AbilitiCBT: free and confidential virtual therapy for Manitobans
Talk Tuesday - July 21, 2020

Presenters

Nigel Branker
Executive Vice President, Morneau Shepell and President, Health and Productivity Solutions

Nigel Branker is Executive Vice President, Morneau Shepell and President, Health and Productivity Solutions. In his role, he leads the teams responsible for providing absence and disability management services, and for delivering Morneau Shepell’s internet-based cognitive behavioral therapy solution, AbilitiCBT. Nigel has helped shape Morneau Shepell’s approach to workplace productivity with his strong focus on employee experience and measurable health outcomes. Nigel also leads the firm’s efforts to help clients identify and implement solutions to address mental health in the workplace, with a focus on providing people with the right tools and supports for varying levels of needs.   

Linda Naranjit
Clinical Director with Health & Productivity Solutions at Morneau Shepell

Linda Naranjit is the Clinical Director with Health & Productivity Solutions at Morneau Shepell. Linda is responsible for the clinical quality and oversight of clinicians that deliver AbilitiCBT.

 

 

 

 

 

 

 

Summary

Nigel shared some background about the AbilitiCBT program including the prompt to develop it – 50% of time off in Canada is as a result of a mental health issue, mostly anxiety and depression. He spoke of its evolution to support people before their symptoms are a barrier to remaining in the workplace. 

Linda provided an overview of Cognitive Behavioural Therapy describing its focus, interventions and outcomes and outlined how it’s delivered on their virtual platform. AbilitiCBT is a therapist-assisted CBT program that uses digital education, videos and assignments with oversight by a therapist to support users as they work through the program. People using AbilitiCBT have access to a 24/7/365 crisis line as well as local resources. The content in AbilitiCBT is tailored to address anxiety symptoms related to the uniquely challenging aspects of pandemics though the insight and skills are widely applicable. 

The program starts with a clinically validated online questionnaire and consultation with a professional therapist by phone or video. Users work through 10 modules at their own pace (usually over about a week) while a therapist tracks and monitors their progress with regularly scheduled check ins along the way either by phone, video or chat. The program wraps up with a relapse prevention plan that brings all the learning done together as a reference acknowledging that falling back onto old patterns is a possibility. 

In the first two and a half months of the program 2500 Manitobans have accessed it.

 

Question and answer

1. What kind of homework do people get in AbilitiCBT?

There is homework associated with each in person CBT session or each module of AbilitiCBT. The idea is for the client to use the skills they have learned and practice them. Some examples include encouraging a client to do a mood log and rate how they're feeling, noticing and logging examples of black and white thinking or avoidance behaviours. The volume of resources and homework is one of the reasons why having the therapist is so important, they help people focus on or choose resources and practices that will be most relevant to their situation, symptoms, experiences, etc.

2. How does the program acknowledge the cultural diversity of pour province, particularly Indigenous culture?

The content is developed very broadly and we’re always in the process of making it more culturally sensitive. It really is our clinicians who bring the sensitivity to the material and to the work. One way they do this is by asking clients directly about their cultural background. Another way is trying to match and give clients the option to find a therapist who is a good fit - if the clinician they’re matched up with initially isn’t a good fit we can move to someone else.

3. Can people access AbilitiCBT from a desktop?

Yes

4. If an individual has been seeing a counsellor trained in CBT before the pandemic, how will transferring to an online program impact them? Is there a way to make sure there is continuity of care so the overall care and support does not decline?

  • AbilitiCBT is just taking new referrals, not taking over existing relationships. If someone had engaged with CBT in the past and wanted to try again or have a refresher using AbilitiCBT they certainly could. The therapist assigned to them would ask about their history, if they are connected to another clinician right now or in the past.
  • The goal is not to replace existing support, AbilitiCBT has a lot of content and exercises on their platform so if someone is familiar with CBT and isn’t interested in connecting regularly with a therapist after that initial conversation, they could access all of the content and then connect with support as or if needed rather than on a schedule.

5. Once a person works through 10 modules and is done, do you ask if they want records shared with their primary care provider or care team?

No, though clients can always request a copy of their file to share with whoever they want.

6. Can the program be used proactively to develop positive thinking skills or is the focus on those experiencing difficulty?

The program can definitely be used proactively. The intent is to help everyone and everyone has anxiety in some way or at one time or another. Building up these skills and this resilience isn’t something most of us were taught in school. This isn’t for someone who is experiencing severe anxiety and might need both immediate and long term counselling but for those on the lower end of the anxiety spectrum there is no reason not to support and refer proactively.

7. What if a person is homeless and cannot afford a smartphone, is there a way to call in?

Currently telephone counselling isn’t an option with AbilitiCBT though it is part of the long term-plan.

8. How secure is the information that is transferred back and forth between client and therapist?

Morneau Shepell is held to a high standard in terms of data security, data is encrypted during transmission and when stored, there is a regular audit process, and the program had to pass the security standards to provide service to members of the RCMP. There is a handout outlining data security they send to clients who request that information.

9. How did you communicate the availability of AbilitiCBT? Where are people from who access the service?

  • Promotion of AbilitiCBT was driven by the province though we’ve attended as many of these webinars as possible to get the word out. The province is working on a phase two awareness campaign anticipating a surge of cases and of symptoms of anxiety in the fall. The partnership is for 12 months acknowledging that trauma impacts last long after the event is over.
  • Not sure how granular the data is in terms of geography and can’t speak to it right now unfortunately.

10. What is the age breakdown of people accessing AbilitiCBT?

About 7% of users have been over 60 years of age with the vast majority falling into the 30-50 age range, about 78% of users have been female.

11. Is there a spiritual component? I think incorporating gratitude would be very positive.

  • Yes, as part of a mindfulness module partway through the program, once people have learned a lot about CBT Tools there is a gratitude journal they can engage in and it’s one of the modules with the most positive feedback. The AbilitiCBT team is particularly proud of that module, everybody worked really hard on it and it really felt like a labour of love.
  • This is a good time to highlight how crucial the role of the therapist is - CBT is structured, you can’t lead with this module even though people love it and find it really useful - if someone isn’t practicing good self-care, if they aren’t sleeping and eating and moving their body...jumping right into gratitude isn’t going to be helpful.
  • Initially the focus is a lot on grounding strategies, building on psycho-education about symptoms before moving onto more difficult pieces. We (the therapist and the client) need to know that the client is going to be okay while they deal with difficult issues/ They need to have addressed coping strategies and stabilization before moving into activation, mindfulness, relapse prevention etc. This program and all CBT is meant to build resilience, not trigger people. They need to be really strong up front before moving forward.
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12. Do you offer this program in any language other than English?

Currently it’s just offered in English and French.

13. If a person starts therapy in Manitoba but moves, is the service portable?

There is a residency confirmation at the beginning of the program but it’s clinically appropriate to complete the program with an individual, even if they’ve moved so yes.

14. How many health care workers use this program?

  • It’s about 15-20% of users who identify as health care workers which is really encouraging especially given it’s a bit higher than expected.
  • We imagine the accessibility helps since they can do it on a smart phone anywhere. There is always a worry about stigma and mental health. People thinking they aren’t in crisis so they should just keep plugging along rather than engaging in preventative or supportive mental health care while things are a bit more manageable.

15. If a therapist becomes concerned about the imminent safety of the client, are they legally obligated to inform the client that emergency services will be called ASAP?

Yes absolutely, we always inform individuals if we have any concerns about safety it is our practice and protocol to do that. We would do an assessment and if the individual isn’t able to engage in safety planning we do connect with local emergency services +/- additional resources. This is in line with clinical regulations and provincial legislation.