LETC Upskilling Project:
Development of the ‘Psychological Practice Skills
for Secondary Care Mental Health Staff’ Models
Dr Judith Bond
Dr Gemma Unwin
Dr Christopher John
Dr Katie Andrews
Dr Sally Bradley
Dr Cath Burley
Dr Geraldine Fletcher
Dr Alison Longwill
Dr Anne Crawford-Docherty
David Kirkwood
Sarah Crowther
September 2016
LETC Upskilling Project: Development of the ‘Psychological Practice Skills for Secondary
Care Mental Health Staff’ Models
Acknowledgements ................................................................................................... 7
LETC Upskilling Project: Development of the ‘Psychological Practice Skills for
Secondary Care Mental Health Staff’ Models ............................................................ 8
1
Executive Summary ........................................................................................... 8
2
Background and Introduction............................................................................ 12
3
2.1
Aims .......................................................................................................... 13
2.2
Objectives ................................................................................................. 13
2.3
Novelty of the Approach ............................................................................ 14
Policy Context .................................................................................................. 14
3.1
Epidemiology ............................................................................................ 15
3.2
Policy Context ........................................................................................... 15
3.3
“No Health without Mental Health” Strategy............................................... 16
3.4
Closing the Gap and Parity of Esteem....................................................... 19
3.5
Better Access ............................................................................................ 19
3.6
Crisis care ................................................................................................. 20
3.7
Public Mental Health Priorities: Investing in the Evidence ......................... 20
3.8
The Francis Report ................................................................................... 21
3.9
NHS England 5 Year Forward View .......................................................... 21
3.10
Mental Health Task Force ......................................................................... 23
3.11
Outcomes framework ................................................................................ 24
3.11.1
4
NHS outcomes framework ................................................................. 24
3.12
Evidence-based best practice ................................................................... 26
3.13
Influencing behaviour through public policy ............................................... 26
3.14
Mental Capital and Wellbeing .................................................................... 26
Methodology .................................................................................................... 27
4.1
Scope........................................................................................................ 27
4.2
Review of Existing Skills/Competency Frameworks and Best Practice/Service
Guidelines............................................................................................................ 28
4.2.1
4.3
Inclusion/Exclusion criteria ................................................................. 29
Results of the literature search .................................................................. 29
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4.3.1
Competency Frameworks and Skills Models for all Staff Working in
Mental Healthcare ............................................................................................ 30
4.3.2
Competency Frameworks and Skills Models for Mental Healthcare Staff
working in Cluster 3-8 Services ........................................................................ 34
4.3.3
Competency Frameworks for Mental Healthcare Staff Working in
Psychosis Services (Clusters 10-17) ................................................................ 36
4.3.4
Competency Frameworks and Skills Models for Mental Healthcare Staff
Working in Dementia Services (clusters 18-21) ................................................ 36
4.3.5
Competence frameworks for the delivery and supervision of
Psychological Therapies .................................................................................. 45
4.3.6
Competency Frameworks for Unqualified Staff .................................. 45
4.3.7
Competency Frameworks for Clinical Psychologists .......................... 46
4.4
Identifying Candidate Skills – Consultation with Mental Professionals through
Focus Groups ...................................................................................................... 47
4.5
4.5.1
Prioritising Important and Specialist Skills .......................................... 49
4.5.2
Development of the Q Set .................................................................. 49
4.5.3
The Q Sort ......................................................................................... 50
4.6
5
Consultation with Multi-Disciplinary Colleagues and National Representatives
50
Identification of Stressors for Staff and Development of Skills Model ............... 51
5.1
6
Collaboration with Expert Reference Groups (ERGs) ................................ 48
Methods .................................................................................................... 52
Results and Discussion .................................................................................... 52
6.1
Categories of Psychological Practice Skill ................................................. 53
6.1.1
Communication, relationships and inter-personal skills: ..................... 53
6.1.2
Assessment and formulation: ............................................................. 53
6.1.3
Intervention: ....................................................................................... 53
6.1.4
Psychological knowledge and awareness: ......................................... 53
6.1.5
Professional development, supervision and training: .......................... 53
6.1.6
Intra-personal skills, self-care and psychological mindedness: ........... 54
6.2
Levels of Psychological Practice ............................................................... 54
6.3
Aligning to Client-related/Service Factors .................................................. 55
6.3.1
Embedding psychological practice skills in existing training courses .. 55
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7
6.3.2
Developing staff resilience ................................................................. 56
6.3.3
Integrated multi-disciplinary development of psychological practice skills
56
Skills Transfer Requirements: .......................................................................... 56
7.1
Stage 1: preparation what do we want to achieve and what is in it for me?
This stage includes: ............................................................................................. 57
8
7.1.2
Stage 2: Delivering the training: ......................................................... 58
7.1.3
Stage 3: Post-training – consolidation and maintenance of new practice
59
7.1.4
Conclusions ....................................................................................... 59
Development of the Interactive Digital Platform ................................................ 59
8.1
Building the Workforce Model.................................................................... 59
8.2
Format and Framework ............................................................................. 60
8.2.1
8.3
9
Representation of skills ...................................................................... 60
Components of the skills models ............................................................... 60
Evaluation of the model .................................................................................... 61
9.1
Benefits Realised ...................................................................................... 62
9.2
Summary................................................................................................... 62
10
Sustainability and Further Work .................................................................... 62
10.1
11
Recommendations for further work: Next Steps ........................................ 62
10.1.1
Dissemination plan ............................................................................. 62
10.1.2
External Reference Group for further development ............................ 63
10.1.3
Pilot site implementation .................................................................... 63
10.1.4
Extending the scope of psychological practice skills models .............. 63
10.1.5
Workforce planning ............................................................................ 64
Expanding areas of demand for psychological practice skills ........................ 64
11.1 Cost-effectiveness, delivery and development of the psychological practice
evidence base ..................................................................................................... 64
11.2 Payment by Results and Care Clusters: Psychological components of care
packages ............................................................................................................. 64
11.2.1
Generic interventions ......................................................................... 65
11.2.2
Condition-specific interventions .......................................................... 65
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11.2.3
Complex/Multi-modal interventions .................................................... 65
11.3 Clinical Health Psychology, Public Health and Prevention and Long Term
Conditions............................................................................................................ 65
11.4
Neuropsychology ...................................................................................... 66
11.5
Adult Mental Health ................................................................................... 66
11.6
Improving Access to Psychological Therapies (IAPT) ............................... 66
11.7
Child and Adolescent Health ..................................................................... 66
11.8
Older Adults .............................................................................................. 67
11.9
Intellectual Disabilities ............................................................................... 67
11.10
Forensic Clinical Services ...................................................................... 67
11.11
Organisational, Management and Clinical Governance ......................... 67
11.12
Applied psychology services .................................................................. 68
12
Appendices ................................................................................................... 69
12.1
Expert Reference Group Members: ........................................................... 69
12.1.1
Severe and Complex Mental Health Conditions (clusters 3-8) ............ 69
12.1.2
Psychosis (clusters 10-17) ................................................................. 69
12.1.3
Dementia (clusters 18-21) .................................................................. 70
12.2
The Q-Set combined for care clusters 3-8, 10-17 and 18-21 ..................... 72
12.2.1
Instructions for Q sort: ........................................................................ 74
12.2.2
Recommended distribution for Q-sort: ................................................ 75
12.2.3
Development of Typology of Skills: Care Clusters 3-8 ........................ 76
12.2.4
Development of Typology of Skills: Care Clusters 18-21 ................... 77
12.2.5
Results of Q Sort Care Clusters 3-8 ................................................... 78
12.2.6
Results of Q sort: Care Clusters 10-17 ............................................... 79
12.2.7
Results of Q Sort Care Clusters 18-21 ............................................... 80
12.3
Roles of Clinical Psychologists .................................................................. 81
12.3.1
Evidence-based practice .................................................................... 81
12.3.2
Range of interventions based on psychological theory and science ... 81
12.3.3
Improving physical health of people with mental health problems ...... 82
12.3.4 Competence frameworks for the delivery and supervision of
Psychological Therapies .................................................................................. 82
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12.3.5
Governance, risk management and quality assurance ....................... 82
12.3.6
Training and Supervision.................................................................... 83
12.3.7
Research and service development and innovation ........................... 83
12.3.8
Leadership Skills of Clinical Psychologists ......................................... 83
13
Glossary of Terms ........................................................................................ 85
14
Bibliography .................................................................................................. 89
14.1
Competency Frameworks and Skills Models ............................................. 89
14.1.1
3-8 Model ........................................................................................... 89
14.1.2
Psychosis ........................................................................................... 90
14.1.3
Dementia ........................................................................................... 91
14.2 Best Practice Guidelines, Service Guidelines and Commissioning
Frameworks ......................................................................................................... 93
14.2.1
Severe and Enduring Mental Health ................................................... 93
14.2.2
Psychosis ........................................................................................... 93
14.2.3
Guidelines, Standards and Job Profiles/Roles for Clinical Psychologists
94
14.3
Transfer of Training ................................................................................... 95
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Acknowledgements
A very large number of people have made important contributions to this project in terms of
their participation in the Expert Reference Groups and associated support (see 12.1 Expert
Reference Group Members:)
Key thanks are due to the Project Board and Project Team, and in particular to the Model
Leads whose tireless and expert input has been invaluable.
Dr Judith Bond
Dr Gemma Unwin
Dr Christopher John
Dr Sally Bradley
Dr Chris Silver
Dr Katie Andrews
Dr Geraldine Fletcher
Dr Cath Burley
Dr Alison Longwill
Dr Anne Crawford-Docherty
David Kirkwood
Sarah Crowther
Thanks are also due to Inclusion Imperative for their work in developing the website and
related products which are essential for effective dissemination of project findings
Christina Sarginson
George Rowley
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LETC Upskilling Project: Development of the
‘Psychological Practice Skills for Secondary Care Mental
Health Staff’ Models
1 Executive Summary
This project was commissioned by Health Education West Midlands (HEWM) to identify the
psychological practice skills required1 by all aspects of the mental health workforce and to
develop a cost effective model to develop a cost effective model to provide well trained
psychological practitioners across the specialist clinical mental health workforce (see Section
2 Background and Introduction).
There is increasing recognition that well-developed psychological practice skills within the
health and care workforce underpin effective delivery of National Policies and Best Practice
Guidance (see Section 3 Policy Context).
Section 4 Methodology outlines in detail the scope of the project (see Section 4.1; 4.2) which
focused on the psychological practice skills required by workers in specialist mental health
services. An extensive literature review (see Section 4.3) related to general competency
frameworks for staff working in mental health care and more specific competency frameworks
relating to psychological practice skills required to deliver secondary mental healthcare to
clients in relation to 3 broad Care Clusters:

Clients with severe and complex mental health conditions (Care Clusters 3-8)

Clients with psychosis (Care Clusters 10-17)

Clients with dementia (Care Clusters 18-21)
A range of psychological practice skills were identified from an extensive review of the
literature and detailed consultation with mental health professions through focus groups (see
Section 4.4), attended by over 70 mental health professionals working across the West
Midlands Region (see Appendix 12.1). The project team then established Expert Reference
Groups (ERGs) of clinical psychologist working in the three secondary care mental health
services (see Section 4.5), representing a collective 1000 years of clinical experience.
A Q sort methodology was used to identify and priorities candidate skills (see Section 4.5;
4.5.1; 4.5.2) and a Q-sort was undertaken (see Section 4.5.3) and further detail regarding skill
typologies is provided in Appendix 12.2.
Identification of stressors for staff and psychological practice skills related to staff well-being
were derived from the literature review and ERGs (see Section 5).
Six broad categories of psychological practice skills were identified for each of the 3 care
cluster models (see Section 6.1):
11
1
Communication, relationships and inter-personal skills
2
Assessment and formulation
http://www.nhsiq.nhs.uk/improvement-programmes.aspx
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3
Intervention
4
Psychological knowledge and awareness
5
Professional development, supervision and training
6
Intrapersonal skills, self-care and psychological mindedness
Six levels of psychological practice skill were identified by the ERGs (see Section 6.2):
1
Level 1: All client-facing, clinical staff: working with psychological awareness
2
Level 2: Qualified mental health professionals (any graduate-level healthcare
professional without further accredited training in delivering psychological therapies):
delivery of psychologically-informed care
3
Level 3: Qualified (uni-model) psychological therapists (any graduate-level
healthcare professional with further post-graduate accredited training in a recognised
psychological therapy): delivery of evidence-based skills
4
Level 4: Highly trained psychological workers who are able to draw on multiple
models and theories (e.g. clinical or counselling psychologists): delivery of specialist
skills
5
Level 5: Principal psychologists: delivery of specialist and complex skills
6
Level 6: Lead/head psychologists: delivery of organisational-level and
competency initiatives, service development (locally and nationally, and provision of
clinical governance
The leadership roles of clinical psychologists in the development and maintenance of
psychological practice skills in the workforce is further expanded in Appendix 12.3.
Each of the 3 skills models was aligned to each service context (see Section 0) and the webbased representation of the skills models includes visual representation of the domains of
psychological practice skill and a hierarchical pyramid model to indicate levels of practice (see
Section 8.2). The skills models are represented schematically in Section 8.3.
There is a clear need to embed psychological practice skills within the context of existing
training courses rather than develop new training courses (see Section 6.3.1). Developing
staff resilience to stress (see Section 6.3.2) will be key to long term success in enhancing
psychological practice skills in mental health services.
Integrated, multidisciplinary approaches developing a workforce capable of delivering
psychological informed healthcare will be key to achieving positive outcomes for service users
and carers (see Section 6.3.3). However, changing clinical practice requires close attention to
the organisational conditions which promote and maintain skills transfer from training to the
work environment (see Section 7). Three key stages are vital for consolidation and
maintenance of new psychological practice skills within the workforce:
1
Preparation (see Section 7.1) including values-based goal setting, aligning
training objectives to organisational goals, support at all organisational levels.,
motivation and engagement of clinicians and managers and preparation of the
environment to promote relevant skills transfer
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2
Delivering the training (see Section 7.1.2) in a relevant “real world” form that
clinicians will use with their service users; supported by care planning systems
3
Post-training consolidation and maintenance of new practice (see Section
7.1.3) through supervision, managerial and clinical practice support, monitoring and
evaluation of clinical outcomes, including the effectiveness of training
The main conclusions are that:

For clinical skills development programmes to benefit service users, effective transfer
processes must be designed and implemented

Transfer mechanisms need to be integrated into all stages of a skills development
programme: preparation, training delivery, consolidation and maintenance
A vitally important part of the project relates to the successful dissemination of the “project
products” or psychological practice skills models and an interactive digital platform had been
developed to guide managers and service leads in staff organisation and development, as
well as to direct the development of training initiatives (see Section 8). The digital platform
will allow users to access appropriate levels of information in a simple and visually
interesting way (see Section 8.2; 8.2.1; 8.2; 8.2.1; 8.3).
The psychological practice skills workforce model will be piloted with a sample of the 7
mental health specialist NHS Trust in the West Midlands Region (see Section 9), with the
continuing support of the West Midlands Region ERGs.
Recommendations for further work (see Section 10) include:
1
Developing and implementing a dissemination plan for the project outputs at a
Regional and National level and linking with relevant professional organisations and
events
2
Developing and extending External Reference Groups to involve national and
local stakeholders, clinicians, managers, commissioners and service users and
carers
3
Reviewing findings from pilot site implementation of the project products
4
Revising and refining the psychological practice skills models in tandem with
training organisations and the ERGs and ensuring that the digital platform is regularly
and readily updated to take account of developments in policy, research and
evidence-based practice
5
Developing relevant performance and outcome measures to evaluate the
psychological practice skills models
6
Extending the scope of the psychological practice skills models to wider
health and care needs and client groups (see Section 11) – for instance, children and
young peoples’ services; physical/general and public health; long term conditions;
learning disability; forensic/criminal justice services; other public/independent sector
services; organisation development and management
7
Developing practical workforce planning tools to estimate population need,
training places, workforce profile and costs associated with upskilling the workforce in
psychological practice skills
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A clear evaluation framework at the individual, team and organisational level needs to be
developed to assess the effectiveness of the skills models in promoting positive service
outcomes. Embedding the model will be fundamental to realising collective benefits

At a service level- outcomes enhanced health and wellbeing and improve safety,
quality, experience and satisfaction

At a workforce level-enhanced multi-disciplinary working, role clarity, staff satisfaction
and good being

At an organisational level-enhanced efficiency and truly integrate ways of working
At regional level-outcomes enhanced the health and to maximise value and spend
A Glossary of Terms (see Appendix 13) and more detailed reference sources (see Appendix
14) are highlighted.
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2 Background and Introduction
This project was commissioned by Health Education West Midlands (HEWM) to identify the
psychological practice skills required2 by all aspects of the mental health workforce and to
develop a cost effective model to develop a cost effective model to provide well trained
psychological practitioners across the specialist clinical mental health workforce.
Psychological practice refers to all elements of psychologically-informed healthcare. This
occurs within the context of continued professional development
and clinical supervision; self-reflection and self-care.
Whilst psychological practice is the foundation of all secondary mental healthcare, the
models of psychological practice presented here focus specifically on the psychological
components of healthcare delivery.
These models of psychological practice complement the range of generic competency
frameworks and skills models that are already available.
The project team have employed an action research approach to identify what the term
“skills gap” means to the mental health workforce and from the perspective of frontline
practitioners. This approach included the use of focus groups with multi-disciplinary
membership from across the West Midlands and included service managers and training
providers from across the region.
This consultation has enabled the project team to understand the current gaps from the
perspective of those responsible for delivering mental health care and support. The focus
groups concentrated on two broad questions namely:

What are the psychological practice skills required by the mental health workforce?

Does the current regional training offer provide the skills required?
The research approach also included a broad literature review covering clinical practice
guidance, up-skilling literature, existing competency frameworks, and models of skills
transfer (learning and change theory) in healthcare settings.
There is little literature to guide organisations in ensuring that the workforce has the right
skills mix to deliver a range of psychological practice which is broadly defined, and which
uses a robust, systematic methodology in development.
Similarly, National Health Service (NHS) Trusts frequently instigate improvement and staff
development initiatives, often in relation to implementation of evidence-based practice. As
these aim to change practice, they are often termed ‘behaviour change interventions’.
However, they do not always result in a change in practice and evidence-based practices
are not always implemented systematically in healthcare settings. Training is a commonly
used method for behavioural change. ‘Skills/learning transfer’ refers to the process of
transforming information gained through training into a change in practice.
22
http://www.nhsiq.nhs.uk/improvement-programmes.aspx
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2.1 Aims
There are numerous frameworks and models that outline the skills and competencies
required by mental health professionals to provide secondary mental healthcare. However,
the majority of these frameworks are generic and cover the skills required to perform the full
spectrum of work-based activities undertaken by mental health staff. Alternatively, those
which are exclusively psychological in focus tend to present competency frameworks relating
to the delivery of specified models of psychological therapy. To the authors’ knowledge, no
frameworks are available which focus on psychological practice skills, broadly defined to
refer to all elements of psychologically-informed mental healthcare, including
communication, relationship and inter-personal skills; professional development and
supervision; intrapersonal skills, self-care, self-reflection and psychological mindedness;
psychological knowledge and awareness; psychological assessment and formulation; and
psychological intervention and therapy (see Appendix 14.1 for a list of existing frameworks).
The aims of this strand of the project were:

To develop a series of models to identify the psychological practice skills that are
required among different levels/professional groups of secondary care mental health
workers to provide mental health care

To align these models to client/service factors such as the Mental Health Care
Clustersi to produce three models:
o
Psychological practice skills required to deliver secondary mental healthcare
to clients with severe and complex mental health conditions (Care Clusters 38)
o
Psychological practice skills required to deliver secondary mental healthcare
to clients with psychosis (Care Clusters 10-17)
o
Psychological practice skills required to deliver secondary mental healthcare
to clients with dementia (Care Clusters 18-21)

To develop regionally agreed models (taking account of the seven West Midlands
Secondary Care Mental Health Trusts) using a systematic methodology and wide
consultation

To develop visually interesting and accessible models which will be used by a wide
audience with appropriate levels of information available to different users. For
example, those responsible for delivering training in services, managers and
commissioners of services, psychologists, and individual staff members.

To ensure the development of a robust system of embedding and maintaining
psychological skills in organisations delivering mental health care
2.2 Objectives

To identify the psychological practice skills that are required to deliver mental
healthcare

To arrange these in accessible, simple, yet detailed models
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
To differentiate the skills according to levels of practice, paying consistent attention to
the differentiation of roles of different levels of psychological practitioners

To highlight skills that should be prioritised

To utilise expert opinion and the current evidence base in the development of the
models.

