your local Division of Family Practice and find your local referral fax number for the form.
How can the CBT Skills Group Program meet patient demand for the service?
Offering group medical visits as a centralized service allows for a small number of facilitators to meet the high patient demand for the service. In Victoria, 12 facilitators offer approximately 25 daytime and evening groups for patients to choose from at any given time, ensuring timely access. The majority of patients get into a group between 2-4 months of their referral.
Becoming a facilitator
Who are the CBT Skills Group facilitators and how are they trained?
The CBT Skills Group facilitators are local psychiatrists and family physicians who have been trained to offer the groups in a group medical visit setting. One or more experienced psychiatrists train local family physicians who are interested to offer this service to their community. There are four phases of the training: (1) the family physician participates in a group facilitated by a psychiatrist; (2) the family physician co-facilitates a group in a minor role with a psychiatrist; (3) the family physician co-facilitates a group in a major role with a psychiatrist; and (4) the family physician solo-facilitates five groups with patient outcome data and feedback analyzed.
This training program was designed for family physicians. We are currently exploring training options for mental health professionals (e.g., counsellors, social workers).
What are the evaluation results of the CBT Skills Group Program?
Training currently involves participation at various levels, with supervision provided by a psychiatrist. Depending on your level of interest and future plans, the following provides an approximation of the time you can expect to dedicate:
- Phase I (observer-participant) – 1 series of eight 90-120 minute weekly group sessions with minimal preparation required
- Phase II (co-facilitation minor) – 1 or more series of eight 90-120 minute weekly group sessions; some pre-group preparation required, depending on your background knowledge and skills, pre-group preparation may take 1-3 hours a week
- Phase III (co-facilitation major) – 1 or more series of eight 90-120 minute weekly group sessions; depending on your background knowledge and skills, pre-group preparation may take 1-5 hours a week
- Phase IV (solo-facilitation) – 5 series of eight 90-120 minute weekly group sessions;
- 8-10 hours per week for preparation for the first two solo groups
- 1 hour per week for preparation for remaining and subsequent groups
What are the options for delivering the CBT Skills Group Program?
Once trained, facilitators can offer the service using three delivery models (1) provide the program to their own patient panel, (2) partner with other family physicians in a group practice and offer the program to their patients, or (3) partner with other trained facilitators and establish a centralized referral centre to offer the groups to the entire community. The delivery model is dependent on the trained physicians and their current practices, and the size and geography of the community.
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