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information giving and shared decision-making which is informed by the five parts or five areas model.

      Problem Statement

      To monitor progress with the patient throughout treatment, facilitate LICBT telephone working (Chapter 1) and form the basis of case management supervision (Chapter 9), a brief and succinct written problem statement associated with the presenting problem in the here and now is developed.

      Table 2.5The CBT Handbook

      Three key features of the presenting problem are broken down to form the problem statement that is returned to regularly with the patient throughout the treatment period to monitor change:

       Trigger

       Symptoms

       Impact.

      It is not uncommon for patients to present with several problems and when this arises the LICBT practitioner and patient work collaboratively using a 0–100 scale to identify how severe, distressing or impactful each of the problems is. A collaborative decision is then reached to prioritise the problems and identify the first problem to tackle.

      Goal-Setting

      Agreeing end of treatment SMART goals is an opportunity to reach a collaborative decision regarding what the LICBT single-strand treatment is aiming to achieve.

      Key Point

      SMART goals are:

       Specific

       Measurable

       Achievable

       Realistic

       Timely.

      Using SMART helps to ensure abstract goals (e.g. I want to feel better around people) are operationalised (e.g. Be able to go out with friends twice a week for a minimum of three hours by the end of treatment), and unrealistic goals (e.g. I want to never feel anxious again) are addressed so that they can become achievable.

      Barriers to Goals

      During assessment the practitioner will explore any barriers that may surround engagement with the LICBT intervention adopted. The COM-B model (Chapter 8; Michie et al., 2011) is commonly used by LICBT practitioners to address practical barriers to engagement throughout subsequent sessions (Chapter 6).

      Psychoeducation

      The LICBT practitioner will already have begun psychoeducation with the introduction of the problem formulation model adopted to demonstrate links between symptoms that the patient may not have previously been aware of. Depending on the LICBT intervention adopted, psychoeducation may either be included within the workbook (e.g. Farrand et al., 2019b), or be available as handouts or online resources (www.nhs.uk/conditions).

      The practitioner uses psychoeducation to provide information to help the patient better understand their presenting problems. In addition to conveying factual information about the patient's presenting problem it is generally useful to provide resources such as booklets and handouts that may be readily available in your workplace or signposting to an online resource.

      Treatment Options

      Decision-making informing the treatment options offered will be dependent on the presenting problem, evidence base and the provision of choice (Chapter 4). Typical options are drawn from the single-strand LICBT interventions, intervention format (booklets, computerised CBT, worksheets), support modality (face-to-face, telephone; Chapter 7) and signposting to other services (statutory, community, charitable) which may include employment support advisors. Availability across options may, however, be dictated by the mental health service.

      Ending the Session

      At the end of the assessment session, the LICBT practitioner should employ short capsule summaries to address three main areas to ensure the patient is able to engage with treatment between sessions.

      Clinical Practice

      Areas Addressed

       Session summary: Summarise the session, asking the patient what they will take away from the session and if they have any questions.

       Next steps: Identify what the patient has understood to be undertaken between sessions to form the basis of the following support sessions (Chapter 6).

       Arrange next session: Agree when, where, and the support modality for the following support session where appropriate.

      Prepare information collected around these areas to form the basis of the next case management supervision session (Chapter 9).

      Summary

      This chapter has provided an overview of a typical structure for an LICBT assessment session, highlighting the importance it represents as the first step to successful collaborative working. The assessment session provides an opportunity to build a strong therapeutic relationship while establishing a clear understanding of the patient's presenting difficulties in the here and now. The use of ROMs is key to measuring progress and should be administered during the assessment session to provide a baseline against which to measure progress within subsequent support sessions (Chapter 6). Working collaboratively to develop a problem formulation to capture the patient's presenting difficulties and inform a problem statement and determining SMART goals inform clinical decision-making (Chapter 4) for subsequent LICBT treatment.

      Assessing Your Understanding

      Declarative

      Multiple Choice Questions

      1 Questioning in an assessment should: [Select all that apply](a) Move from open to closed questions(b) Use open questions throughout to gain a broad understanding(c) Use closed questions throughout to clinch lots of detail(d) Move from closed to open questions(e) Should maintain a structure at all times

      2 When is it appropriate to disclose confidential information without the consent of the patient? [Select all that apply](a) If the patient is at risk of harming themselves(b) Never(c) If the patient is at risk of harming others(d) If there are child protection issues(e) When the member of the family enquires about a patient

      3 The only people outside the care team who should be routinely advised of information disclosed by a patient are: [Select all that apply](a) The patient's immediate family(b) The patient's partner(c) A trusted friend of the patient(d) All of the above(e) No-one

      Procedural

      Self-Practice/Self-Reflection

      You are going into an assessment session with Zena. All you know is that she has self-referred for a problem she is experiencing with panic attacks.

       Using the assessment structure, write down at least one question in each section that you might like to ask Zena.

       Reflect how you might feel being asked those questions.

       Revisit your questions and revise them accordingly.

       Reflect on what you learned from this exercise.

      Answers to Assessing Your Understanding questions can be found in the appendix on p. 333.

      Further Reading and Resources

       Bennett-Levy, J., Richards, D.A., Farrand, P., Christensen,

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