To identify key factors in organisations which promote the successful transfer and
maintenance of psychological practice skills for the benefit of service users
2.3 Novelty of the Approach
The present approach is novel in a number of ways:
Firstly, the development of the skills models was informed by wide scale consultation with
the regional mental healthcare workforce through a series of focus groups (detailed in a
separate report). This helped to ensure that the resulting models were clinically relevant,
meaningful, and reflected current issues in psychological practice.
Furthermore, the focus groups highlighted the importance of considering staff well-being and
the skills required to address issues of work-based stress. These were therefore included in
the models and are reported in more detail in a separate report.
The skills models consider all elements of psychological practice, but do not go into detail
about the specialist skills required to deliver specific psychological therapies but the skills
identified have relevance across multiple therapeutic models.
Existing competency frameworks (such as the Roth & Pilling CORE frameworks) were
consulted in the development of the models to ensure comprehensiveness and those
seeking details on specific therapeutic approaches are directed towards these documents.
Finally, the models include more levels of practice than found in most competency
frameworks, which tend to use three levels of practice. The models differentiate between
three levels of chartered psychologists and three levels of other psychological practitioners
in an attempt to ensure appropriate use of specialist skills in both client-facing and service
development roles.
3 Policy Context
It is important to situate any the upskilling in psychological practice skills in the context of key
national strategies and policy implementation related to the delivery of health and care and
the promotion of well-being. It is evident that the current and growing need for psychological
practice skills is implicit in any implementation of major national healthcare policies although
it is not always fully acknowledged or resourced by commissioners and providers of
services.
Although the focus of this project concerns upskilling the secondary mental health service
workforce in psychological practice skills, it is increasingly evident that such skills are
relevant to all aspects of health and care delivery.
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3.1 Epidemiology
A recent WHO reportii concludes that globally, more than 25% of all years lived with
disability, and over 10% of the total burden of disease is attributable to mental, neurological
and substance misuse disorders. Left unaddressed, lost economic output due to these
disorders will increase significantly from the already enormous levels. Feasible, affordable
and cost-effective measures are available for preventing and treating these conditions. The
European Union also acknowledges the need to improve the mental health of the
populationiii and plans to implement an EU strategy to address this.
One in 4 people suffer from poor mental health and this has an enormous impact on
personal, social and economic well-being. One in 10 children has clinically significant
psychological problems and there is an increasing need for early intervention services to
address these issues and prevent the development of a lifelong mental health disability.
Rising trends in male suicide and self-harm also attest to rising needs for services.
Demographic trends linked to an ageing population mean that there is an increasing demand
for older adult services to be associated with dementia and mental health issues of later life
in addition to the psychosocial sequelae of living with long term illness and disability.
There are an increasing number of data sources of value in estimating needs including the
Health and Social Care Information Centre3 and the National Mental Health, Dementia and
Neurology Intelligence Network4
3.2 Policy Context
There are a plethora of a health and care, both National and Local policies and good
practice guidance relevant to current and future demand for psychological practice skills.
Such areas include:
1. NHS England, Scotland, Wales and Northern Ireland
2. Health Education England, Scotland, Wales and Northern Ireland guidance of
workforce needs and training
3. National Accreditation bodies for Training and Supervision
4. Public Health recommendations# NICE guidelines (mental and physical health)
5. NICE guidelines (mental and physical health)
6. HCPC standards and monitoring of professional practice across a range of
disciplines
3
http://digital.nhs.uk/searchcatalogue?topics=0%2fMental+health&sort=Relevance&size=10&
page=1#top
4
http://www.yhpho.org.uk/default.aspx?RID=191242
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7. British Psychological Society policy and practice guidance (or other professional
bodies e.g. BABCP, BAOT, RCN)
8. National Reviews (e.g. Francis report)
9. Care Quality Commission (local and national service reviews)
10. Any Qualified Provider and the mixed economy of care delivery
3.3 “No Health without Mental Health” Strategy
Building on the National Service Frameworks for Mental Health (1999)iv, the Department of
Health 2011 Mental Health Strategy for England "No Health without Mental Health"v , vistated
that mental health must have equal priority with physical health, that discrimination
associated with mental health problems must end and that everyone who needs mental
health care should get the right support, at the right time. Tackling premature mortality of
people with mental health problems is a priority. More must be done to prevent mental ill
health and promote mental wellbeing. The six priorities are:

More people will have good mental health

More people with mental problems will recover

More people with mental health problems will have good physical health

More people will have a positive experience of care and support

Fewer people will suffer avoidable harm

Fewer people will experience stigma and discrimination
Key commitments include:

to improve mental health services, providing cost-effective evidence-based
treatments;

to ensure early and accurate identification of health needsvii;

to tackle the underlying cause of mental ill health and to reduce social inequality;

to invest in prevention and recovery services across the lifespan (and across
physical-mental health boundaries);

To improve patient experience, safeguard patient safety, measure outcomes, provide
strong clinical leadership and clinical governance, whilst also providing value for
money.
The Mental Health Strategy recognises that early interventions can help reduce the
estimated £105 billion annual costs to the economy of mental ill health. Early interventions
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Health Staff’ Models
that lead to good outcomes will be required for successful delivery of the 2011 Mental Health
Strategy. The Mental Health Strategy also prioritises psychosocial interventions and includes
a commitment to further increase investment in evidence-based psychological therapies,
accompanied by a four-year action planviii.
Table 1 Key mental health priorities
Key drivers
1.Cross-Government outcome strategy
Public Health England is charged with raising mental health as a
key workforce priority. The benefits of early intervention are
acknowledged and this strategy aims to further promote mental
health.
2.Improving Access to Psychological Therapies
As part of the outcome strategy outlined above, investment is
pledged for the Improving Access to Psychological Therapies (IAPT)
programme to increase the workforce to approximately 6000
cognitive behaviour therapy staff and expand access to children
and young people, older people, carers, those with long-term
physical conditions and severe mental health needs. This is the
second stage in this national programme that originally focused on
adults of working age. It continues to affect the type of staff typically
involved in delivering cognitive behaviour therapies in the NHS.
Relevant policy
No health without mental
health: A Cross-Government
mental health outcomes
strategy for people of all ages
- a call to
action (DH, 2011a)
Talking therapies: A four-year
plan of action - A supporting
document to No health
without mental health: A
cross- government mental
health outcomes strategy for
people of all ages (DH,
2011b)
Applied psychologists continue to be involved in both
designing and delivering the IAPT programme.
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Figure 1 Mental Health Dashboard
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3.4 Closing the Gap and Parity of Esteem
Parity of esteem9 is the principle by which mental health must be given equal priority
to physical health. It was enshrined in law by the Health and Social Care Act 2012
and was to be made operational through the NHS Mandate10.
People with severe mental illness die on average 20 years younger than the general
population.
The proportion of people between 16 and 64 meeting the criteria for one common
mental disorder increased from 15.5 % in 1993 to 17.6 % in 2007. Only a minority of
people with mental health problems in England, with the exception of those with
psychosis, receive any intervention for their problem.
Overall, the evidence suggests that at least 30% of all people with a long-term
condition also have a psychological problem. By interacting with and exacerbating
physical illness, co-morbid mental health problems raise total healthcare costs by at
least 45% for each person with a long-term condition and co-morbid mental health
problem.
In "Closing the Gap: Priorities for essential change in mental health"11 the following
priorities are outlined

Increasing access to mental health services

Integrating physical and mental health care

Starting early to promote mental wellbeing and prevent mental health
problems

Improving the quality of life of people with mental health problems
3.5 Better Access
Better access to mental health services12 is a Department of Health priority and an
additional £40 million funding boost for mental health services was committed in
2014-15. This comprised:

an investment of £7 million to end the practice of young people being
admitted to mental health beds far away from where they live, or from being
inappropriately admitted to adult wards; and

An investment of £33 million to support people in mental health crisis, and to
boost early intervention services, to help some of the most vulnerable young
people in the country to get well and stay well.
It was anticipated that an £80 million investment would deliver:

Treatment within 6 weeks for 75% of people referred to the Improving Access
to Psychological Therapies programme, with 95% of people being treated
within 18 weeks.

Treatment within 2 weeks for more than 50% of people experiencing a first
episode of psychosis.
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A £30 million targeted investment would help people in crisis to access
effective support in more acute hospitals.
A suite of tools for commissioners and provider managers are being developed to
monitor and improve access and waiting times13,14, 15
The second round of the National Audit of Psychotherapies16 found that whilst there
have been some improvements since the baseline, including reduced waiting times
and better recording of ethnicity and diagnostic data, there are a number of ongoing
areas of concern. There is still marked variation in performance between services,
some therapies are still being provided by therapists who do not have specific
training to do so and older adults with anxiety and depression are not getting the help
they need.
Within NHS Scotland17, recent years has seen an unparalleled demand for increased
access to Applied Psychologists and Psychological Therapies. A demand from both
patients and professionals has arisen due to the ever increasing evidence base for
psychological interventions.
3.6 Crisis care
The Crisis Care Concordat18 is a shared agreed statement, signed by senior
representatives from all the organisations involved. It covers what needs to happen
when people in mental health crisis need help – in policy making and spending
decisions, in anticipating and preventing mental health crises wherever possible, and
in making sure effective emergency response systems operate in localities when a
crisis does occur.
The Concordat is arranged around:

Access to support before crisis point

Urgent and emergency access to crisis care

The right quality of treatment and care when in crisis

Recovery and staying well, and preventing future crises
The Concordat expects that, in every locality in England, local partnerships of health,
criminal justice and local authority agencies will agree and commit to local Mental
Health
Crisis Declarations: these will consist of commitments and actions at a local level that
will deliver services that meet the principles of the national concordat.
A recent report19 evaluates progress to date and recommendations for development
and more inclusion of service users and carers in this process.
3.7 Public Mental Health Priorities: Investing in the Evidence
This wide-ranging report20 of Dame Sally Davies, Chief Medical Officer, covers a
number of areas of key priority for mental health service development. The report
raises concerns about the 70 million working days lost to mental illness and £70£100 billion cost to the economy. It calls for cost-benefit analysis to investigate
possible fast-track mental health care for working people at risk of falling out of work;
makes a case for investment in children and young people’s mental health to prevent
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later life mental illness, unemployment and criminal behaviour; and calls for piloting
services integrated into primary care.
The report finds that: 75 per cent of people with diagnosable mental illness receive
no treatment at all; there is a need for greater focus on mental health care for
children and young people; and there should also be a greater focus on the link
between long-term physical conditions and mental illness.
A recent report “Better Mental Health for All: A public health approach to mental
health improvement” focuses on what can be done to enhance the mental health of
individuals, families and communities, using a public health approach. Mental health
is a key determinant of physical health and promotion of mental wellbeing is
important in primary prevention of mental health problems and associated disability.
There is clear evidence of the economic and social cost of poor mental health but
also a clear rationale for investing in early intervention to address childhood and adult
mental health issues. This requires a coordinated policy implementation approach
across a variety of public sector bodies including local government, public health,
NHS and criminal justice agencies and the need to address social inequalities and
the socio-economic environment.
A parliamentary briefing21 from the Royal College of Psychiatrists highlights the links
between smoking, heart disease and mental ill health and focuses on the necessity
to address inequalities and promote early intervention. A practical toolkit22 for
improving the physical health of people with serious mental illness has recently been
developed.
Table 2 Public Health Outcomes
3.8 The Francis Report
The Francis Inquiry report was published on 6 February 2013 and examined the
causes of the failings in care at Mid Staffordshire NHS Foundation Trust between
2005-2009. The report makes 290 recommendations, including: openness,
transparency and candour throughout the healthcare system (including a statutory
duty of candour), fundamental standards for healthcare providers, improved support
for compassionate caring and committed care and stronger healthcare leadership.
3.9 NHS England 5 Year Forward View
The NHS 5 Year Forward View23, accompanied by planning guidance to deliver the
strategy via local health system Sustainability and Transformation Plans (STPs),24,25
emphasises prevention of ill health related to obesity, smoking and alcohol misuse
and recommends setting up workplace incentives to promote employee health,
backed by stronger public-health related powers for local government. Supporting
people to get and stay in employment is a key goal with a focus on mental health and
disability. Providing incentives to support healthier behaviour is seen as a key to
success.
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Patients will gain greater control over their own care with the option of shared health
and social care budgets and more support will be provided for unpaid carers. Greater
use of technology in the diagnosis and management of health conditions will be
increasingly important and will help people manage their own health.
The need to break down organisational barriers between community and hospital
care and between mental and physical health is emphasised, as is the recognition
that many people have complex, longer term multiple health conditions not just a
single disease. People with mental health problems die on average 15-20 years
younger than those who do not have these problems. Innovative and locally flexibly
care delivery is to be promoted. More support for people with dementia to remain
healthy and active in the community is highlighted. Further development of liaison
psychiatry and mental health support to hospitals and improvement in crisis care,
including links with the criminal justice system will ensure improved access to care.
There is a commitment to achieve parity of esteem26 between physical and mental
health and to reduce the waiting time for psychological assessment and intervention
for a first episode of psychosis, including the development of more inpatient facilities
and comprehensive mental health services for young people.
The details of the redesign required have not been mandated, with policy allowing
local variation and experimentation to meet local needs. There are a number of pilot
projects (probably around 70 in various programmes) with varying scope and scale,
but all represent steps towards creating Accountable Care Organisations (ACOs) –
Organisations with a single budget to deliver all care to a defined population
All of these pilots have some common themes:

Integration across health and care and into wider public services (particularly
criminal justice and education).

Greater engagement of patients, service users and family/informal carers.

The use of digital technologies to enable self-service, digital delivery and Big
Data analytics.
There is also a significant secondary “Wealth” agenda in many of the pilots to create
economic opportunity for the national and local economies.
ACOs will take a more holistic view of the cost of individual citizens to the systems
and in particular focus on those individuals and groups with long-term conditions
and/or complex needs who consume a disproportionate proportion of resources.
NHS Policy as outlined in 5 Year's Forward lays out a vision for very substantial
redesign of models of care to enable the UK health and care system to deal with the
challenges it faces.
Possible opportunities for clinical psychologists include

Provision of more effective formulation with people presenting with mental
health problems to ensure people are directed to appropriate services and
that those with severe and enduring problems (including personality disorder)
who consume disproportionate resources across mental and physical health
services, social care and criminal justice.
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
More active engagement in physical health (as there is clear evidence for the
impact of psychological factors in long-term conditions, with this typicality be
the most significant determinant of outcome and quality of life).

More effective use of their analytical and research skills in the use of data
collection, evaluation and service redesign. These skills, extensively
developed in training, are currently under-utilised in many settings.
The challenge for the profession falls in to three areas:

The identification and/or creation of new systems of care in mental and
physical health that make the best use of clinical psychology expertise.

The data collection to demonstrate to commissioners the cost and quality
benefits that flow from the application of these models to commissioners.

The active engagement of practitioners in developing, promoting and
engaging in these new systems of care.
The NHS England Business Plan (2016/2017)27, 28targets increases in early
intervention, shorter waits for treatment and expanded crisis services as key
priorities, linked to the Mental Health Taskforce Report and The Dementia
Implementation Plan29,30 which focuses on early diagnosis31,32 and more consistent
access to effective treatment and support. There are further targets to improve
integration of health and social care via local Sustainability and Transformation Plans
(STPs) to develop new and cost-effective care models. Prioritising health and
wellbeing of NHS staff is also a commitment.
There are important workforce challenges to be addressed in implementing 5YFV
which involve the development of new roles to address skills and staff shortages and
to empower local employers to commission a workforce which is “fit for purpose” to
deliver transformational change in healthcare33.
3.10 Mental Health Task Force
In March 2015 NHS England launched a Taskforce to develop a five-year strategy to
improve mental health outcomes across the NHS, for people of all ages. Essentially,
this will be a 'Mental Health Five Year Forward View' which clearly sets out how
national bodies will work together between now and 2021 to help people develop and
retain mental health and ensure they can access evidence-based treatment rapidly
when they need it.
Emerging themes and priorities relate to prevention of mental ill health, addressing
stigma, access, choice and quality of services - particularly for Black, Asian and
Minority Ethnic and other under-served groups. More emphasis on access to
psychological therapies and in co-production of care are also highlighted by the BPS
Experts by Experience group. A well-trained, responsive workforce with a recovery
mindset and emphasis on the value of lived experience and peer support are vital.
The Mental Health Task Force34 public engagement report outlines many key areas
for service improvement and development, including the need for increased Child
and Adolescent Mental Health Service funding35 and funding for n early intervention
for psychosis36
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Other developing areas include the need for more clinical psychologists to work with
people living with eating disorders, 37to improve access and waiting times. Additional
input is required for psychological interventions in physical health, especially in areas
such as coronary heart disease and paediatrics38; as part of general drive for parity of
esteem between mental and physical health.
The Five Year Forward View for Mental Health (2016)39 outlines the policy context
and evidence base for transforming mental health services and the need for
additional investment which will generate significant long term savings for the
population in terms of improved economic productivity and a reduction in long term
costs of care and support by a variety of public sector agencies. Key
recommendations include access to 7-day crisis services; promotion of mental health
and prevention of poor mental health, early intervention, and addressing poor
physical health of people with mental health problems and improving liaison services.
New models of care underpinned by an appropriately skilled workforce are essential.
There is a need to improve the quality and transparency of access and outcome data
for mental health services and to develop more effective payment models which
promote and sustain change.
NHS England has published a document implementing the Five Year Forward View
for Mental Health40. It is proposed that access to psychological therapy will be
increased so that at least 25% of people with common mental health conditions will
have access to services each year. This will involve an expansion of 3000 new
mental health therapists co-located in primary care. Targets to improve access,
waiting times and recovery have been set. Improvements in services for children and
young people including perinatal mental health aim to reduce the future health41 and
social care morbidity and provide cost-effective interventions. Early intervention in
psychosis and access to NICE recommended packages of care and a reduction in
premature mortality of people with severe mental illness are additional key
objectives. Improved mental health intervention in criminal justice pathways and
suicide prevention are also highlighted. There is recognition of the need to address
the mental wellbeing of NHS staff, including improving their access to psychological
therapies.
Similar documents have been developed by the other UK Nations (see Bibliography).
3.11 Outcomes framework
Key policy outcomes are outlined in this Section in relation to NHS, Public Health and
Social Care policies. Commissioners have increasing amounts of guidance and tools
to assist them in achieving health positive outcomes from their investment42
3.11.1 NHS outcomes framework
The NHS has adopted an outcomes framework43 as part of “The Mandate44” from the
Department of Health for local healthcare commissioners and providers. The
outcomes framework45 also includes improving outcomes from psychological
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therapies and a "mental health dashboard" of performance indicators and measures
to underpin this46.
The development of quality47 and outcomes measures in relation to delivering FYFV48
is a key objective.
Figure 2 NHS Outcomes Framework
The social care outcomes framework is summarised below and further referenced49
Table 3 Social Care Outcomes Framework
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3.12 Evidence-based best practice
There is a raft of NICE best practice guidance for clinical health and care delivery (see
http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/mental-health-and-wellbeing ) which
in many instances details specific roles for psychological therapists in service delivery of
NICE compliant interventions and therapies.
3.13 Influencing behaviour through public policy
The Cabinet Office Mindspace Documentl acknowledges that "influencing behaviour is
central to public policy challenges such as crime, obesity or environmental sustainability.
Behavioural approaches offer a potentially powerful new set of tools. Applying these tools
can lead to low cost, low pain ways of “nudging” citizens - or ourselves - into new ways of
acting by going with the grain of how we think and act. This is an important idea at any time,
but is especially relevant in a period of fiscal constraint".
A recent independent evidence-based Commissionli, chaired by Liberal Democrat MP Paul
Burstow goes further stating:
"We must prioritise the promotion and protection of the wellbeing and mental and social
capital of the nation. The pursuit of happiness should be a goal of government.
The promotion of wellbeing requires a co-ordinated approach with both universal services
and targeted interventions. A well-designed and delivered wellbeing programme can over
time reduce the burden of mental health problems.
Primary care organisations must be equipped to recognise and meet the mental health
needs of their patients.
Investment in the wellbeing and mental health of our children and young people should be a
priority and would reduce the lifetime cost of mental health problems.
Timely identification and access to the right treatment requires effective collaboration
between schools and child and adolescent mental health services"
3.14 Mental Capital and Wellbeing
The Government Department for Innovation, Universities and Skills commissioned a report
entitled "Mental Capital and Wellbeing: Making the most of ourselves in the 21st Centurylii
which focuses on a broad canvas of mental health related issues and interventions of social
relevance detailed in the Figure below. Applied psychologists have much to contribute in this
area.
There is recognition at the highest government level
(https://www.gov.uk/government/organisations/behavioural-insights-team/about). The
Behavioural Insights Team, often called the ‘Nudge Unit’, applies insights from academic
research in behavioural economics and psychology to public policy and services and
considers the application of behavioural science to policy design and delivery, advancing
behavioural science in public policy and championing scientific methodology to bring greater
rigour to policy evaluationliii. Clearly, the wider implications of the application of psychological
science to the delivery of health and care services should be cascaded down to improve
systems of care.
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Figure 3 Mental Capital and Well-being
4 Methodology
The project team has employed an action research approach to identify what the term “skills
gap” means to the mental health workforce and from the perspective of frontline
practitioners. This approach included the use of focus groups with multi-disciplinary
involvement from across the West Midlands to include service managers and training
providers from across the region.
This consultation has enabled the project team to understand the current gaps from the
perspective of those responsible for delivering mental health care and support. The focus
groups concentrated on two broad questions namely:

