A total of 517 surveys were returned, of which 509 comprised the final analysis data. Just over half respondees (257) were members of ACAMH, 181 (36%) members of BABCP and 155 (31%) belonged to the BPS Child Faculty. Most were members of one organisation (43%), 27% were members of two, 20% members of three or more, with 10% being members of none. Clinical psychologists were the largest professional group (192, 38%), followed by child and adolescent psychiatrists (160, 32%) and nurses (55, 11%); an educational background was identified by 33 (6%) and social work by 25 (5%), with the remaining 8% (38) being counsellors, occupational therapists, child psychotherapists, paediatricians, family therapists etc
Conclusion
This survey supports the widely held belief that the availability of specialist child focused CBT is limited. CBT would appear to be neither the dominant nor preferred therapeutic approach of 40% of those who completed this survey. Whilst child focused CBT is practiced across the UK it is limited and was the dominant approach (i.e. used in over 60% of caseload) of only 20% of respondents. This would be the most optimistic estimate since there is a suggestion that proportionately more expert practicing CBT clinicians have responded to this survey.
Clinical Psychologists were the professional group most likely to use CBT as their dominant approach. They were more likely to have acquired CBT through their basic and specialist training and to rate their expertise more highly than other professional groups.
Of those who use CBT, one third have undertaken specialist post-graduate training and 58% of those who used this as their dominant approach have a named or identified supervisor. The availability of specialist supervision is however limited. The majority of supervision is provided by comparatively few people and there is currently little spare capacity to increase the availability of supervision.
Two thirds of those surveyed identified training needs in child focused CBT. These predominantly related to training in the basic skills of CBT (Socratic questioning, identifying and working with cognitions, and case formulations) and in treating the disorders that NICE have recently reviewed and recommended the use of CBT.
Recommendations
The following recommendations are therefore being proposed:
Proposed Way Forward
The results of the survey have been discussed with the Department of Health and have been fed back to the professional groups and organisations involved. There are of course significant implications for training of CAMH staff groups which will need to be addressed on a national level by workforce development and training commissioners. For our part, ACAMH is planning a series of Master Classes, some of which will focus upon the development of CBT skills for specific disorders. ACAMH is also collaborating with BABCP in orgainsisng a two day conference on CBT in Oxford in March 2007. In addition, BABCP are considering whether they are able to facilitate the development of specialist CBT supervision.