what are the psychological practice skills required by the MH workforce?
 does the current regional training offer provide the skills required?
The development of the skills models incorporated wide scale consultation and collaboration
with mental health professionals working in Secondary Care Mental Health Trusts in the
West Midlands along with synthesis of existing competency frameworks/skills models and
guidance on best practice in service delivery. The resulting skills models were developed
into interactive digital platforms which are available online.
Model leads, namely a psychologist with appropriate specialism and expertise, led on the
development of each model, supported by the project and research team. These leads were
responsible for reviewing existing literature, assimilating recommendations made by the
expert reference groups, and consulting with multidisciplinary colleagues and national leads
to develop draft models which were subject for review, as outlined below.
4.1 Scope
The skills models clearly have some relevance outside the project target area of Secondary
Care Mental Health Trusts in the context of increasingly integrated, holistic patterns of
service provision. The findings have relevance nationally although the project originated in
the West Midlands.
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The Expert Reference Groups (ERGs) refined the scope of the models to ensure breadth
and clinical applicability whilst maintaining manageability in the task. The models refer to
secondary adult mental health care and relate to psychological practice; they do not cover all
the skills required by mental health staff. This ensured that the models were specific,
allowing detailed consideration of psychological practice and avoided producing generic
frameworks, which are already available and which do not provide sufficient detail on
psychological practice.
The working definition of psychological practice is as follows:
Psychological practice refers to all elements of psychologically-informed healthcare,
including communication, relationships and inter-personal skills; professional development
and supervision; intrapersonal skills, self-care, self-reflection and psychological mindedness;
psychological knowledge and awareness; psychological assessment and formulation; and
psychological interventions and therapy.
Psychological practice should underpin secondary mental healthcare, however, the models
of psychological practice presented here do not consider all aspects of secondary mental
health care and instead focus on the psychological components of healthcare delivery. A
range of generic competency frameworks and skills models are available that cover all
aspects of healthcare delivery, but which do not provide specific detail on psychological
practice.
The ERGs elected to focus the model on community services; they therefore do not cover
crisis and acute (inpatient) services. However, elements of the skills may be applicable
across all services.
The models predominantly refer to client-facing clinical staff, however, the importance of
non-clinical, client-facing staff engaging in psychological practice and having access to
training is recognised. Non-clinical, client-facing staff are defined as those in supporting roles
who do not directly provide healthcare, such as call handlers, receptionists, administrative
and support staff. The following categories of skill are also relevant for non-clinical staff and
Trusts should consider all staff have at least level 1 skills in these categories:




Communication, relationships and inter-personal skills
Professional development, supervision and training
Intra-personal skills, self-care and psychological mindedness
Psychological knowledge and awareness.
4.2 Review of Existing Skills/Competency Frameworks and Best
Practice/Service Guidelines
There are existing frameworks for psychological therapy (delivered by the qualified
therapists), however, comparatively little is known about the recommended organisation of
core/fundamental psychological practice skills required across the workforce. The skills sort
therefore aimed to develop an understanding of expert opinion on psychological practice at
these levels. The skills sort considered generic interventions as described by Brechin and
Heywood-Everett (2013) which also align to IAPT (Improving Access to Psychological
Therapy) ‘Step Two’ interventions and those which could be considered ‘Step One’
psychologically-informed practice.
A number of literature searches were undertaken using Google and Google Scholar to
identify: competency frameworks, skills models, best practice treatment and service
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guidelines, commissioning frameworks, and job profiles/roles for clinical psychologists.
These searches were supplemented by hand searches and search suggestions from experts
in the field, including ERG members.
The primary aim of the review was to identify and summarise literature relevant to staff
working with

All staff working in mental healthcare (all clusters)

All staff working with patients with severe and complex mental health issues (clusters
3-8),

All staff working in psychosis services (clusters 10-17)

All staff working in dementia services (clusters 18-21).
Competency frameworks and skills models were also identified for specific staff groups:

Unqualified staff working in mental health services

Therapists working in mental health services

Clinical Psychologists working in mental health services
The results of the review were considered by the model leads in the development of the
models to ensure consistency and compatibility with existing literature. The review was used
to inform wording, to identify additional skills to be included in the models, to identify
omission from existing frameworks, to ensure that the models did not simply replicate
existing work, to ensure that the models were reflective of current best practice intervention
and service recommendations and to ensure that the models were reflective of current NICE
recommendations.
4.2.1
Inclusion/Exclusion criteria
The following inclusion/exclusion criteria were applied when undertaking these reviews:

Publication date: 2000-2016

Initial searches focused on competency frameworks specific to mental health,
however, search was broadened to include all healthcare

Primary focus on frameworks relating to UK-based staff, but also considered
international publications where relevant

Focus on staff working community-based, outpatient services (excluded inpatient)

Included journal articles as well as ‘grey literature’
4.3 Results of the literature search
Twenty-four competency frameworks and skills models were located: 9 generic frameworks,
13 dementia-specific frameworks/skills models and 2 psychosis-specific frameworks.
Generic competency frameworks were identified for unqualified staff (1) and clinical
psychologists (1). Dementia specific frameworks were found for unqualified staff (primary
care liaison worker (1) and nurses (1).
Twenty-nine best practice guidelines/service guidelines and frameworks were found: 1
relevant to staff working in generic/severe and generic mental services and twenty-eight
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relevant to staff working in psychosis services. Seven commissioning frameworks were
found: 2 relevant to staff working in generic/severe and generic mental services, 3 relevant
to staff working in psychosis services, and 2 relevant to all staff working in dementia
services.
Three guidelines and standards for clinical psychologists were found and 3 national job
profiles were identified (bands – 8a, 8b and 8c). A bibliography is presented in Appendix 1
and separate reports on the literature review are available (summarising existing
competency frameworks and skills models; summarising best practice guidelines, service
guidelines and commissioning frameworks; and summarising job profiles/roles for clinical
psychologists).
Other relevant frameworks, guidelines, standards and pathways are also included.
4.3.1
Competency Frameworks and Skills Models for all Staff Working in Mental
Healthcare
4.3.1.1 Knowledge and Skills Framework (KSF) (DH, 2004)5
4.3.1.1.1 Summary:

Introduced as part of the agenda for change and was intended to support the
appraisal process.

NHS Staff Council found the take up of the KSF was variable. Some trusts felt the
KSF was too complex and difficult to integrate - NHS Staff Council simplified the
KSF - increased flexibility for employers (see below)
4.3.1.2 Appraisals and KSF made simple a practical guide (The NHS Staff Council,
2010)6
4.3.1.2.1 Summary:

The KSF practical guide is designed to supplement the existing KSF guidance
(above).

Applicable to all healthcare staff in the NHS and across all settings

Developed through partnership working between management, trade unions and
professional bodies.

6 core dimensions - relevant to every post. 24 specific dimensions - apply to
some but not all jobs.

Each dimension has 4 levels, with indicators describing the knowledge and skills
required at that level. Alongside each level and indicators are examples of
application
5
http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_
dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4090861.pdf
6
http://www.nhsemployers.org/~/media/Employers/Publications/Appraisals%20and%20KSF%20made%20simp
le.pdf
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The simplified KSF tool (The NHS Staff Council, 2010) focuses specifically on
these six core dimensions
4.3.1.3 UCL - CORE Competency Frameworks (Roth and Pilling, 2007/2009)7
4.3.1.3.1 Summary:
•
Competence frameworks developed for therapeutic modalities and for
their supervision include:
o
CBT
o
Psychoanalytic/Psychodynamic Therapy
o
Systemic Therapy
o
Interpersonal therapy
•
Developed for mental health professionals (e.g. Clinical Psychologists,
nurses, OTs)
•
Builds upon the IAPT stepped care model
•
Competencies organised into 5 domains
•
Activities associated with each competence are outlined, some activities
apply to all staff and some to staff with specific training/experience
4.3.1.4 A Capability Framework for Working in Acute Mental Health Care – The Values
Skills and Knowledge Needed to Deliver High Quality Care in a Range of Acute
Settings (NHS Scotland, 2009)8
4.3.1.4.1 Summary:

Competency framework outlining skills/competencies for all staff working within
healthcare services

Not specific to mental healthcare

Principally developed for nurses, however a range of disciplines and workers can use
this framework

Specific to acute care services

Links in with other frameworks (e.g. NOS) and key legislative/policy drivers

Split into core competencies and specific competencies
7
http://www.ucl.ac.uk/pals/research/cehp/research-groups/core/competence-frameworks
8
http://www.nes.scot.nhs.uk/media/351850/acute_mental_health_care_framework.pdf
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4.3.1.5 Digest of National Occupational Standards for Psychological Therapies
(Fonagy et al. 2010)9
4.3.1.5.1 Summary:

Aim to provide a common language to be used across professional
groups to aid MDT working

Not specific to mental health

Based on the competencies identified by Roth and Pilling (2009) and the
views and experiences of mental health practitioners expressed during
Expert Reference Groups

Certain elements are common to all therapeutic modalities (e.g.
assessment, formulation and engagement)

Outlines skills required to deliver specific psychological interventions
including: CBT, Psychoanalytic/Psychodynamic Therapy, Family and
Systemic Therapy and Humanistic Therapy

Supervision not explicitly described, but recognised as important for safe
and effective practice
4.3.1.6 A Capable and Competent Workforce (Malvern, 2011)
4.3.1.6.1 Summary:

Identifies the skills and knowledge required to work with specific cluster
presentations

Relevant competencies included from the NHS KSF guidelines (DH,
2004)

Competency matrix developed through staff self-assessment process
(questionnaire)

Focuses on core competencies

Framework for all mental health professionals (e.g. Clinical Psychologists,
nurses, OTs)

Does not include competencies for managers or administrative staff
4.3.1.7 Mental Health Commissioning and Psychological Interventions (Brechin and
Heywood-Everett, 2012)
4.3.1.7.1 Summary:

Framework for all staff working in secondary mental health
9
http://apps.bps.org.uk/_publicationfiles/consultationresponses/NOS%20for%20Psychological%20Therapies%2
0-%20final%20digest%20%28Mar%2010%29.pdf
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
Aligns different levels of practice to the mental health clusters and identifies and
describes interventions delivered at Step 4 and above

Builds upon the Nice Guidelines (2009), NOS (2010), UCL Core Competency
frameworks (Roth and Pilling, 2007/2009) and IAPT competency frameworks

Identified 3 levels of practice/intervention – skills model provides visual
representation of this

Does not include competencies for managers or administrative staff
4.3.1.8 London Mental Health Models of Care – Competency Framework (NHS, 2013)10
4.3.1.8.1 Summary:
10

Competency framework designed for all staff that come into contact with people with
mental health problems and those responsible for commissioning and developing
services

Developed for those working with people with long-term mental health problems or
those experiencing crisis.

Aims to increase the level of support provided within primary care and community
settings, to reduce unnecessary secondary care admissions.

Core pathway developed by project team through a series of focus groups and
interviews with mental healthcare professionals and stakeholders (including families,
friends, carers, GPs and non-mental health staff)

Competencies organised into 3 parts/levels:
o
Universal competencies – relevant to those who may come into contact with
people with mental health problems as part of day to day work
o
Further competencies – for those who are not mental health specialists
o
Additional competencies – relevant to wide staff group, e.g. mental health
clinicians or GPs

5 essential functions for staff identified

Other relevant frameworks are summarised in the appendices (e.g. NHS KSF)

Outlines that evidence for competencies can be provided through self-reflection,
feedback (during appraisals, supervision and performance reviews) and through
learning and reflection from study, reading or training.
http://www.opm.co.uk/wp-content/uploads/2013/10/LondonMentalHealthModelsOfCare1.pdf
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4.3.2
CONFIDENTIAL
Competency Frameworks and Skills Models for Mental Healthcare Staff working
in Cluster 3-8 Services
4.3.2.1 UCL Competence frameworks
There are currently nine competence frameworks available to download
(www.ucl.ac.uk/CORE/). Four of these focus on the main therapeutic approaches utilised by
psychological therapists:

CBT

Humanistic

Psychoanalytic/Psychodynamic

Systemic
These map on five domain competencies including generic therapeutic competencies and
four therapy specific competencies; basic; specific; problem specific; Metacompetencies.
The fifth competency framework available is Supervision.
The supervision map locates only four domains; generic supervision; specific supervision;
model specific supervision; Metacompetencies supervisors need to apply across all the other
domains of the framework, these are usually examples of higher-order decision making.
4.3.2.2 National Occupational Standards/Skills for Healthliv
The national occupational standards concentrate on a further four frameworks:

CBT

Humanistic

Analytic/Dynamic

Systemic
These frameworks can be accessed from the National Occupational Standards/ Skills for
Health Website (www.skillsforhealth.org.uk/about-us/competence%10national- occupationalstandards).
4.3.2.3 IAPT Competence frameworks
Four further frameworks were commissioned as part of the expansion to the IAPT
programme to develop greater choice for those clients with depression:
1. Brief dynamic interpersonal therapy for depression
2. Interpersonal psychotherapy for depression
3. Couple therapy for depression
4. Counselling for depression
These can also be accessed through the IAPT website (www.iapt.nhs.uk/workforce).
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4.3.2.4 Relationship between the competence frameworks and National Occupational
Standards
The competence frameworks and National Occupational Standards are constituent parts of a
programme overseen by the Department of Health. This has the objective of specifying
occupational standards for the practice and training of psychological therapists, initially in
four modalities (CBT, psychoanalytic/psychodynamic, systemic and humanistic personcentred/experiential).
Visit www.bps.org.uk/dcp for a full account of the relationship between these two pieces of
work- Digest of National Occupational Standards for Psychological Therapies (Fonagy et al.,
2010).
The competencies from UCL present knowledge and ability progressively from the generic to
the problem specific, with an emphasis on knowing what and knowing how. The NOS, in
contrast, addresses the steps that a client will be taken through in therapy (the process). It
concentrates on the therapist’s interdependent actions, from determining the suitability of
therapy for a client, developing the manner of the intervention, and deciding how the therapy
may be ended. The emphasis in the NOS is on what you can expect to be doing, as a
therapist, or, as a client, what you can expect to experience or receive.
This methodology implies that the application of the NOS centres on the client problems that
were included in the research at UCL.
4.3.2.5 UCL competence frameworks, produced by Roth & Pilling and colleagues
UCL competencies focus on what the therapist needs to know in order to deliver the
intervention.
Construction of the competence frameworks includes:

Generic Therapeutic competencies in psychological therapy

Basic competencies (related to the type of therapy)

Specific competencies (related to the type of therapy)

Problem-specific competencies

Metacompetencies
4.3.2.6 Modality specific competence frameworks:

Cognitive and Behavioural Therapies

Psychoanalytic/Psychodynamic Therapies

Systemic Therapies

Humanistic Therapies
Extended to frameworks for the expansion of IAPT:

Interpersonal Psychotherapy (IPT)
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
Dynamic Interpersonal Therapy (PIT)

Counselling for Depression

Couples Therapy for Depression

Working with older people
4.3.3
CONFIDENTIAL
Competency Frameworks for Mental Healthcare Staff Working in Psychosis
Services (Clusters 10-17)
4.3.3.1 UCL - CORE Competency Frameworks (Roth and Pilling, 2007/2009)11
4.3.3.1.1 Summary:
4.3.4

Competency framework for psychological interventions for people with
psychosis and bipolar disorder

Framework applies to mental health professionals across a range of settings

Identifies role of supervision in supporting competent practice

Project overseen by ERG group and competence lists were reviewed –service
users included as part of ERG

Outline set of underpinning skills (core and generic therapeutic competencies)

Use shading to outline competencies required by all staff

Competency map includes: 1. Core competencies 2. Therapeutic stance, values
and assumptions 3. Generic therapeutic competencies 4. Assessment 5.
Formulation and planning 6. Specific interventions (e.g. CBT) 7.
Metacompetencies (based on expert consensus, manuals and research
evidence)
Competency Frameworks and Skills Models for Mental Healthcare Staff Working
in Dementia Services (clusters 18-21)
One of the biggest challenges facing health and social care in the United Kingdom is the
projected increase in the number of older people who require dementia care. The National
Dementia Strategy (Department of Health, 2009) emphasizes the critical need for a skilled
workforce in all aspects of dementia care. In the West Midlands, the Strategic Health
Authority commissioned a project to develop a set of generic core competencies that would
guide a competency based curriculum to meet the demands for improved dementia training
and education. A systematic literature search was conducted to identify relevant frameworks
to assist with this worklv. The core competency framework produced and the methods used
for the development of the framework are presented and discussed.
11
https://www.ucl.ac.uk/pals/research/cehp/researchgroups/core/pdfs/Psychosis_and_Bipolar_Disorder/Psychosis_Background_Doc.pdf
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4.3.4.1 Summary:

National competency framework developed following regional project undertaken
in the West Midlands

Not specific to mental healthcare

Outlines the generic competencies relevant to all staff working in dementia
services

Conducted systematic literature search to identify other competency frameworks

8 core competencies and 87 knowledge, technical and attitude/behavioural skills
identified

Identified risk factors and protective factors relating to stress and burnout
A study by Smythe et al (2014)lvi developed a framework was developed with eight main
clusters from findings from focus groups and review of the literature. These were: skills for
working effectively with people with dementia and their families; advanced assessment skills;
enhancing psychological well-being; understanding behaviours; enhancing physical wellbeing; clinical leadership; understanding ethical and legal issues; and demonstrating skills in
personal and professional development.
The framework could be implemented in practice by managers, health care professionals
and training providers as a tool to identify strengths and limitations in knowledge skills and
attitudes and to identify areas for competency development through specific training.
4.3.4.2 Summary:

Regional competency framework - research conducted in the West Midlands.

A literature review was conducted, identifying specific competency frameworks
relevant to the dementia workforce

Not specific to mental health

8 main clusters outlined

Semi-structured interviews with clinical leads and focus groups with a wider
group of staff provided an in depth understanding of the roles within the service

Profession specific skills identified

Identifies both specialist and generic skills

Framework reflects continuum of expertise
4.3.4.3 Dementia Competency Frameworks and Skills Models for Therapists
Health Education England have produced a national skills model for dementia nursinglvii
4.3.4.3.1 Summary:

National skills model

Describes what is expected of all nurses and the values required
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
Pyramid with levels of skill presented – bottom level = awareness, middle level =
dementia skilled, top level = dementia specialists

Outlines key documents in dementia care
Dewing & Traynor (2005)lviii developed a competency framework based on emancipatory
action research and systematic practice development approach, for Admiral Nurses who are
specialist dementia care nurses working in the community with carers of those who have a
dementia. The aim of the competency project (2000-2003) was threefold. Firstly, to work
collaboratively with these specialist nurses to facilitate the development a competency
framework that reflects the needs of the Admiral Nursing Service. Secondly, to provide a
way to structure evidence demonstrating evolving competency. Thirdly, to specifically enable
the nurses to demonstrate evidence of achieving the UK Nursing and Midwifery Council's
Higher Level Practice standard.
The main outcome from this project was the development of a specialist nursing competency
framework. The Admiral Nurses' Competency Framework is made up of a set of eight core
competencies with three levels of competency statements, loosely structured around the
Higher Level Practice standard, and guidance documentation to illustrate how work-based
evidence can be generated to demonstrate competence. There were also process-derived
outcomes associated with combining systematic practice development with emancipatory
action research that had an impact on the culture. The main outcomes here were that
practitioners engaged in and experienced learning about how to research their own practice
and the consequences of doing this. They also learnt about specialist nursing practice more
widely than Admiral Nursing. Finally, there was some increase in awareness about the
culture within their teams and organizations. The final competency framework reflects the
needs of the service, is owned by the majority of practitioners and project commissioners
and this has had a positive impact on implementation.
4.3.4.3.2 Summary:

National competency framework

Not specific to mental health

Used action based emancipatory research – involves the researchers and
practitioners working together

5 phases of the project – 1. Scoping exercise 2. Sharing the findings with key
stakeholders (nurses) 3. Developing the content and structure 4. Piloting a draft
version 5. Setting the scene for implementation

8 core competencies developed

3 levels of competency – intermediate, advanced and expert

Competency framework linked with standards of care and new job descriptions
The Table below summarises some competency framework findings for staff working in
dementia services.
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CONFIDENTIAL
4.3.4.4 Knowledge and Skills for Dementia Care (Michigan Dementia Coalition, 2006)12
4.3.4.4.1 Summary:
•
Competency framework developed for direct care workers in dementia services
•
Identifies special care assistance skills – assumes that staff have the broader set of
skills and knowledge required for their role
•
7 areas of competency identified (see full text)
•
Provides a list of useful resources for staff
•
Identifies the philosophy and values that underlie these competencies
•
Not specific to mental healthcare
•
Not UK based framework – USA
4.3.4.5 Dementia Toolkit (South West Yorkshire NHS Trust, 2008)13
4.3.4.5.1 Summary:
•
Regional competency framework - applicable to all staff working with people with
dementia and their carers within South West Yorkshire Mental Health NHS Trust
•
Not specific to mental healthcare
•
Initial scoping undertaken via a multidisciplinary focus group – emergent themes
identified
•
Key topics were devised - staff who attended the focus group were asked to rate the
priority of each area
•
From these general topic areas a list of questions was developed through a literature
search of existing guidelines and discussions with relevant staff
•
Each stage of the project was developed within a consensus group
•
Draft document was reviewed by the contributors, service users and carers,
collaborative project members and Practice Effectiveness Subgroup of the Older Peoples
Service Delivery Group (PESOPSDG) members and piloted across the trust
•
The training section of this toolkit can be used to assist staff in their Knowledge and
Skills Framework (KSF) appraisal processes
12
https://www.interiorhealth.ca/sites/Partners/DementiaPathway/EducationalResources/Documents/DemCom
pGuide_181812_7.pdf
13
http://www.southwestyorkshire.nhs.uk/documents/832.pdf
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4.3.4.6 Promoting Excellence: A Framework for Health and Social Services Staff
Working with People with Dementia, their Families and Carers (Scottish
Government, 2011)14
4.3.4.6.1 Summary:
•
Regional competency framework – Scotland
•
Not specific to mental health
•
Designed for all health and social staff who have contact with people with dementia,
their carers and families
•
Aims to support the delivery of changes outlined in the Scottish Government’s
National Dementia Strategy
•
Developed alongside the ‘The Standards of Care for Dementia in Scotland’ and
supplements existing frameworks (NHS KSF, Social Services Continued Learning Statement
and the NOS for Health and Social Care).
•
4 levels of skill outlined - 1. Dementia Informed practice level 2. Dementia Skilled
Practice Level 3. Enhanced Dementia Practice Level 4. Expertise in Dementia Practice Level
•
4 stages of the dementia journey identified – 1. Keeping well, prevention, and finding
out it’s dementia 2. Living well 3. Living well with increasing help and support 4. End of life
and dying well
4.3.4.7 Dementia Competency Framework (South West Dementia Partnership, 2011)15
4.3.4.7.1 Summary:
•
Regional competency framework
•
Not specific to mental healthcare
•
Staff group that framework is applicable to not stated
•
Builds on and expands the ‘Common Core Principles for supporting people with
Dementia’ (page 5)
•
Identifies the importance of the right attitudes and values for dementia care, such as
kindness, caring and compassion.
•
Offers a stepped model distinguishing the different competencies needed across
three steps from basic awareness to specialist knowledge and skills
•
The framework is incremental and is mapped against suggested NOS
•
Based on 12 principles of care
14
http://www.gov.scot/resource/doc/350174/0117211.pdf
15
http://dementiapartnerships.com/wp-content/uploads/sites/2/dementia-competency-framework.pdf
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4.3.4.8 Better Dementia Care. A Practical Guide’ (Norfolk and Suffolk Dementia Action
Alliance)16
4.3.4.8.1 Summary:
•
Regional competency framework
•
Not specific to mental health
•
Outlines skill needs for the wider workforce including carers and volunteers.
•
Based on work by the Michigan Dementia Coalition (page 4)
•
Developed with input from an expert panel and the views of carers, volunteers,
registrants, support staff
•
Framework is mapped against the NOS
4.3.4.9 Excellence in dementia care across general hospital and community settings.
Competency framework 2013-2018 (South Tees Hospitals NHS Foundation
Trust, 2014)17
4.3.4.9.1 Summary:

Regional competency framework

Relevant to all mental health staff working in general hospital and community settings

Not specific to mental health

Amalgamates the Scottish Government’s “excellence: a framework for all health and
social services staff working with people with dementia, their families and carers” and
the “South West dementia partnership dementia competency framework”

Embedded within this framework are the ‘common core principles for supporting
people with dementia: A guide for training the social care and health workforce’.

Framework informed by:
o
Evidence, best practice guidance and literature reviews
o
Existing competency frameworks
o
Listening to the views of those with dementia, their friends, families and
carers both locally and nationally.

Framework is incremental (with 3 levels): moving from essential skills through
enhanced skills, to specialist skills in dementia care.

Uses seven outcomes to cover the fundamental areas of dementia care.
16
http://www.dementia-alliance.com/Media/framework.pdf
17
http://southtees.nhs.uk/content/uploads/Dementia-Care-Competencies-Framework.pdf
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4.3.4.10 West Midlands Dementia Generic Service Interventions
Framework (North Staffordshire Combined Healthcare, 2015)18
Competency
4.3.4.10.1 Summary:

Regional competency framework

Applicable to all staff working in health and care – not specific to mental health

Generic, specialist and advanced skills reported.

Diverse range of stakeholders involved in refining the framework

Cross referenced with national and local documents, but also engages in a bottom up
approach

Identifies that staff will operate at one of the following three tiers:
Awareness/foundation (applicable to all staff), intermediate/practitioner (knowledge
and skills required for staff that have regular contact with people with dementia) and
specialist/advanced (knowledge and skills required for experts in leadership roles)

The framework is incremental – so assumes those working at tier 2 will have the
competencies identified at tier 1

The framework has been mapped to the National Occupational Standards

Intended for use by managers and service leads: in the recruitment process,
informing commissioning contracts, with individuals in supervision and appraisal, and
to identify learning and development needs.

A training programme was developed based on this competency framework.
4.3.4.11 Dementia Core Skills Education and Training Framework (Department of
Health, 2015)19
4.3.4.11.1 Summary:

National competency framework developed in collaboration by Skills for Health
and Health Education England

Applicable to all staff in the health and care – not specific to mental health

Steered by expert reference and stakeholder groups

Designed to support implementation of the National Dementia Strategy, focusing
on improved awareness, earlier diagnosis and intervention, and a higher quality
of care for people living with dementia.
18
https://www.myhealthskills.com/uploads/articles/files/Dementia%20Comp%20Framework%20VS61432889344.pdf
19
http://www.skillsforhealth.org.uk/images/projects/dementia/Dementia%20Core%20Skills%20Education%20an
d%20Training%20Framework.pdf?s=cw1
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
Describe core skills and knowledge that are transferable and applicable across
different types of service provision, necessary across the health and social care
spectrum

Three tiers identified:
1. Awareness, which everyone should have
2. Basic skills which are relevant to all settings where people with dementia are
likely to appear
3. Leadership

The framework is incremental i.e. Tiers 2 and 3 assume that the learners possess
the skills and knowledge at preceding levels
4.3.4.12 Improving the Dementia Care Pathway Legacy for Acute Hospital Care
(Healthcare for London, 2012)20
4.3.4.12.1 Summary

Regional skills model

Not specific to mental healthcare

Developed through engagement with stakeholders and after consulting existing
pathways and models

Outlines the process, the key elements, the tolls/actions and critical success
factors within the pathway
4.3.4.13 Development of Role, Competencies and Proposed Training for;" Primary Care
Liaison Worker" to Support Pathway to Diagnosis of Dementialix
4.3.4.13.1 Summary:

Report commissioned West Midlands Strategic Health Authority

Based on extensive literature review and focus groups interviews and written
feedback from people living with dementia, their family caregivers and those
working within the dementia care field

Job description, person specification and related competencies for primary care
liaison role developed

7 essential competencies identified

Key characteristics for the role identified

Training and education requirements outlined
20
http://www.londonhp.nhs.uk/wp-content/uploads/2012/09/Improving-the-Dementia-Care-Pathwaylegacy.pdf
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4.3.5
CONFIDENTIAL
Competence frameworks for the delivery and supervision of Psychological
Therapies
The second round of the National Audit of Psychological Therapieslx found that whilst there
have been some improvements since the baseline, including reduced waiting times and
better recording of ethnicity and diagnostic data, there are a number of ongoing areas of
concern. There is still marked variation in performance between services, some therapies
are still being provided by therapists who do not have specific training to do so and older
adults with anxiety and depression are not getting the help they need most.
Clinical psychologists are trained in multi-modal therapies and have a pivotal role in training
and governance of the delivery of psychological therapies.
4.3.6
Competency Frameworks for Unqualified Staff
To date, there is little in the literature which relates to competency frameworks for unqualified
staff (i.e. health and care workers without recognised mainstream health or care qualifications.
4.3.6.1 The Care Certificate Standards (Skills for Care, 2015)21
4.3.6.1.1 Summary:
21

Applicable to non-regulated staff (e.g. nursing assistant, support worker)
working in health and social care

Specific to healthcare assistants and social care support workers

Not specific to mental healthcare

Outlines fundamental skills, values and behaviours needed to provide safe,
effective and compassionate care.

Satisfies Care Quality Commission requirements

Replaces both the National Minimum Training Standards and the Common
Induction Standards. Introduced from 1 April 2015.

From 2016 all NHS-funded student nurses in England will attain the Care
Certificate within their first year of study, if they have not already achieved it.

A wide range of employers and staff were engaged with the testing of the Care
Certificate

Analysis of feedback received indicated that the draft proposals for the Care
Certificate were suitable in terms of content and process.

Based on 15 standards, all of which individuals need to complete in full before
they can be awarded their certificate

Links to NOS
http://www.skillsforhealth.org.uk/images/projects/care_certificate/Care%20Certificate%20Standards.pdf
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4.3.7
CONFIDENTIAL
Competency Frameworks for Clinical Psychologists
4.3.7.1 Clinical Psychology Leadership Framework (BPS, 2010)
4.3.7.2 Summary:

Tool to promote personal and professional development

Sets out framework for leadership behaviour – incremental and cumulative, from
pre-qualification to director levels

Outline the clinical, professional and strategic drivers of leadership at each level

Outlines the combination of skills required to bring leadership, and how these
skills are developed and used at all levels

Within this the clinical, professional and strategic drivers of leadership are
outlined at each level

The Clinical Leadership Competency Framework (CLCF) is mapped to the
Clinical Psychology Leadership Development Framework 2010 (Practicing
Clinical Psychologist)
4.3.7.3 Guidelines and Job Profiles for Clinical Psychologists
4.3.7.4 Guidelines on Activities for Clinical Psychologists (BPS, 2012)
4.3.7.5 Summary:

Guidelines developed to provide clarity to other mental health professionals,
managers and commissioners regarding the roles and responsibilities of clinical
psychologists

Outlines the range of areas of work that will come under the remit of a clinical
psychologist

Makes recommendations about how a local arrangement might be best
developed

Examples of job plans for different grades provided

Recommends that all clinical psychologists have a job plan that is reviewed
annually
4.3.7.6 Older People Psychology Job Planning & Service Planning Guide (NHS, 2013)
4.3.7.7 Summary:

Regional guidelines (Cambridgeshire and Peterborough Foundation NHS Trust)

Evaluates the old age psychological services caseloads of clinical psychologists

Draws on relevant literature, including: Guidelines on Activities for Clinical
Psychologists (BPS, 2012; above), Generic Professional Practice Guidelines,
2nd Edition (The British Psychological Society, February 2008) and Example job
plans for psychological therapists (Greater Manchester West Mental Health
NHS Foundation Trust, June 2010, & Trafford Psychological Therapies, June
2011)
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
CONFIDENTIAL
Considers local variation of services
4.3.7.8 Job Profile of 8a Clinical Psychologist (NHS, 2016)
4.3.7.9 Summary:

Job profile from NHS Jobs

Outlines role and responsibilities

Includes person specification outlining knowledge/experience, approaches and
values required. Skills are required in the following areas:

o
Communication/relationships
o
Analytical and judgement skills
o
Planning and organisational skills
o
People management/leadership/resources
o
IT skills
o
Physical skills
Also outlines the ability to deal with mental and emotional effort and working
conditions of the role
4.3.7.10 Job Profile of 8b Clinical Psychologists (NHS, 2013)
4.3.7.11 Job Profile of 8c Clinical Psychologists (NHS, 2016)
4.3.7.12 Standards of Proficiency for Practitioner Psychologists (HCPC, 2011)
4.3.7.13 Summary:
•
15 generic standards applicable to all practitioner psychologists outlined with a
breakdown of individual indicators
•
Identify standards that are relevant to all professions and within specific professions
– profession specific standards in different colour text
•
Recognises differing scopes of practice – therefore some standards may not be met
4.4 Identifying Candidate Skills – Consultation with Mental
Professionals through Focus Groups
A series of focus groups were convened early in the project to scope current issues and
considerations in delivering psychological practice in mental health care, including some
discussion around the skills required by mental healthcare staff. These focus groups were
attended by over 70 mental health professionals working across the West Midlands region
and are reported in detail elsewhere.
Analysis of the focus group transcripts by the project team identified a large number of
candidate psychological practice skills which could be organised under the following
headings:

psychological assessment;
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
psychological formulation skills;

core communication skills;

core therapeutic skills;

knowledge of psychological theory; psychological interventions;

working with risk;

a team approach to care;

understanding and managing interpersonal dynamics;

clinical supervision;

working with diversity

Self-care for staff.
Skills were allocated to three levels of practice as is most commonly used in psychological
intervention frameworks (e.g. Brechin and Heywood-Everett, 2013). Whilst this initial model
provided a useful framework, it did not accommodate differences between client/diagnostic
groups; there were too many categories of skill for a simple and accessible model and too
few levels of practice to differentiate between the roles and responsibilities of all members of
the mental health workforce. The project team therefore sought collaboration with regional
colleagues to refine the model.
4.5 Collaboration with Expert Reference Groups (ERGs)
The project also established Expert Reference Groups (ERGs) consisting of Clinical
Psychologists working in secondary care mental health services (Clusters 3-21) across the
West Midlands. The main responsibilities of the ERG’s were to

consider the evidence generated by the research team;

support the development of the care cluster skills framework

Ensure that the project outputs are transferable to the local Mental Health Trusts.
Further input was sought from National experts and multidisciplinary colleagues.
The combined input from across the region and beyond has meant that the consultation
approach has resulted in over 1000 Years of clinical experience feeding into the project.
Development of the model subsequently harnessed expertise from clinical psychologists
working across the West Midlands. Three Expert Reference Groups (ERGs) were convened,
each responsible for developing one of the models. The groups comprised psychologists
working in each area of specialism, and representation was sought from all seven regional
Secondary Care Mental Health Trusts.
The groups met four-five times from October 2015 to June 2016 with additional input through
email. The groups reviewed and commented on the developing skills models and training
recommendations, considered evidence generated by the Project Team, and advised on
literature searches, dissemination and promotional material. A key role of the ERGs was to
work collaboratively to ensure that the project outputs were transferable and applicable
across the Region.
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Prioritising Important and Specialist Skills
At the first ERG meetings, the members performed a ‘skills sort’ based on Q sort methods
(Van Exel & de Graaf, 2005) as outlined below. The aim was to start to structure the large
set of candidate skills identified in the focus groups to develop a typology of skills, and to
organise according to priority/importance, relevance to the three areas covered by the
models (severe and complex mental health: Care Clusters 3-8; psychosis: Care Clusters 1017; dementia: Care Clusters 18-21) and applicability across the workforce (generic skills
versus specialism and expertise). The skills sort exercise allowed active collaboration with
the ERGs, to ascertain their views without imposing the views of the project team.
4.5.2
Development of the Q Set
4.5.2.1 Construction of the concourse
The Project Team constructed the ‘concourse’ (possible statements about the skills required
to deliver secondary mental healthcare) from the initial draft model, supplemented by
consultation with leadership and review of the literature (e.g. Brechin and Heywood-Everett,
2013; NICE guidelines, and existing competency frameworks).

All possible statements about the skills required to deliver secondary mental
healthcare were collated through focus groups with mental health professionals,
survey of mental health professionals, consultation with leadership and literature
review (NICE guidelines, Brechin and Heywood Everett Briefing Paper (2013), and
existing competency frameworks e.g. CORE) to establish the current verbal
concourse

The gathered material represented existing opinions – things which representative
organisations, professionals, and academics considered important for mental health
care. The verbal concourse formed the raw material for the Q sort.

The sample consisted of a list of psychological practice skills that may be important
for secondary mental health care.
An extensive list of candidate skills was developed, from which a sample was selected which
formed the raw material for the Q sort.
4.5.2.2 Selection of the Q sort sample items
Owing to the large number of skills cited across the sources consulted, the Q sort focussed
on core psychological practice skills and excluded those considered intermediate- or highlevel and which specifically related to the delivery of psychological therapies in the form of
condition-specific or complex interventions.
Thematic analysis (Braun & Clark, 2006) was used to conceptualise the concourse and to
develop a structure for selection of the sample. Fourteen categories of skills were identified
(largely based on those included in the initial model); therefore, the sample was selected to
include as much breadth as possible and to cover all 14 categories. Some single skills were
amalgamated and similar statements were removed. This process was informed by the
clinical experts on the project team (JB and GF).
A representative (subset) sample from the concourse of 60 statements was selected to form
the Q-set. The aim was to have a Q-set that was representative of the wide range of existing
opinions on the topic to provide a balanced set of statements, but whilst ensuring that the
sort would be manageable within the timeframe of an ERG meeting. Each statement was
assigned a random number.
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The Q Sort
The Q sort was completed independently by the three ERGs. The group members
(respondents), working as a group, rank ordered the statements from most important to least
important based on how important each skill was for all mental health workers to deliver
mental healthcare to the Care Clusters under consideration (3-8, 10-17 and 18-21). The
respondents were asked to consider all client-facing, clinical professionals when deciding on
where to rank each skill, including clinical psychologists, trained therapists, counsellors,
nurses, occupational therapists, social workers, support time and recovery workers, and
support workers.
The Q set was given to the respondents in each group in the form of a pack of randomly
numbered cards with each card detailing one skill from the Q set. A score sheet was
provided with the suggested distribution for the Q sorting task. The score sheet presented a
continuum ranging from least important to most important with 10 levels, from -5 to +5, and
with a relatively flattened distribution. The respondents were asked to first read through all of
the statements to get an impression of the type and range of skills purported to be relevant
to mental healthcare. The respondents were then instructed to begin with a rough sorting
while reading which was later refined through further discussion and using the
recommended distribution. Flexibility was allowed in the use of the recommended
distribution and blank cards were available for the respondents to add in skills. Respondents
were also encouraged to annotate the cards to give more subjective and contextual meaning
to them.
Notes were taken during the sort to record the verbal discussion and sorting behaviours
(these are detailed in the minutes of the meetings). The respondents were encouraged to
elaborate on the reasons for their choices, including the most salient statements: those
placed at both extreme ends of the continuum on the score sheet, as well as more
ambiguous ratings. In this way, respondents were interviewed during the sort. These notes
were used to help the interpretation of the results.
The raw results of the sorts are presented in Appendix 12.2 The raw results and notes taken
during the sorts were analysed by the project team (GU, JB & GF) to start to develop a
typology of psychological practice skills (see Appendix 12.2.3; 12.2.4). Draft typologies were
developed for the severe and complex mental health and dementia models which were then
reviewed by the relevant ERGs to refine the typologies into categories of skill and tiered
framework to be used in the models. The psychosis group considered the results of their sort
alongside the developing typology and framework to check for consistency. The ERGs
agreed on six categories of psychological practice skill, with six levels of practice and
identified some specific skills and skills sets as priority
4.6 Consultation with Multi-Disciplinary Colleagues and National
Representatives
The draft skills models were reviewed by multi-disciplinary team members, working at all of
the identified levels of practice to sense-check and ensure that the models were reflective of
current working practices.
Some National representatives were also consulted in the development of the models, but
further consultation with national experts will be important to further refine and develop the
skills models.
There is a need for wider consultation with colleagues from other disciplines, including
psychiatry, and also with carers and people who use mental health services or ‘experts by
experience’ in order to develop and test models further.
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5 Identification of Stressors for Staff and Development of
Skills Model
The Focus Groups highlighted high levels of stress amongst NHS staff and the focus group
data was explored in more detail to identify stressors. NHS staff sickness absence is 27 per
cent higher than any other public sector organisation and is 46 per cent higher than the
average for all other sectors. Over the last five years, ambulance and mental health trust
staff have had the highest rates of sickness absence (see
http://www.qualitywatch.org.uk/indicator/nhs-staff-sickness-absence ).
In the 2014 NHS staff survey, 39 per cent of respondents reported being unwell from workrelated stress in the last year and only 41 per cent felt that their Trust valued their work. A
recent survey by the Royal College of Nursing revealed widespread problems relating to
work-related stress linked to workload, bullying cultures and experience of violence and
aggression from service users and carerslxi. However, staff health and well-being is
associated with improved patient outcomes.
The Francis Report (2015) highlighted the need for culture change in the NHS as a result of
the lessons learnt from the inquiry of failures in the quality of care at Mid Staffordshire
Hospital. A chapter of this report relates to ensuring that healthcare staff are trained and
motivated. The report recommends building a culture of compassion that values and
supports staff and highlights the relationships between staff wellbeing and the delivery of
effective, safe and compassionate care. Effective leadership and staff engagement are
implicated along with values-based selection and recruitment to NHS posts and preregistration courses. However, further detail on effective methods for training and supporting
staff is not provided.
NHS organisations need to promote staff health and well-being and consider the effects of
stress. A recent report from the Point of Care Foundation (2014)lxii calls for NHS
organisations to make supporting staff central to strategies to improve patient care,
productivity and financial performance. The authors draw together expertise from and
advisory group, information from case studies and literature reviews, and a survey of 52
NHS chief executives in 2013. They suggest that staff engagement varies widely across the
NHS with poor levels in some areas, however, it can be developed and nurtured by
organisations and can have a direct impact on staff performance. Employee engagement is
cited as the best predictor of positive NHS Trust outcomes. Despite evidence of stress
amongst NHS staff, a recent survey found that fewer than half of NHS Trusts had a plan or
policy to promote staff well-being (Royal College of Physicians, 2015, cited in Kings Fund
Briefing). Staff engagement has been measured by the annual NHS Staff Survey since
2009. Engagement tends to be higher among managers than frontline staff.
A recent, large-scale programme of researchlxiii provides evidence that NHS staff health,
well-being, support and management were highly variable, but directly relate to patient
experience, safety and quality of care (Dixon-Woods et al, 2014). The authors call for NHS
Trusts to improve ‘organisational systems and nurture caring cultures by ensuring that staff
feel valued, respected, engaged and supported’ (p. 106) and that this will result in improved
patient outcomes.
A literature review was undertaken to identify journal publications pertaining to stress or
resilience amongst staff working in mental healthcare settings. The primary objective was to
identify sources of stress with a secondary aim of identifying effective interventions,
organisational features or workplace conditions that ameliorate stress or build resilience
amongst staff.
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NHS organisations need to prioritise staff health and wellbeing in the long term. Staff health
and wellbeing needs to be championed by senior management. More managers need
support to identify stress and ‘burn out’ earlier, as fewer than half of NHS managers say they
have ever received training, and managers need to have the available resources to act. Most
importantly, staff need to feel that they can influence their work experience, engage with
their organisation and feel that their feedback is valued.
Between 2003 and 2013, there was a 2% decline in the number of full-time equivalent
mental health nurses, with some Trusts cutting staff levels by more than 10% (Royal College
of Nursing, 2014, cited in Kings Fund Briefinglxiv). A briefing from the Kings Fund (2015) also
highlights that integration and decommissioning of generic and specialist community teams
has led to an overall decrease in staff, with specialist such as psychologists being spread
more broadly across teams. The Royal College of Nursing (2014, cited in Kings Fund
Briefing) highlighted that reductions in the workforce have resulted in widening the gap
between the service needed by users and the service that are available.
High caseloads impact on staff morale and many issues faced by staff and service users
relate to a lack of properly trained staff, with insufficient time to treat service users
sensitively, with patience and empathy.
There are significant challenges in meeting the workforce requirements in social care. A
number of studies have highlighted a shortage of social workers in mental health services
(Crosidale-Appleby 2014; Clifton and Thorley 2014, cited in Kings Fund Briefing op. cit.).
Furthermore, questions have been raised about both the quality of candidates coming
through and the quality of social work education, with fewer than 8 per cent of students
completing a placement in a mental health setting. The role of social workers within
integrated teams has been denigrated, with many feeling devalued and de-professionalised
(Clifton and Thorley 2014). In a study of staff morale in the mental health workforce, social
workers scored significantly higher than other staff on emotional exhaustion (Johnson et al
2012) and the annual NHS Staff Survey in 2013 showed that social workers in mental health
trusts suffered the highest recorded level of work-related stress since the survey started a
decade previously (McNicoll 2014).
5.1 Methods
The focus group transcripts were analysed to identify material relating to staff stress,
primarily to identify stressors for staff, but also to generate ideas for how stressors could be
overcome.
Each focus group transcript was scrutinised for any text relating to staff stress.
Relevant text was copied and posted into a table, organised according to the focus group
from which it was taken. Brief descriptors were generated for each quote which were then
considered, along with the text, to generate themes.
6 Results and Discussion
This work incorporates the development of a skills component to meet the needs of people
living with severe and complex mental health problems, psychosis and dementia. This
component aims to differentiate skills according to levels of practice; to prioritise skills for
development and to consider client and other service factors that affect clinical practice.
Allied to this is the need to identify the organisational conditions required to ensure that
training is delivered within a service/team environment that is conducive to skills
development. Central to this is identifying the necessary support mechanisms to ensure that
skills taught are transferred into practice. This requires a systems approach to support the
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multi-disciplinary delivery of psychological practice and to enable the wider mental health
workforce
6.1 Categories of Psychological Practice Skill
Six categories of psychological practice skills were identified and short descriptors are
provided for each. It was felt that these six categories could accommodate all the skills whilst
providing a simple framework.
6.1.1
Communication, relationships and inter-personal skills:
These skills reflect being able to communicate effectively with a range of people on a range
of different matters, in whatever form that communication takes (verbal, non-verbal, spoken,
written). This includes skills in understanding what others are communicating, skills in
expressing oneself, and skills in establishing effective relationships. Progression of this skill
is characterised by developments in the complexity of the subject matter, situation/context,
purpose, number of people being communicated with, diversity/difference, and potential
impact.
6.1.2
Assessment and formulation:
Assessment is the process of gathering relevant information and data in order to help
understand a problem. Formulation is the process of using this information to inform an
intervention plan, whatever form that may take. Assessment and formulation are core
aspects of psychological work, and are normally ongoing processes rather than one-off
events. As such, there are different levels of skill appropriate to different purposes and
contexts. Increasing skill in this domain reflects greater ability to be able to access and
synthesise information from a range of sources.
6.1.3
Intervention:
Intervention can take many forms, but should always be underpinned by a level of
assessment and formulation. However, it is possible that the person who carried out an
assessment and provided a formulation may not be the person delivering the actual
intervention, which allows for flexibility in skill mix within teams. Intervention is commonly
with individuals, although may be in a couple, group or system context. Intervention may not
always be in the context of a formal therapy relationship, but may take place in more
informal or implicit ways, especially at lower levels. For each level except level 1, there is an
implicit assumption that the professional staff will be expected and able to advise, guide, and
supervise the work of those in lower skill levels.
6.1.4
Psychological knowledge and awareness:
This domain is about having the underlying knowledge and awareness of psychological
theory, psychological processes, and psychological understanding of mental health to
enable effective working. Although all of the dimensions of the model are closely interrelated, this dimension in particular underpins several of the other dimensions. For instance,
the ability to communicate information rests on having an understanding of that information;
the ability to assess, formulate and intervene depends on having sufficient knowledge in
order to do so. Increasing skill in this domain is reflected by having higher levels of formal
education, more in-depth training, and accreditation in specific areas of psychological skill,
and higher level critical thinking.
6.1.5
Professional development, supervision and training:
Professional development and training includes taking responsibility for one’s own continued
skills and knowledge development needs in relation to psychological practice, which may not
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be already adequately specified by the minimum standards for different professional groups.
At higher levels, there is the expectation that training will also include an ability to train
others. Supervision is included here both from the perspective of being able to receive and
utilise supervision, and also the ability to offer and deliver supervision to those at lower
levels.
6.1.6
Intra-personal skills, self-care and psychological mindedness:
This domain is about skills in relation to one’s own mind and wellbeing, both on a
professional and personal level. A basic level of skill in emotional intelligence underpins skill
in all of the other domains, particularly communication with others (interpersonal skills).
However, increasing levels of this skill reflect greater ability to be aware of one’s own
thought processes and emotional reactions, including being able to choose how to respond
in challenging situations rather than simply reacting, but also being able to access and use
this information within supervision and in the moment with people with whom they are
working. Self-care is also included here as an important component of being able to apply
psychological skills in challenging environments whilst minimising burn-out and reduction in
effectiveness.

Key themes which emerged from thematic analysis included:
o Basic identification and self-management of one’s emotional states
o Understanding links between and impact of own and others’ emotional states
and behaviour
o Enhanced self-reflection abilities
o Supporting self-reflection and self-care for others
o Advanced supervision skills
o Understanding stress in teams and building resilience
o Identifying and addressing systemic sources of stress in services and
organisations
6.2 Levels of Psychological Practice
Six levels of practice, of increasing specialism and expertise, were identified. Not all six
levels of practice may be applied to each category of skill; levels of practice are differentiated
only where there is a significant difference in the skills required at each level. The levels of
practice are additive so that the skills at level 1 are relevant for all client-facing, clinical staff,
those working at level 2 have enhanced skills at level 1 plus those specific to the higher level
and so on:
Level 1: All client-facing, clinical staff. Psychological awareness
Level 2: Qualified mental health professionals (any graduate-level healthcare
professional without further accredited training in delivering psychological therapies)
Psychologically-informed healthcare; delivery of evidence-based assessment
and intervention
Level 3: Qualified (uni-model) psychological therapists (any graduate level
healthcare professional with post-graduate accredited training in delivery of
psychological therapies e.g. Masters or Post-Graduate Diploma) Delivery of
evidence-based (uni-model) psychological assessment, formulation and (uni-model)
therapy
Level 4: Clinical ‘psychologists’ (healthcare professionals using multiple models,
including clinical psychologists, counselling psychologists and psychotherapists
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Delivery of specialist assessment and formulation and (multi-model)
psychological therapy
Level 5: Principal psychologists
Delivery of specialist assessment and
formulation and complex psychological therapy, and identification of need and
appropriate resource
Level 6: Lead psychologists Delivery of organisational-level intervention, staff wellbeing and competency initiatives, local and national service development and
clinical governance
6.3 Aligning to Client-related/Service Factors
Each of the three models took a different approach to address client- and service-related
factors. Consideration was paid throughout the development of the models for whether
recommended skills profiles differed when working with different client groups or in different
service contexts.
'For the dementia model, the skills described reflect the range of contexts in which services
are delivered and the changing cognitive capacity of people living with dementia as they
progress along the dementia care pathways provided by those services. The dementia
model is therefore divided into subsets for the skills required for working with people before
and after diagnosis of dementia is given, how to help people live well with dementia,
including how to maintain and improve cognitive function; working with stress, anxiety and
depression experienced by people with dementia and their families; providing person
centred care; working with psychological and behavioural signs of distress and providing
sensitive end of life care
Initially, the psychosis model was subdivided to reflect skills required in delivering care to
clients with first episode psychosis, ongoing or recurrent psychosis and severe and enduring
psychosis. However, review of the draft model indicated that there was little differentiation in
the skills required so no subdivisions were used in the model.
Similarly, the model leads and ERG felt that subdivision was not necessary for the severe
and complex mental health model. Moreover, this model was initially restricted to care
clusters 5-8, but was later broadened to include care clusters 3 and 4 as the skills required
to deliver psychological practice are similar across all these care clusters.
The model focuses primarily on community services and does not consider crisis and acute
(inpatient) services. However, elements of the skills may be applicable across these services
and beyond. The model predominantly refers to client-facing clinical staff, however, the
importance of non-clinical, client-facing staff engaging in psychological practice and having
access to training is recognised. Non-clinical, client-facing staff are defined as those in
supporting roles that do not directly provide healthcare, such as call handlers, receptionists,
administrative and support staff. Trusts should consider that all staff are trained to at least
skills level 1 as reflected in the skill component of the models
6.3.1
Embedding psychological practice skills in existing training courses
As highlighted in the approach and methods a cluster specific model is being developed
from the research. Project outputs are evidence based and aimed at making most efficient
use of staff development resources. A key message from our scoping exercise is that there
is no significant demand for additional training courses as there are numerous training
initiatives across the region. The identified needs were multi-faceted and included the need
for training to be embedded in clinical practice and tailored to the needs of service providers
and service users.
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Developing staff resilience
In terms of client and other service factors that affect clinical practice, focus group
participants identified conflict between the realities of clinical practice and expectations
placed on staff. In response to this key theme the project team have reviewed the literature
on staff stress and resilience and developed a staff stress model that considers sources of
stress, impact of stress and solutions to stress.
6.3.3
Integrated multi-disciplinary development of psychological practice skills
Another consistent theme pointed towards more effective inter-disciplinary working with
psychologists integrated in clinical teams. This approach involves staff working as part of a
multi-disciplinary team having an awareness of the principles of psychological practice and
the confidence and opportunity to contribute to the psychological wellbeing of service users,
based on the principle that psychological interventions are not limited to the therapy room
and that recovery support workers, mental health nurses and other professionals have a part
to play in the therapeutic process when working closely with clinical psychologists.
The model does not develop/deploy learning and & development programmes directly, but
will provide resources to help Trusts and other organisations to do this themselves.
In terms of the workforce development model psychological practice refers to all elements of
psychologically-informed healthcare. This includes direct and indirect communication with
service users and colleagues, and refers to a variety of qualities including: effective
communication, relationship and inter-personal skills; psychological knowledge and
awareness; psychologically informed assessment and formulation of presenting problems
and psychological interventions and therapy. This occurs within the context of continued
professional development and clinical supervision; self-reflection, self-care, and
psychological mindedness. Whilst psychological practice is the foundation of all secondary
mental healthcare, the models of psychological practice presented in this model focus
specifically on the psychological components of healthcare delivery. This model of
psychological practice complements the range of generic competency frameworks and skills
models that are already available, and which cover all aspects of healthcare delivery, but do
not necessarily provide specific detail on psychological practice.
7 Skills Transfer Requirements:
The premise of this component is that changing clinical practice does not and cannot occur
through providing theoretical and skills-based training to clinical staff alone. It requires
placing the desired staff behaviour change within an organisational context that addresses
the means by which the current clinical skills are ‘triggered’ and maintained in practice, and
how those means need to be redesigned to ensure that the new, desired skills are triggered
and maintained. Thus the means by which ‘the way we do things around here’ is embedded
in our paperwork, supervision systems, management conversations and scrutiny and
governance systems.
As these issues are worked through in designing this ‘up-skilling’ project, it has become clear
that the clinician operates within a web of supporting, enabling and blocking processes that
will be critical to ensuring that the path to change in clinical practice and better outcomes for
patients/service users is as smooth as possible. This journey is described in terms of
‘preparation’ prior to any training, the design features of transfer to be incorporated into
training and the ‘post-training’ processes for consolidation and maintenance of new skills.
The three key stages are:
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7.1 Stage 1: preparation what do we want to achieve and what is in
it for me? This stage includes:
7.1.1.1 Goal-setting:

Align training objectives with organisational goals – identifies learning outcomes
in terms of new behaviours, attitudes, and knowledge for staff as well as for
teams/services;

Link training objectives to specific organisational goals and values

Make this link visible – show that the training matters
(Anderson 94; Brannick and Levine 02; Brown 02; Salas et al 2009; Crawford-Docherty 13)
7.1.1.2 Support:

Provide organisational support for the training initiative – obtain practical and
symbolic commitment and ensure that all stakeholders are on board with the
initiative (senior leaders and managers)

Demonstrate that there is support and commitment to line managers, staff and
service users e.g. through new/amended policies

Determine required resources and time commitment for the project and ensure
their availability, including trainees having adequate time to participate in training
and engage with post-training consolidation processes
(Goldstein and Ford 02; Greenhalgh et al 04; Salas et al 08, 09; Kirwan 09; CrawfordDocherty 13)
7.1.1.3 Motivation:

Get frontline clinical leaders on board – find one frontline clinical leader who is
committed to and enthusiastic about the initiative;

Provide positive reinforcement (verbal praise and public recognition) for that
commitment - lead by example; always show don’t just tell.

Engage clinicians, clinical leaders and line managers as early as possible in
conversations to promote commitment and participation

Hold clinicians and managers accountable for achieving training goals through
setting of realistic change targets and means by which to monitor progress
against them
(Rouiller and Goldstein 93; Tannenbaum and Yukl 92; Greenhalgh et al 04; Kirwan 09; Salas
et al 09; Crawford-Docherty 13)
7.1.1.4 Warm-up:

Prepare environment and trainees for training – set right expectations (e.g.
provide relevant information about training, myth-bust) before training to
demonstrate value to clinician, service and service user, communicate what it is
and is not; ensure clinicians brings service users in mind to training
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
Develop training course and materials collaboratively with trainers, managers and
clinicians to reflect local context of work e.g. local language, team configurations,
means of staff release etc.

Select trainers based on expertise and ‘lived professional experience’ of teams
from which trainees will be selected, ideally reflecting all disciplines from which
trainees will be selected

Design skills practice and supervision as well as applied theory into training
delivery

Design ‘transfer tasks’ for use during and after the training course e.g. assessed
case studies of skills in practice

Make required changes to clinical records infrastructures e.g. codes on electronic
records for new interventions, sections in records for new forms used with service
users (e.g. thought diary sheets for CBT)

Make required changes to management and supervision structures e.g. allocate
clinical staff to clinical supervisor to consolidate skills during and after training,
add training transfer to operational management agendas, set appraisal goals,

Develop and set in place audit systems for monitoring transfer into practice (e.g.
audit entries in care records and careplans), so enabling demonstration of
accountability

Select appropriate staff for training – start with most motivated and committed as
they will become ambassadors for the training within their teams

Develop training contract, agreed between trainee and manager as to what new
contribution the clinician will make as result of training and what support the
manager will provide to enable this
(Cannon-Bowers et al 98; Rall, Manser and Howard 00; Greenhalgh et al 04; Meyer et al 06;
Kirwan 09; Salas et al 09; Crawford-Docherty 13)
7.1.2
Stage 2: Delivering the training:

Relevance – all aspects of the training to be delivered in the form that clinicians
will use directly with their service users, thus ensuring its ‘ready to go’ with no
need for translation

Training addresses real-world clinical situations and service users

Training draws on real-world systems within which clinicians will work e.g.
assessment tools, record-keeping systems

Training incorporates interventions targeting knowledge, skills practice and direct
feedback and supervision/reflection

Training incorporates ‘transfer assignments’ e.g. workbooks, case-studies, that
require clinicians to use their skills whilst on the training course and immediately
afterwards

Clinicians prompted to think about and practice with specific service users in mind
during the course
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Clinicians supported to develop new ways of recording their new practice in
clinical records and careplans, and reporting on their use of new skills in
accordance with decisions made in stage 1
(Walker 01; Glen 04; Greenhalgh et al 04; Meyer et al 06, 07; Griscti and Jacob 06; Kirwan
09; Crawford-Docherty 13)
7.1.3
Stage 3: Post-training – consolidation and maintenance of new practice

Provide opportunities to practice through assisting clinician with the selection of
cases with which to start using new skills

Establish positive climate to use new skills through positive interest and
reinforcement proactively shown by line and clinical managers, especially for effort in
trying to use new skills

Clinical supervision models to directly reflect skills development e.g. CBT supervision
if skills development is CBT skills, SFT if SFT etc.

Provide appropriate level of practice support for each clinician e.g. joint work with
clinical psychologist in team, individual supervision reflecting frequency of contact
with service users with whom new skills being used, less frequent supervision as
clinician becomes more confident and skills become more consolidated

Monitor attendance at practice support (e.g. supervision, joint work etc.) to show it
matters

Audit use of skills in practice in accordance with system designed in stage 1. Provide
regular positive feedback and address any issues of transfer falling away.

Measure effectiveness of training programme – assess training on multiple levels
(reactions, learning, behavioural change, organisational impact) - use data from
evaluations to refine future training initiatives
(Kirkpatrick 76; Lim and Johnson 02; Greenhalgh et al 04; Salas et al 06 07, 09; Meyer et al
07; Kirwan 09; Crawford-Docherty 13).
7.1.4
Conclusions

For clinical skills development programmes to benefit service users, effective transfer
processes must be designed and implemented

Transfer mechanisms need to be integrated into all stages of a skills development
programme: preparation, training delivery, consolidation and maintenance
8 Development of the Interactive Digital Platform
8.1 Building the Workforce Model
Agreement has been reached that the model will be hosted on Health Education West
Midlands website initially and accessible to key stakeholders/end users across the region.
The project team have now completed a detailed scoping exercise across the various work
streams and have developed a comprehensive project plan to build the end user products
with a completion date of 30th September 2016.
The product plan incorporates the three main elements of the project:
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Workforce psychological practice and skill levels

Skills transfer

Research data base
CONFIDENTIAL
To date the components of the model have been represented in a one-dimensional paper
format. When adapted to a digital format, the product will be multi-dimensional, user friendly
and easy to navigate. The content will contain information that is accessible and relevant to
a wide variety of users. As well as the practical end user products, users will also be able to
drill down to access the underpinning research and findings.
The ERGs advised on the framework, organisation and display of the models. The aim was
to develop simple models, but which provided sufficient detail to guide managers and service
leads in staff organisation and development, as well as to direct the development of training
initiatives. The models were therefore presented on an interactive digital platform to allow
users to access appropriate levels of information in a simple and visually interesting way.
8.2 Format and Framework
8.2.1
Representation of skills

Same structure across all categories of care cluster to provide consistency

Segments of circle for categories of skills

Click and hierarchical pyramid model to indicate levels of practice

An additive structure indicating that all skills in lower levels are enhanced in higher
levels, in addition to the skills specified at that level. Shading used to indicate this

Layers of increasing detail and complexity – to appeal to a variety of users and uses

Different ways to access the material – different indexes – for example, look at
everything relating to category of skill or everything relating to service/client or
everything relating to level of practice

System to highlight prioritised skills such as communication skills
8.3 Components of the skills models
The diagram below provides an over-arching schematic representation of the three
psychological practice cluster skills models; in terms of the 6 domains of clinical practice
(including sub-domains for the dementia Care Cluster 18-21 model) and the 6 levels of
psychological practice.
Within each of the 6 broad domains of clinical practice for each of the 3 care cluster models,
individual psychological practice skills have been grouped in skill categories where possible.
This material will be accessible via the PROMPT website.
Figure 4 Schematic diagram of psychological practice skills models
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‘Live platform’ – to be updated and refined – models to be continued to be developed?
Potential limitation owing to host site?
9 Evaluation of the model
The workforce model will be piloted initially across an agreed sample of the 7 Mental Health
Trusts across the region.
The West Midland regional ERG’s are positioned to be part of an on-going system of quality
monitoring and enhancement. The premise being that the model can be adapted, grown and
rolled out nationally.
Measurement of the dividends of the model through a methodology framework that is cyclic
covering the different levels -organisation, individual and team needs to be developed in
order for the model to grow, adapt and have longevity.

The first level can use existing data which is captured by Trusts to avoid duplication
relating to service user and staff surveys, training including demographics, attendees
and staff health and wellbeing measures and established key performance indicators
regarding clinical outcomes.

The second level would need to be more data specific relating to changes to clinical
practice and service delivery.
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9.1 Benefits Realised
A key benefit of this model will be an ability to grow, adapt and transfer across other
disciplines.
Embedding the model will be fundamental to realising the collective benefits set out in the
contract as:

At a service level- outcomes enhanced health and wellbeing and improve safety,
quality, experience and satisfaction

At a workforce level-enhanced multi-disciplinary working, role clarity, staff satisfaction
and good being

At an organisational level-enhanced efficiency and truly integrate ways of working

At regional level-outcomes enhanced the health and to maximise value and spend.
9.2 Summary
In conclusion, the project team are in the end delivery phase, finalising the components of
the workforce model and developing the end user products to be showcased through HEWM
website. We have now completed a detailed scoping exercise across the various work
streams and have a comprehensive technical plan to build the end user products by the end
of September 2016.
The project team are confident that the end products are firmly grounded in the evidence
base and when implemented will provide the means of achieving desired outcomes in terms
of a better return on training investments, more effective multi-disciplinary team working for
the delivery of psychological practice and improved patient/client clinical outcomes.
The processes that the project team have used to develop the model have been
commended and are attracting regional and national attention. The research will result in a
number of publishable papers for peer review.
10 Sustainability and Further Work
10.1 Recommendations for further work: Next Steps
10.1.1 Dissemination plan
Developing a plan for dissemination of project outputs e.g.
a. Within the host Trust
b. Within West Midlands
c. Health Education England
d. Nationally re: professional organisations e.g. British Psychological Society,
British Association of Behavioural and Cognitive Psychotherapy, Royal
College of Nursing etc.
e. Professional conferences and meetings/roadshows
f.
Launch event in October 2016
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g. Social media publicity (e.g. Twitter, YouTube, Facebook, radio/TV etc.)
h. Publication in professional journals (e.g. Health Service Journal; The
Psychologist; Clinical Psychology Forum etc.)
10.1.2 External Reference Group for further development
a. Link with key national and local stakeholders e.g. commissioners, Kings Fund, mental
health leads (local and national) External Reference Group of potential end-users of the
project from a mix of clinical, provider manager and commissioning manager
perspectives.
b. Continue to develop and test the models with a wider group multidisciplinary colleagues
– particularly from psychiatry and nursing backgrounds
c. Link with service users (local and national groups) and experts by experience to further
develop models
d. Set up a group to review the models and refine. Incorporate best practice as it emerges.
To sign off changes to content and receive/consider change requests. Changes
managed by a Health Education England site administrator - possibly consisting of
existing ERG members.
e. Recommend that ERGs are ongoing as means of sharing good practice across
region/end user testing and evaluation of products
10.1.3 Pilot site implementation
Development of further pilot site(s) for implementation of project outputs to upskill the
workforce in psychological skills building on the learning from two existing
pilot/Implementation groups established as part of this project (consisting of initial facilitated
workshop and 1 follow up meeting)
a.
Developing an implementation plan for robust skills transfer
b.
Development of Action Learning Sets
c.
Training – link with Group of Trainers in Clinical Psychology and other
relevant training organisations for workforce
d.
Evaluation e.g.
i.
Impact on service user wellbeing
ii.
Staff wellbeing
iii.
Performance indicators
iv.
Risk indicators (e.g. serious untoward incidents)
10.1.4 Extending the scope of psychological practice skills models
The skills models can be extended and developed to meet the needs of a wider group of health
and care needs. For instance, services relating to children and young people, people with long
term conditions and physical health morbidities.
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In addition, the psychological practice skill needs of staff in other public (and independent)
sector agencies (e.g. education, local authority, criminal justice, public health etc.) should be
identified and the existing models adapted to be fit for purpose in these arenas.
10.1.5 Workforce planning
Link to workforce planning and estimate the number of psychological practitioners at various
levels in terms of estimates of population need, training places and workforce profile and
associated costs.
a.
Development of practical tools to assist providers and commissioners in this task
11 Expanding areas of demand for psychological practice
skills
A recent collaborative piece of work between the Information Services Division (ISD) of NHS
National Services Scotland (NSS) and NHS Education for Scotland (NES)lxv noted "recent
years have seen an unparalleled demand for increased access to Applied Psychologists and
Psychological Therapies. A demand from both patients and professionals has arisen due to
the ever increasing evidence base for psychological interventions".
11.1 Cost-effectiveness, delivery and development of the
psychological practice evidence base
A recent Briefing Paper from the British Psychological Society for commissionerslxvi
highlights areas of good practice where clinical psychologists can offer cost-effective service
delivery in terms of direct psychological interventions and supervision and management of
other professions delivering psychological therapies. Clinical Psychologists' assessment,
formulation, intervention and evaluation skills help to ensure appropriate targeting of
therapies and can assist teams in management of care in mental health and physical health
settings. The roles of clinical psychologists in delivering and developing health and care
models of psychological practice is further expanded in Appendix 12.3
Clinical psychologists' training enables them to act as multi-modal rather than single
modality therapists. However, their training uniquely enables them to function at various
levels of work in the organisation. In addition, they are trained to apply their knowledge in
systematic methods and practice which are scientifically evaluated to test clinical practice for
its effectiveness. Clinical psychologists have doctoral level training in scientific research
methods and analysis and can play a key role in developing the evidence base for
psychological practice and contributing to service innovation and re-design.
11.2 Payment by Results and Care Clusters: Psychological
components of care packages
Brechin & Heywood-Everett (2013)lxvii identify the psychological components of each care
package within the national Mental Health Payment by Results (PbR) programme in relation
to the20 individual care clusters which are differentiated in terms of presentation, severity
and duration of care to specify the care package needed to meet the needs of service users;
based on NICE recommendations and best evidence-based practice. This paper
recommends a framework by which psychological work is defined and understood based on
the type and level of skill required to deliver a particular psychological behaviour within each
package of care. It primarily focuses on three levels of practice/intervention: generic
intervention, condition specific intervention and complex interventions. This links to previous
work on care packages and pathwayslxviii
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11.2.1 Generic interventions
These interventions are targeted at populations of people (e.g. people with mental distress)
where broad psychological principles from generic psychological theories are applicable to
large groups of people. This level covers low intensity interventions within the IAPT
framework.
11.2.2 Condition-specific interventions
This level of practice involves the application of specific psychological theories for the
amelioration of specific conditions (e.g. cognitive therapy for depression), and encompasses
manualised treatment approaches. This level covers the high intensity interventions with the
IAPT framework.
11.2.3 Complex/Multi-modal interventions
This level of practice involves the application of theories which go beyond addressing a
specific condition/diagnosis, and allow for a more detailed understanding of the personal
meaning of experiences. Practitioners at this level may be working in an integrative
approach, calling upon different theoretical perspectives as appropriate. This level of working
is appropriate to step 4 work.
There are some limitations in the National Institute for Health and Clinical Excellence
approach to reviewing evidence as many RCTs (Randomised Control Trials) exclude people
with complex co-morbid conditions although these are frequently encountered in routine
clinical work. Therapist competence and therapeutic alliance account for much of the
variance in terms of treatment efficacy and the RCT threshold may exclude interventions and
therapies based on more complex formulationslxix which integrate relevant interpersonal,
biological, social and cultural factors.
Service users should receive psychological interventions from practitioners who are suitably
qualified, trained and supervised to deliver these interventions and there is a need to
recognise the different levels of competency related to the delivery of psychological
interventions. Indirect psychological work involving training, supervision and consultation to
the multidisciplinary team needs to be valued and measured as clinical activity.
Clinical psychologists are well-placed to provide clinical leadership within the IAPT
(Improving Access to Psychological Therapies) programme.
11.3 Clinical Health Psychology, Public Health and Prevention and
Long Term Conditions
Many people with long-term physical health conditions also have psychological problems.
These can lead to significantly poorer health outcomes and reduced quality of life.
People with long-term physical health conditions – the most frequent users of health care
services – commonly experience mental health problems such as depression and anxiety, or
neurodegenerative disorders such as dementia in the case of a proportion of older peoplelxx.
As a result of these co-morbid problems, the prognosis for their long-term condition and the
quality of life they experience can both deteriorate markedly. In addition, the costs of
providing care to this group of people are increased as a result of less effective self-care and
other complicating factors related to poor psychological well-being. People with long-term
physical health conditions could also have mental health problems. These can lead to
significantly poorer health outcomes and reduced quality of life. Costs to the health care
system are also significant – by interacting with and exacerbating physical illness, co-morbid
mental health problems raise total health care costs by at least 45 per cent for each person
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with a long-term condition and co-morbid mental health problem. Research would also
suggest that there is a strong probability of adverse mental health conditions in their carers.
This suggests that between 12 per cent and 18 per cent of all NHS expenditure on long-term
conditions is linked to poor mental health and psychological wellbeing – between £8 billion
and £13 billion in England each year. The more conservative of these figures equates to
around £1 in every £8 spent on long-term conditions
Prevention and the behavioural intervention units that are developing in Public Health are a
government priority for behavioural clinical psychology approaches to targeting lifestyle
issues such as smoking, stress exercise and obesity.
An increasing number of psychologists now work in cancer, diabetes, cardiovascular, and
pain services helping to promote psychophysical recovery and adjustment.
For instance, Macmillan Cancer Research is funding a study to identify the increased need
for clinical psychology input to provide NICE compliant psychological therapy and support for
people with cancer/their carers and staff.
In addition, psychological therapy can be effective in primary care and other settings for
people with psychosomatic and medically unexplained symptoms.
11.4 Neuropsychology
Neuropsychology services linked to the assessment and neuro-rehabilitation of those with
traumatic and acquired brain injury are areas of growth in demand for clinical psychologists
and psychological therapists.
11.5 Adult Mental Health
Psychological therapists have had a long and valued presence in specialist and primary care
mental health service but recent work expands their contribution in the management of
severe mental health problems such as schizophrenia and bipolar disorder where family
intervention and cognitive behavioural approaches to symptom management have a sound
evidence baselxxi
11.6 Improving Access to Psychological Therapies (IAPT)
The Improving Access to Psychological Therapies (IAPT) is set to expand with targets to
reduce waiting times for access to psychological therapies. The remit has also expanded to
include psychological therapy for people with long term conditions, psychosis and
personality disorder and those in contact with the criminal justice system. Many
psychologists are already employed in these services as high intensity practitioners and as
supervisors and managers of psychological practice.
However, there is a need to ensure continuing provision for people with longer term complex
needs who may need highly skilled multi-modal therapy approaches, often delivered by
clinical psychology services.
11.7 Child and Adolescent Health
In addition to more traditional roles for psychologists in Child and Adolescent Mental Health
Services, there are increasing opportunities in child physical health, services for children with
special needs and paediatric neuropsychology services. A growth in demand for
psychological therapists and clinical psychologists is noted in these areas.
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11.8 Older Adults
Older people will increasingly form a larger proportion of the population and may present with
complex, longer term mental and physical health problems at the later stages of their lives.
Better access to crisis, home treatment and psychological therapies services is required and
more integrated working with primary and secondary care services and physical and mental
health services is being developed. As with other population groups, early intervention is
beneficial. Outcomes are more successful in IAPT services where IAPT workers have training
and supervision from clinical psychologists with expertise and experience in working with older
people. Better care for people living with dementia involves early identification and
intervention to support the individual, families and carers., There is a need for services which
provide good pre-diagnostic counselling and post diagnostic interventions and support
including skilled psychological/neuropsychological assessment and formulation; interventions
in terms of the design of design of multi-disciplinary care packages and increased capacity
for the training and support of staff in delivering psychologically informed care.
11.9 Intellectual Disabilities
Clinical psychologists have a long history in the assessment and development of services for
people with intellectual disabilities and continue to play important roles in service innovation
and management of services, working with people living with Autism spectrum disorder across
primary and secondary care services is an expanding area. Clinical psychologists are skilled
at working collaboratively with people living with intellectual disabilities and their families to
ensure their health and social care needs are met. In recent years they have had a strong
voice in developing the policies and strategic direction for working with this client group
11.10 Forensic Clinical Services
There has been a steady growth in demand for psychologists and psychological therapists to
work in forensic settings including low, medium and high secure mental health services but
also within prisons and community criminal justice services such as liaison and diversion
serviceslxxii.
11.11 Organisational, Management and Clinical Governance
The combination of indirect application skills (e.g. expert supervision, consultancy and
problem solving skills, teaching and training, service development can help provider and
commissioning organisations ensure that clinical governance standards are maintained
regarding safety and quality in care delivery (see Appendix 12.3.8).
A number of clinical psychologists have moved into general management, service director
and Board Director posts within NHS Trusts and private, independent and voluntary sector
organisations where they have been able to influence policy implementation and service
development at an organisational level where their grounding in scientific approaches to
behaviour and attitude change can exert a positive influence on services Private,
Independent and Voluntary/Third Sector
An increasing number of psychological therapists and clinical psychologists are being
employed within the private, independent and voluntary or "third" healthcare sector. At the
moment around 15-20% of psychologists undertake some work in this area and this sector is
likely to grow. However, there has been little or no scoping of current and future demand in
this sector.
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11.12 Applied psychology services
A number of leading psychologistslxxiii are advocating the development of applied psychology
services incorporating the services of many types of practitioner psychologist (e.g. clinical,
counselling, educational, forensic, and occupational) to improve the psychological health and
wellbeing of individuals and organisations. Applied psychology services may be constituted
as for-profit or not-for-profit entities capable of bidding for health, care and business
contracts in the future. Increasingly, psychologists who have traditionally worked as
singleton independent/private practitioners have been forming independent psychology
companies with capacity to fulfil such contracts. Bernard Kat and Derek Mowbray are codirectors of the National Centre for Applied Psychology with the aim of promoting new
working models and practices for applied psychologists with national networks.
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12 Appendices
12.1 Expert Reference Group Members:
Gemma L. Unwin (University of Birmingham)
Judith Bond (Coventry and Warwickshire Partnership Trust)
Geraldine Fletcher (Coventry and Warwickshire Partnership Trust & University of
Birmingham)
12.1.1 Severe and Complex Mental Health Conditions (clusters 3-8)
Mel Jennings
Clinical Psychologist
Birmingham and Solihull Mental
Health NHS Foundation Trust
Julia Conneely
Consultant Clinical
Psychologist
Coventry and Warwickshire
Partnership Trust
Dr Katie Andrews
(model lead, 3-8)
Clinical Psychologist
Dudley and Walsall Mental Health
Partnership NHS Trust
Dr Jennifer Thompson
Clinical Psychologist
Dudley and Walsall Mental Health
Partnership Trust
Dr Nasreen FazalShort
Consultant Clinical
Psychologist
North Staffordshire Combined
Healthcare NHS Trust
Dr Chris John
(model Lead, 3-8)
Clinical Psychologist
South Staffordshire and Shropshire
Healthcare NHS Trust
Lynne Reep
Consultant Counselling
Psychologist
Worcestershire Health and Care
NHS Trust
12.1.2 Psychosis (clusters 10-17)
Dr Alan Meaden
Consultant Lead
Psychologist
Birmingham and Solihull Mental
Health Trust
Rose Rae
Clinical Psychologist
Black Country Partnership NHS
Foundation Trust
Ramira Fernandes
Clinical Psychologist
Black Country Partnership NHS
Foundation Trust
Dr Vicky Nicklin
Clinical Psychologist
Black Country Partnership NHS
Foundation Trust
Kat Brunet
Clinical Psychologist
Coventry and Warwickshire
Partnership Trust
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Sally Bradley
(model lead, 10-17)
Principal Clinical
Psychologist
Coventry and Warwickshire
Partnership Trust
Lizzie Newton
Clinical Psychologist
Coventry and Warwickshire
Partnership Trust
Dr Daniella Wickett
Clinical Psychologist
Dudley and Walsall Mental Health
Partnership Trust
Dr John Sorenson
Consultant Clinical
Psychologist
North Staffordshire Combined
Healthcare NHS Trust
Dr Chris John
Clinical Psychologist
South Staffordshire and Shropshire
Healthcare NHS Trust
Dr Kate Pover
Consultant Clinical
Psychologist
South Staffordshire and Shropshire
Healthcare NHS Trust
Dr Natasha Lord
Clinical Psychologist
Worcestershire Health and Care
NHS Trust
Dr Tom Barker
Clinical Psychologist
Worcestershire Health and Care
NHS Trust
12.1.3 Dementia (clusters 18-21)
Professor Chris
Brannigan (and
members of the
Alcester Dementia
Café Carers’ Group)
Chair of Alcester
Dementia Café
Alcester Dementia Café
Professor Linda Clare
Professor of Clinical
Psychology of Ageing
and Dementia
The Centre for Research in Ageing
and Cognitive Health(REACH)
Melanie WalwynMartin
Clinical Psychologist
Birmingham and Solihull Mental
Health Trust
Dr Viba Pavan Kumar
Clinical Psychologist
Birmingham and Solihull Mental
Health Trust
Dr Gemma Fisher
Principal Clinical
Psychologist
Black Country Partnership NHS
Foundation Trust
Dr Clare Rose
Principal Clinical
Psychologist
Black Country Partnership NHS
Foundation Trust
Dr Sarah Major
Principal Clinical
Psychologist
Coventry and Warwickshire
Partnership Trust
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Dr Julia Cook
Senior Clinical
Psychologist
Dudley and Walsall Mental Health
Partnership Trust
Dr Darren Perry
Consultant Clinical
Psychologist
North Staffordshire Combined
Healthcare NHS Trust
Angela Rowley
TBC
South Staffordshire and Shropshire
Healthcare NHS Trust
Dr Anna Buckell
Clinical Psychologist
Worcestershire Health and Care
NHS Trust
Dr Tom Patterson
Academic Director
Coventry University
Directorate in Clinical
Psychology
Dr Nicky Bradbury
Clinical Psychologist
National Perspective
Kate Ross
Consultant Clinical
Psychologist
National Perspective/South
Staffordshire and Shropshire
Foundation Trust
Catherine Burley
(model lead, 18-21)
Former Chair, Faculty of
the Psychology of Older
People
National Perspective
Dr Judith Bond
(model lead, 18-21
and project team
member)
Consultant Clinical
Psychologist
Coventry and Warwickshire
Partnership Trust
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12.2 The Q-Set combined for care clusters 3-8, 10-17 and 18-21
A Q-set of typology of skills across all care clusters is outlined below:
1. Basic understanding of the principles of learning theory
2. Establishing and managing expectations
3. Intervention planning & management (the whole intervention)
4. Person-centred assessment
5. Working with forensic & high risk clients
6. Solution-focused approaches
7. Attunement and building and managing working alliance
8. Understanding team dynamics
9. Distress tolerance
10. Cognitive Behavioural Approaches
11. Building and maintaining resilience
12. Dealing with loss and change and working with acceptance
13. Life story work
14. A basic understanding of the use of psychological perspectives and strategies in risk assessment and
management
15. Goal-setting and progress reviewing (at appropriate levels)
16. Compassion-Focused Approaches
17. Assessing cognitive difficulties
18. Activity recording and scheduling
19. Adopting a team approach to delivering various psychological interventions
20. Mood stabilisation and emotion regulation
21. A basic understanding of dynamic processes, transference, counter-transference and the impact on the
working relationship
22. Assessing motivation and suitability for psychological work
23. Working with shame
24. Cognitive Stimulation Therapy and Cognitive/Memory Strategies
25. Coping with the impact of organisational change
26. Warmth, empathy, genuineness and a non-judgemental approach
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27. A basic understanding of intervening appropriately in a crisis situation with regard to consistency of
approach
28. Use of appropriate measures to monitor change
29, Basic understanding of unconscious material
30. Working with alcohol and substance misuse issues that complicate primary intervention
31. Assessing psychological distress and basic maintenance processes (through differentiating thoughts,
feelings, behaviours, psychological symptoms & relevant environmental factors
32. Working with high levels of distress
33. Use of appropriate psycho-education
34. Utilising clinical supervision
35. Basic understanding of psychology of attachment and transitions
36. Psychological formulation at a basic level (e.g. consideration of thoughts, feelings, behaviours
psychological symptoms & relevant environmental factors and identifying basic maintenance processes)
37. Engagement and trust building skills
38. Supporting clients to develop coping strategies
39. Running groups
40. Adapting communication to needs of clients and families
41. Recognising and managing vicarious traumatisation
42. Establishing and managing boundaries
43. Mindfulness based approaches
44. Basic understanding of the principles of learning theory
45. Problem solving skills
46. Self-reflection
47. Session planning & management (including session structure & adherence)
48. Assessing capacity
49. Helping clients to use self-help material
50. Working collaboratively with challenging clients
51. Adapting approaches to work with clients from different ethnic and cultural backgrounds
52. Adapting interventions to suit client needs
53. Containment skills
54. Anxiety management skills
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55. Basic understanding of evidence-based psychological models and interventions
56. Newcastle model (for people with behaviours that challenge)
57. Graded exposure
58. Relapse prevention work
59. Working with families and systems
60. Active listening & appropriate expressive communication skills (verbal & non-verbal)
12.2.1 Instructions for Q sort:



Rank the statements from most important to least important based on how important the specific
psychological skill is for all mental health workers to deliver mental healthcare to the care clusters under
consideration.
Consider all client-facing professional groups when deciding on agreement, including, clinical psychologists,
trained therapists, counsellors, nurses, occupational therapists, social workers, support time and recovery
workers, and support workers
Context for the sort – to develop a structure for core psychological practice skills and generic interventions
(those below Step 3 of the IAPT model)
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12.2.2 Recommended distribution for Q-sort:
Least Important
important
Dr Alison Longwill Page 75 of 99
Most
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12.2.3 Development of Typology of Skills: Care Clusters 3-8
Key
A. These skills required at a higher level by more highly trained individuals
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B. These skills relate to ‘understanding’ then ‘use of’ at higher levels of expertise
C Important for CC4-5 and critical for 6-8. In both team working and formulation categories. Team working category becomes more important with 6-8.
D Most relevant to 6-8, crucial for 8, more skilled practitioners should be working with CC8
12.2.4 Development of Typology of Skills: Care Clusters 18-21
Results from Q sort 22/10/2015: CC18-21
Development of Typology of Skills
Other lower rated:
Recogni s i ng and managi ng vi cari ous
trauma
A bas i c unders tandi ng of dynami c
proces s es
Bas i c unders tandi ng of uncons ci ous
materi al
Worki ng wi th forens i c and hi gh ri s k
cl i ents
Rel aps e management
Communication relationship and interpersonal skills (team working:
intermediate):
Adopti ng a team approach to ps ychol ogi cal
i nterventi on
Worki ng col l aborati vel y wi th chal lengi ng
cl i ents (s ervi ce dependent)
Working consistently in a crisis?
Unders tandi ng and us i ng MDT formul ati on
Unders tandi ng team dynami cs
Intervention (higher level/more specialist):
Interventi on pl anni ng and management
Cogni ti ve s ti mul ati on therapy
Sol uti on focus s ed approaches
Worki ng wi th s ubs tance mi s us e
Runni ng groups
Mi ndful nes s approaches (l es s of a pri ori ty?)
Graded expos ure (l es s of a pri ori ty?)
Acti vi ty recordi ng and s chedul i ng (l es s of a
pri ori ty)
Psychological knowledge/awareness
Bas i c unders tandi ng of ps ychol ogi cal models
and i nterventi ons
Bas i c unders tandi ng of l earni ng theory (l es s
of a pri ori ty?)
Knowl edge of ps ychol ogi cal proces ses i n
dementi a (more s peci al ist?)
Bas i c unders tandi ng of attachment and
trans i ti ons (l es s of a pri ori ty?)
Assessment and formulation:
As s es s i ng moti vati on and s ui tabil ity for
ps ychol ogi cal work
Dr Alison Longwill Page 77 of 99
Intra-personal skills/self-care/psychological
mindedness (prioritised):
Sel f-refl ecti on
Copi ng wi th i mpact of organi s ati onal change
ADD MORE?
Communication relationship and interpersonal skills (intermediate):
Attunement and bui l di ng worki ng al liance
Es tabl i s hing and managi ng expectati ons
Establishing and managing boundaries
Breaki ng bad news
Assessment and Formulation
(intermediate/lower level):
As s es s ment of capaci ty
Bas i c unders tandi ng of ps ychol ogi cal
approaches i n rel ati on to ri s k as s es sment
Us i ng MDT formul ati ons
As s es s i ng cogni ti ve di ffi culties
Ps ychol ogi cal formul ati on – bas i c l evel
As s es s i ng ps ychol ogical di stres s and
mai ntenance proces s es
Intervention (intermediate/higher level):
Goal s etti ng and progres s revi ewi ng
Probl em s ol vi ng
Ses s i on pl anni ng and management
Anxi ety management s ki l ls
Mood s tabi l i sati on and emoti onal recogni ti on
Supporti ng cl i ents to devel op copi ng s trategi es
Di s tres s tol erance
Bui l di ng and mai ntai ning res i lience
Memory s trategi es
Us i ng meas ures to moni tor change
Contai nment s ki l ls
Worki ng wi th acceptance
Newcas tl e model (for CB)
Us i ng l i fe s tory work
Compas s i on focus ed approaches
CBA
11 September 2016
Communication relationship and interpersonal skills (prioritised):
Engagement and trus t bui l di ng
Acti ve l i s teni ng and expres s i ve
communi cati on
Adapti ng to cl i ents ’ and (fami l i es ’)
communi cati on needs
Warmth, empathy and a non-j udgemental
approach
Worki ng wi th fami l i es and s ys tems
Emoti onal val i dati on?
Intervention (prioritised):
Worki ng wi th hi gh di s tres s
Adapti ng ps ychol ogi cal practi ce and
i nterventi on to s ui t cl i ents
Adapti ng approaches to work wi th cl i ents
from di fferent ethni c and cul tural
backgrounds
Deal i ng wi th change and l os s
Emoti onal val i dati on
An unders tandi ng of l i fe s tory work
Compas s i on-focus sed awarenes s and
unders tandi ng
Hel pi ng cl i ents to us e s el f-hel p
Us e of appropri ate ps ychoeducati on
Bas i c unders tandi ng of i nterveni ng i n a cri s is
Deal i ng wi th the i mpact of bad news
Assessment and Formulation
(prioritised/lower level):
Pers on-centred comprehens i ve as s es s ment
Knowl edge of ps ychol ogi cal ass ess ment (i nc.
mai ntenance proces s es )
Psychological
(prioritised):
Knowl edge of
Knowl edge of
Knowl edge of
trans i ti on
knowledge/awareness
dementi a
age-rel ated changes
the proces s of l os s and
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12.2.5 Results of Q Sort Care Clusters 3-8
Appendix 2: Raw Results of the Skills Sorts
Results from Q sort 22/10/2015: CC3-8
Least Important
13) Life story
work
56) Newcastle
model (for CB)
5) Working with
high risk clients
– highly
specialist, not
necessarily
provided by
service
24) Cog stim
therapy and
cog/mem
strategies
Most important (in order)
43) Mindfulness
approaches
(caution)
16) Compassion
approaches
12) Dealing with
change and
working with
acceptance
25) Coping with
impact of org
change – basic
understand process
39) Running groups
33) Use of app.
Psycho ed
23) Working
with shame
17) Knowledge of
cog difficulties
59) Working
with families
and systems
8) Understand.
Team dynamics
61) Using MDT
formulations
21) A basic
understand. of
dynamic process
etc.
29) Basic
understand. of
unconscious
material
41) Recog, and
managing
vicarious
trauma.
31) Assess psych distress
and maintain process (to
diff degrees)
4) Personcentred
(comprehen
sive) assess
19) Adopt team
approach to
psych intervent.
50) Working collab
with challenging
clients
62) Dealing with differences of
opinion (client and provider) - crisis
34) Utilising clin
supervision
37) Engagement and
trust building
46) Self-reflection
7) Attunement and
working alliance
35) Basic understanding
of attach and transitions
36) Psych formulation –
basic - awareness
55) Basic
understand psych
models and ints
9) Distress
tolerance
28) Use measures to
monitor change
(SUDS/GAS not PBR)
20) Mood stab.
And emo recog
49) Help clients
to use self-help
10) CBA
18) Activity
recording and
scheduling
6) Solutionfocussed
approaches
54) Anxiety
manage. skills
27) Basic
understanding
of intervening in
crisis
11) Build and
maintain resilience
22) Assess motivation
and suitability for psych
work
48) Assess capacity
58) Relapse manage
57) Graded exposure
53) Containment
skills
44) Basic
understand of
learning theory
30) Working
with substance
misuse (depends
on service)
45) Problem solving
38) Support to
develop coping
51) Adapting
approaches - culture
40) Adapting to comm needs
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60) Active listening
and expressive comm
26) Warmth,
empathy, non-judge
2) Estab and
manage expect
42) Estab and manage
boundaries
14) More than basic understand
of psych in risk assess
32) Working with
high distress
52) Adapting ints to
suit clients
47) Session planning and
management (after a very
good assess)
3) Int planning and
management
15) Goal set and
progress review
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12.2.6 Results of Q sort: Care Clusters 10-17
Results of Q sort 21/12/2015: CC10-17
Least Important
69)
Newcastle
model
44) Basic
understand
of the
principles
of learning
theory
41) Recognising
+ managing
vicarious
trauma
29) Basic und of
unconscious
material
24) Cog Stim
Therapy +
Cog/Memory
Strategies
17) Assessing
cog difficulties
Most Important
48) Assess
ing capacity
39) Running
groups
25) Coping
with the
impact of
org change
22)
Assessing
motivation +
suitability for
psych work
11) Building
+
maintaining
resilience
8) Und team
dynamics
5a) Working
with forensic
clients
47) Session
planning + man
(including sess
structure and
adherence)
13) Life story
work –
genograms,
timelines, DUPs
3) Int planning
+ man (the
whole int)
55) Basic und
of evidencebased psych
models +
interventions
36) Psych
formulation at
a basic level
(e.g. thoughts,
feelings,
behaviour
psych
symptoms +
relevant enviro
factors +
identifying
basic
maintenance
processes
Dr Alison Longwill Page 79 of 99
35) Basic
und of psych
attach and
transitions
19) Adopting a
team approach
to delivering
various psych int
23) Working
with shame
43) Mindfulness
based
approaches
9) Distress
tolerance
68) Working
with trauma
associated
with
psychosis
54) Anxiety
man skills
57) Graded
exposure –
formulation
informed
28) Use of
appropriate
measures to
monitor
change
49) Helping
clients to use
self-help
material
66) Building selfconfidence +
self-esteem
20) Mood
stabilisation +
emotional reg
12) Dealing with
loss + adj +
working with
acceptance in
both individuals
and families
59) Ability to
work with
families and sys
67) Awareness of
diagnosis on
sense of self
6) Solutionfocused
approaches
18) Activity
recording +
scheduling
2) Establishing
+ managing
expectations
31) Assessing
psych distress
+ basic
maintenance
processes
14) A basic
underst of the
use of psych
perspectives +
strategies in
risk
assessment +
management
63) Making
sense of diag +
offering alt
explanations to
make sense of
exp – creative
meaning
64) Und + using
psychological
formulation
33) Use of
appropriate
psychoeducation
65) Social
recovery +
return to
work
58) Relapse
prevention work
– staying well +
managing
setbacks
16)
CompassionFocused
Approaches
38) Supporting
clients to
develop coping
strategies
10) Cog Beh
Approaches
4) Personcentred
assessment
1) Basic und
of the
principles of
learning
theory
15) Goal setting
+ prog reviewing
(at appropriate
levels)
5b) Working
with high-risk
clients (to
self)
30) Working with
alcohol + sub
misuse issues
that complicate
the primary int
11 September 2016
34) Utilising
clin supervision
(+ having
awareness of
the benefits of)
32) Working
with high levels
of distress
27) A basic und
of intervening
appropriately in
a crisis
situation with
regard to
consistency of
approach
50) Working
collaboratively
with
challenging
clients
51) Adapting
approaches to
work with clients
from different
ethnic + cultural
backgrounds
61) Normalising,
de-stigmatising +
promoting the
recovery model
45) Problem
solving skills
(worker + client)
52) Adapting
ints to suit client
needs
53) Containment
skills
46) Developing
the capacity for
self-reflection
62) Und of relational positions
+ the enactment of those
40) Adapting
comm to the
needs of clients
and families
42) Establishing
+ managing
boundaries
60) Active
listening +
appropriate
expressive comm
skills
7) Attunement +
building +
managing
working alliance
26) Warmth,
empathy
genuineness + a
non judgemental app
37) Engagement
+ trust building
skills
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12.2.7 Results of Q Sort Care Clusters 18-21
Results from Q sort 22/10/2015: CC18-21
Least Important
41) Recognise
and manage
vicarious trauma
29) Basic
understand
unconscious mat
5) Working with
forensic and
high risk
Most important
21) A basic
understand. of
dynamic process
etc.
58) Relapse
manage
35) Basic
understand of
attach and
transitions
23) Working
with shame
57) Graded
exposure
18) Activity
recording and
scheduling
19) Adopt team
approach to
psych
interventions
8) Understand.
Team dynamics
43) Mindfulness
approaches
24a) Cog stim
therapy
47) Session
planning and
management
50) Working collab
with challenging
clients – service
dependent
6) Solutionfocussed
approaches
55) Basic understand psych
models and interventions
30) Working
with substance
misuse
39) Running groups
3) Intervention planning
and management
22) Assess
motivation and
suitability for
psych work
44) Basic
understand of
learning theory
68) Knowledge of psych
process involved in dementia
12a) Working
with acceptance
56) Newcastle
model (for CB)
7) Attunement
and working
alliance
48) Assess
capacity
17) Assess
cognitive
difficulties
34) Utilising clin
supervision
42) Establish and
manage
boundaries
14) Basic
understand of
psych in risk
assess
11) Build and
maintain
resilience
24b) Memory
strategies
13a) Life story
work –using
16) Compassion
focused
approaches
67) Breaking
bad news
15) Goal set
and progress
review
45) Problem
solving
25) Coping
with impact
of
organisation
change
53) Containment
skills
1) Basic
understand
learning theory
38) Support to
develop coping
10) CBA
36) Psych
formulation –
basic
31) Assess psych
distress and
maintain
process –
differentiate
between
awareness and
knowledge
9) Distress
28) Use measures to monitor change
2) Establish and manage
expectations
54) Anxiety
management skills
20) Mood stabilisation and
emotional recognition
61) Using MDT formulations
Dr Alison Longwill Page 80 of 99
11 September 2016
49) Help
clients/c
arers to
use selfhelp
33) Use of
app.
Psycho ed
46) Selfreflection
51)
Adapting
approach
es culture
52) Adapting
interventions
to suit clients
60) Active
listening
and
expressive
comms
4) Personcentred
assess
37)
Engageme
nt and
trust
building
27) Basic
understan
ding of
interveni
ng in
crisis
64)
Knowledg
e of
dementia
12b)
Dealing
with
change
and loss
66)
Dealing
with
impact of
bad news
65)
Knowledg
e of agerelated
changes
32)
Working
with high
distress
61)
Knowledg
e of
process
of loss
and
transition
62) Compassionfocussed
awareness and
understanding
63) Emotional
validation
13b) Life story work –
understanding
26)
Warmth,
empathy,
non-judge
40)
Adapting
to comm
needs
59)
Working
with
families
and
systems
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12.3 Roles of Clinical Psychologists
Practitioner psychologists have much to contribute to the achievement of the policy
implementation outcomes associated with various current health and care strategies.
The British Psychological Society has recently published a paper: "National Mental
Health, Well-being and Psychological Therapies - the role of Clinical Psychology - A
briefing paper for NHS Commissioners74.
12.3.1 Evidence-based practice
Clinical Psychologists apply the science of Psychology to a range of clinical health
care services and settings. Clinical Psychologists use this knowledge to design,
implement and evaluate health care services that enhance well-being and minimises
ill health and impairment. They are trained to apply their knowledge in systematic
methods and practice which are scientifically evaluated and to test clinical practice
for its effectiveness
A framework for Clinical Psychology in a mental health context is based around five
strategic purposes:

to prevent mental and physical ill health from occurring in the first place;

to prevent anyone with mental ill health from deteriorating;

to restore anyone with mental ill health back to their normal level of
independent life and beyond;

to support and raise the standard of independent life amongst those with
chronic mental ill health;

To facilitate a sustained approach to prevention.
12.3.2 Range of interventions based on psychological theory and science
Psychologists have a key role in implementation of the Department of Health "Talking
Therapies: a four-year plan of action"75
Formulation is a core skill for all Clinical Psychologists76. It can be described as a
summary of an individual’s difficulties, grounded in psychological theory, and
indicating the most appropriate intervention. The Core Purpose and Philosophy of the
Profession (DCP, 2010, pp.5-6) states:
Psychological formulation is the summation and integration of the knowledge that is
acquired by this assessment process that may involve psychological, biological and
systemic factors and procedures. The formulation will draw on psychological theory
and research to provide a framework for describing a client’s problem or needs, how
it developed and is being maintained. Because of their particular training in the
relationship of theory to practice, clinical psychologists will be able to draw on a
number of models (bio-psycho-social) to meet needs or support decision making and
so a formulation may comprise a number of provisional hypotheses. This provides
the foundation from which actions may derive. Psychological intervention, if
considered appropriate, is based upon the formulation.
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Research has shown that formulation can serve a range of purposes for teams,
including generating new ways of thinking, achieving a consistent approach to
intervention, helping to manage risk, and raising staff morale.
Clinical psychologists offer a range of expertise in relation to healthcare delivery:

Individual, family and group assessment and therapies

Supervision and teaching other professions to provide psychological
treatments to ensure best practice and minimise risk.

Expertise and leadership77 in organisational development, audit, service
redesign, and policy development.

Innovative service development and re-design in health and care services.

Leadership and support to teams of clinical workers in providing
psychologically informed assessment and treatment.
The combination of indirect application skills (e.g. expert supervision, consultancy
and problem solving skills, teaching and training, service development can help
provider and commissioning organisations ensure that clinical governance standards
are maintained.
Band 7 clinical psychologists are multimodal therapists and are able to work with all
levels of complexity of psychological needs.
12.3.3 Improving physical health of people with mental health problems
Psychological skills are important in helping people with mental health problems lead
healthier lives as there is clear evidence that people with severe mental illness have
significantly higher mortality from a range of health conditions78
12.3.4 Competence frameworks for the delivery and supervision of
Psychological Therapies
The second round of the National Audit of Psychological Therapies79 found that
whilst there have been some improvements since the baseline, including reduced
waiting times and better recording of ethnicity and diagnostic data, there are a
number of ongoing areas of concern. There is still marked variation in performance
between services, some therapies are still being provided by therapists who do not
have specific training to do so and older adults with anxiety and depression are not
getting the help they need most.
Clinical psychologists are trained in multi-modal therapies and have a pivotal role in
training and governance of the delivery of psychological therapies.
12.3.5 Governance, risk management and quality assurance
Clinical psychologists have much to offer in terms of clinical governance to promote
safety and quality in care delivery and have played a key role in the Accreditation
Programme for Psychological Therapies Services80.
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12.3.6 Training and Supervision
All psychological therapists require supervision and there are potential governance,
safety and risk issues if clinical psychology posts are reduced. Clinical psychologists
can promote psychologically informed care systems, based on a scientific, evidencebased approach to service development along the lines recommended in the Berwick
Report.81
12.3.7 Research and service development and innovation
Effective investment in the promotion of positive mental health and prevention and
recovery services across the lifespan (and across physical-mental health boundaries)
can promote cost-effective service delivery.
Clinical Psychologists can apply a range of evidence-based treatments. Research
expertise delivered into services creates a unique science-based clinical profile,
bringing clinical expertise in psychological approaches to health, well-being and
performance, utilising both direct and indirect applications. Clinical psychologists can
support a continually developing evidence base so that current services can be
improved and supporting timely and cost-effective application in a range of services
across the lifespan. For instance, this includes:

problem solving approaches to address the psychosocial determinants of ill
health

innovative service development in acute services

co-ordinated intervention for co-morbid physical and mental health problems

assessment and formulation to address medically unexplained symptoms

interventions that promote resilience and coping, enabling employment

Comprehensive science-based assessment to identify effective strategies and
minimise waste
This can help to reduce waste of resources and thus promote cost-effective delivery
of healthcare through expert, reliable and high quality assessment of need followed
by psychological formulation grounded in psychological theory, science and best
practice to guide the most appropriate individual or team interventions.
Clinical psychologists can promote psychologically informed health and care
systems.
12.3.8 Leadership Skills of Clinical Psychologists
Clinical psychologists are well-placed through their undergraduate and postgraduate
professional training to offer clinical leadership in a variety of services82 and often
become involved in management and service improvement work. This is consistent
with the recommendations of the "New ways of Working for Applied Psychologists in
Health and Social Care"83
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Figure 5 Leadership skills of Clinical Psychologists
2. What combination of skills do I as a clinical psychologist bring to leadership?
Post-Grad Doctoral Trainee
Clinical Psychologist
Practising Clinical
Psychologist
Consultant Clinical
Psychologist
Clinical
Director
Clinical
Clinical
Clinical
Clinical
■
■
■
■
■
■
■
■
■
■
Formulation skills from more than one
psychological model to inform
interventions.
Awareness/building/
maintenance of interpersonal
relationships.
An understanding of the emotional
impact of change (including resistance).
Self-reflection/helping others selfreflect.
Emotional I n t e l l i g e n c e /resilience.
Able to lead on complex psychometric
testing.
Comprehensive
p s y c h o l o g i c a l assessment
including risk.
Professional
■
■
■
Skills in coordinating research teams
(supervisors, governance officers,
collaborators).
Experience t r a i n i n g of other
professionals within the team.
Understanding of diversity values ethics
and integrity.
Strategic
■
■
Critiquing t h e literature and guidelines
regarding therapeutic interventions used
in service.
Ability t o use evidence, data collection,
outcomes and audit to constructively
critique current service practice.
Dr Alison Longwill Page 84 of 99
■
■
■
■
Broad knowledge o f different
therapeutic models that are used to
lead a client’s care.
Reflection a n d awareness of systemic
issues operating within teams/able to
lead team dynamics discussions.
Encourage t e a m reflection on
current/innovative practice.
Psychological p e r s p e c t i v e on
multifarious health and mental health
presentations.
Ability t o develop and operationalise
clinical and service outcome
evaluations.
Professional
■
■
■
■
Application o f different psychological
models to supervision and consultation
with other professionals.
Training other professionals in the
application of complex psychological
models.
Conflict m a n a g e m e n t skills.
Participate in and oversee research
projects.
■
■
■
Able to construct and share service
development plans.
Influence organisational policies and
procedures.
Ability t o draw on broad body of
research & integrate psychological
knowledge across a range of specialties
using common themes to influence
health economy pathways of care.
■ Experience and in-depth psychological
understanding which informs judgement
when facilitating organisational/
National clinical credibility /respect
for profession.
■ Able to clinically appraise and quality
assure consultant level performance.
Professional
Professional
■
■
■
■
■
Able to inspire, supervise and develop
leadership in others using psychological
knowledge.
Reflect on other professionals’
Perception of psychology.
Identify and work with organisational
distress.
Strategic involvement in research.
Strategic
■
■
Strategic
■
Ability t o integrate psychological
knowledge to inform client care
pathways and service innovation.
Where problems occur-be able to
identify links between elements in the
organisational system and formulate
service solutions.
Advise directors/commissioners on
speciality clinical standards / skill mix /
safe evidence based clinical practice /
resources.
■
Able to assess psychological service
development ideas at different levels:
client, professional and organisational.
Skilled i n developing strong working
relationships with other professionals service leads directors and
commissioners.
Setting the direction of relevant
organisational policy procedures.
11 September 2016
Able to influence professional practice
at national guideline and policy level.
■ Able to create opportunities at the most
senior levels of influence to market the
profession.
■ Political a w a r e n e s s and containment of
organisational distress.
Strategic
■
■
■
Able to assess and implement
psychological ideas at higher
organisational levels/health economy
wide/national/ professional and political.
Skilled at understanding dynamics of
relationships and developing
relationships at a board level e.g. health
economy wide/commissioners/political
and national levels as appropriate.
Able to set the service direction and
influence corporate strategy.
DRAFT ONE Clinical Psychology Workforce Project: DCP UK
CONFIDENTIAL
13 Glossary of Terms
ACT: Acceptance and Commitment Therapy
ADHD: Attention Deficit Hyperactivity Disorder
BADS: Behavioural Assessment of the Dysexecutive Syndrome
Boundaries: A boundary in therapy represents an agreed standard of professional
conduct and ethics governing relationships during therapeutic intervention and in
relation to the therapeutic context and contract.
Capacity (Mental): Mental Capacity relates to the ability of a person to take a
particular decision at a particular time. The Mental Capacity Act describes 5 key
conditions which need to be met before a person can be said to have capacity.
Clinical psychologists are in demand as a professional group with the competencies
to carry out accurate capacity assessments
CAT: Cognitive Analytic Therapy
CBT: Cognitive Behaviour Therapy
Closed questions: Close-ended questions are those which can be answered by a
simple "yes" or "no," while open-ended questions are those which require more
thought and more than a simple one-word answer.
Cognitive Stimulation Therapy (CST), is an intervention aims to improve cognitive
skills and quality of life for people with dementia
Consent: Consent to treatment is the principle that a person must give permission
before they receive any type of medical or psychological intervention, test or
examination
CPD: Continuing Professional Development
DBT: Dialectical Behaviour Therapy
EMDR: Eye Movement Desensitisation and Reintegration
ERG: Expert Reference Group
Formulation: Psychological formulation is the summation and integration of the
knowledge that is acquired by this assessment process that may involve
psychological, biological and systemic factors and procedures. The formulation will
draw on psychological theory and research to provide a framework for describing a
client’s problem or needs, how it developed and is being maintained. Because of
their particular training in the relationship of theory to practice, clinical psychologists
will be able to draw on a number of models (bio-psycho-social) to meet needs or
support decision making and so a formulation may comprise a number of provisional
hypotheses. This provides the foundation from which actions may derive.
Psychological intervention, if considered appropriate, is based upon the formulation.
Integrative therapy, or integrative counselling is a combined approach to
psychotherapy that brings together the different elements of specific therapies which
are appropriate for intervention following a person-specific formulation.
KSF: Knowledge and Skills Framework
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Life Story Work: Life story work is a therapeutic activity for people with dementia
where they are encouraged to make a personal record of important experiences,
people and places in their life and to understand the relevance of these.
Mental Health Act: The Mental Health Act 1983 (which was substantially amended in
2007) is the law in England and Wales that allows people with a ‘mental disorder’ to
be admitted to hospital, detained and treated without their consent – either for their
own health and safety, or for the protection of other people. (Scotland and Northern
Ireland have their own laws about compulsory treatment for mental ill health.)
MMSE: Mini Mental State Examination
Multi-model: Multi- model therapies and interventions draw on a variety of therapeutic
models
Newcastle Model: The Newcastle Model-provides a framework and process to
understand behaviour that challenges in terms of unmet needs and suggests a
structure in which to develop effective interventions that keep people with dementia
central to their care.
NICE guidelines: National Institute of Clinical Excellence evidence-based best
practice guidelines in health and care
NOS National Occupational Standards
Open questions: Open questions encourage the respondent to think and reflect and
express their opinions and feelings rather than give simple yes/no responses
Recovery: Personal recovery is a set of values about a person’s right to build a
meaningful life for themselves, with or without the continuing presence of mental
health symptoms. In recent years’ users of mental health services have identified
three overarching principles to support better outcomes for themselves (Mental
Health Network 2012):
•
the continuing presence of ‘Hope’ in the possibility to pursue
personal goals and ambitions
•
The need for service users to maintain a sense of ‘Control’ through
empowerment and self-determination
•
Having the ‘Opportunity’ to build a life beyond mental illness
Socratic questioning: Socratic questioning has been used in therapy, most notably as
a cognitive restructuring technique in cognitive therapy. The purpose is to help
uncover the assumptions and evidence that underpin people's thoughts in respect of
problems. A set of Socratic questions in cognitive therapy to deal with automatic
thoughts that distress the person involve:
Solution Focused: Solution-focused brief therapy - also known as solution-focused
therapy - is an approach to psychotherapy based on solution-building rather than
problem-solving.
Transference/Counter-transference: Transference is the phenomenon whereby we
unconsciously transfer feelings and attitudes from a person or situation in the past on
to a person or situation in the present. Counter transference is the response that is
elicited in the recipient (therapist) by the other's (patient's) unconscious transference
communications
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Uni-model: Uni-model therapy refers to training and practice of one evidence-based
therapeutic intervention
Validation Therapy Validation therapy (VT): is a therapy developed by Naomi Feil
which emphasises the importance of looking for the emotional meaning behind the
behaviour of a person living with dementia.
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Results from Q sort 22/10/2015: CC18-21
Development of Typology of Skills
Other lower rated:
Recognising and managing vicarious
trauma
A basic understanding of dynamic
processes
Basic understanding of unconscious
material
Working with forensic and high risk
clients
Relapse management
Communication relationship and interpersonal skills (team working:
intermediate):
Adopting a team approach to psychological
intervention
Working collaboratively with challenging
(
clients service dependent)
Working consistently in a crisis
Understanding and using MDT formulation
Understanding team dynamics
Intervention (higher level/more specialist):
Intervention planning and management
Cognitive stimulation therapy
Solution focussed approaches
Working with substance misuse
Running groups
Mindfulness approaches
Graded exposure
Activity recording and scheduling
Psychological knowledge/awareness
Basic understanding of psychological models
and interventions
Basic understanding of learning theory
Knowledge of psychological processes in
dementia
Basic understanding of attachment and
transitions
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Intra-personal skills/self-care/psychological
mindedness (prioritised):
Self-reflection
Coping with impact of organisational change
ADD MORE?
Communication relationship and interpersonal skills (intermediate):
Attunement and building working alliance
Establishing and managing expectations
Establishing and managing boundaries
Breaking bad news
Assessment and Formulation
(intermediate/lower level):
Assessment of capacity
Basic understanding of psychological
approaches in relation to risk assessment
Using MDT formulations
Assessing cognitive difficulties
Psychological formulation – basic level
Assessing psychological distress and
maintenance processes
Intervention (intermediate/higher level):
Goal setting and progress reviewing
Problem solving
Session planning and management
Anxiety management skills
Mood stabilisation and emotional recognition
Supporting clients to develop coping strategies
Distress tolerance
Building and maintaining resilience
Memory strategies
Using measures to monitor change
Containment skills
Assessment and formulation:
Working with acceptance
Assessing motivation and suitability for
Newcastle model (for CB)
psychological work
Using life
story work
11 September
2016
Compassion focused approaches
CBA
Communication relationship and interpersonal skills (prioritised):
Engagement and trust building
Active listening and expressive
communication
Adapting to clients’ (and families’)
communication needs
Warmth, empathy and a non-judgemental
approach
Working with families and systems
Emotional validation
Intervention (prioritised):
Working with high distress
Adapting psychological practice and
intervention to suit clients
Adapting approaches to work with clients
from different ethnic and cultural
backgrounds
Dealing with change and loss
Emotional validation
An understanding of life story work
Compassion-focussed awareness and
understanding
Helping clients to use self-help
Use of appropriate psychoeducation
Basic understanding of intervening in a crisis
Dealing with the impact of bad news
Assessment and Formulation
(prioritised/lower level):
Person-centred comprehensive assessment
Knowledge of psychological assessment (incl.
maintenance processes)
Psychological knowledge/awareness
(prioritised):
Knowledge of dementia
Knowledge of age-related changes
Knowledge of the process of loss and
transition
DRAFT ONE Clinical Psychology Workforce Project: DCP UK
CONFIDENTIAL
14 Bibliography
List of Competency Frameworks, Skills Models, Best Practice Treatment and
Service Guidelines, Commissioning Frameworks, and Job Profiles/Roles for
Clinical Psychologists Consulted in the Development of the Models
Braun V & Clarke V (2006). Using thematic analysis in psychology. Qualitative
Research in Psychology, 3 (2): 77-101.
Brechin D & Heywood Everett S (2013). A Briefing Paper. Mental Health Clustering
and Psychological Interventions. Leicester: British Psychological Society.
Van Exel NJA, G de Graaf (2005). Q methodology: A sneak preview. Available from
www.jobvanexel.nl.
14.1 Competency Frameworks and Skills Models
Brechin, D. and Heywood-Everett, S. (2013) Mental health commissioning and
psychological interventions, BPS: London
British Psychological Society. Accreditation Through Partnership. Doctoral
programmes in educational psychology in England, Northern Ireland and Wales:
required competencies mapping document
Department of Health. (2004). The NHS Knowledge and Skills Framework (NHS
KSF) and the development review process. Department of Health: London
Department of Health. (2004b). The ten essential shared capabilities: A framework
for the whole of the mental health workforce. National Institute for Mental Health in
England: London
Fonagy, P. (2010). Digest of national occupational standards for psychological
therapies. Bristol: Skills for Health.
Malvern, C. (2011). A capable and competent workforce. South Staffordshire and
Shropshire NHS Foundation Trust: Stafford
NHS. (2013). London mental health models of care: Competency framework.
London: London Health Programmes
NHS Education for Scotland (2009). A capability framework for working in acute
mental health care: The values skills and knowledge needed to deliver high quality
care in a range of acute settings. Edinburgh: NHS Education for Scotland
Skills for Care. (2015). The care certificate standards. Skills for Health, Health
Education England
The NHS Staff Council (2010). Appraisals and KSF made simple: A practical guide.
London: NHS Employers.
14.1.1 3-8 Model
Brechin, D & Heywood-Everett, S. (2014) Briefing Paper - Mental Health clustering and
psychological interventions
British Association of Behavioural and Cognitive Psychotherapy (2013) Core
Curriculum
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Department of Health (2001) National Service Framework for Older people
Department of Health (2004) The NHS Knowledge and Skills Framework (NHS KSF)
and the Development Review Process
Health Education England (2015) Skills for Health: Care Certificate Standards
Joint Commissioning Panel for Mental Health (2013) Guidance for commissioners of
older people’s mental health services
Lemma A, Roth AD, Pilling, S. (2008) The competencies required to deliver effective
Psychoanalytic/ Psychodynamic therapy
Lemma A., Roth, A. D., Pilling S. (2010) The competencies required to deliver effective
Interpersonal Psychotherapy
London Health Programmes (2013) London mental health models of care –
competency framework
Mental Health Foundation (2007) Better Prepared to Care: the training needs of nonspecialist staff working with older people with mental ill health.
Moriarty, J. (2005) Social Care Institute for Excellence - Update for SCIE best practice
guide on assessing the mental health needs of older people
NHS Education Scotland (2008) A Capability Framework for Working in Acute Mental
Health Care: The values, skills, and knowledge needed to deliver high quality care in
a full range of acute settings
Pilling, S., Roth, A. D., Stratton, P. (2009) The competencies required to deliver
effective Systemic Therapies
Roth A. D., Hill, A., Pilling S. (2010) The competencies required to deliver effective
humanistic psychological therapies
Roth, A. D. & Pilling, S. (2015) A competence framework for the supervision of
psychological therapies
Roth, A. D.& Pilling, S. (2008) A competence framework for psychological interventions
with people with personality disorder
Roth, A. D.& Pilling, S. (2012) A competence framework for psychological interventions
with people with psychosis and bipolar disorder
Roth, A. D., Pilling S. (2008) The competencies required to deliver effective cognitive
and behavioural therapy for people with depression and with anxiety disorders
Skills for Care (2014) Common Core Principles to support good mental health and wellbeing in adult social care
14.1.2 Psychosis
Roth, A. D., & Pilling, S. (2012). A competence framework for psychological
interventions with people with psychosis and bipolar disorder. London: Research
Department of Clinical EaHP UCL
O’Hagan, M. (2001) Recovery competencies for New Zealand mental health workers.
NZ, Wellington: Mental Health Commission
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14.1.3 Dementia
De Vries, K., Brooker, D., & Porter, T. (2010). Workforce development for dementia:
Development of role, competencies and proposed training for primary care liaison
workers to support pathway to diagnosis of dementia.
Department of Health. (2011). Dementia competency framework. South West
Dementia Partnership
Department of Health. (2013). Making a difference in dementia: Nursing vision and
strategy, Department of Health: London
Dewing, J., & Traynor, V. (2005). Admiral nursing competency project: Practice
development and action research. Journal of Clinical Nursing, 14(6), 695-703.
Healthcare for London. (2009). Dementia integrated care pathway workforce
competencies (Appendix 2): Healthcare for London dementia services guide.
London: NHS Commissioning Support for London.
Healthcare for London. (2012). Improving the dementia care pathway legacy for
acute hospital care. NHS: London
Michigan Dementia Coalition. (2008). Knowledge and skills needed for dementia
care: A
guide for direct care workers. Lansing, MI: Michigan Dementia
Coalition.
National Health Service (2014). Dementia framework West Sussex 2014-2019. West
Sussex County Council
National Health Service Haringey (2015). Haringey’s older people’s mental health
and dementia: Commissioning framework, Haringey Council
Norfolk and Suffolk Dementia Action Alliance. (2011). Better Dementia Care. A
Practical Guide. Bristol: Skills for Health
North Staffordshire Combined Healthcare (2015). West Midlands dementia generic
service interventions competency framework
Scottish Government (2011). Promoting excellence: A framework for health and
social services staff working with people with dementia, their families and carers
Skills for Care. (2005). Social care (adults, England): Knowledge set for dementia.
Leeds: Skills for Care.
Smythe, A., Jenkins, C., Bentham, P., & Oyebode J. (2014). Development of a
competency framework for a specialist dementia service. The Journal of Mental
Health Training, Education and Practice, 9(1), 59–68.
South Tees Hospitals NHS Foundation Trust. (2014). Excellence in dementia care
across general hospital and community settings: Competency framework 2013-2018
Skills for Health. (2015). Dementia core skills education and training framework.
Skills for Care, Health Education England
South West Yorkshire NHS Trust. (2008). Dementia toolkit: Information for staff.
Yorkshire: NHS England
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Tsaroucha, A., Benbow, S. M., Kingston, P., & Le Mesurier, N. (2013). Dementia
skills for all: A core competency framework for the workforce in the United Kingdom.
Dementia, 12(1), 29-44.
14.1.3.1 End of life care
https://www.nice.org.uk>guidance End of Life Care for adults/guidance and guidelines
www.bgs.org.uk>goodpractice Palliative and End of Life Care for Older People, British
Geriatrics Society
www.nhs.uk>endoflifecare>planners>pages What end of life care involves. NHS
Choices
www.eapcnet.eu The End of Life Care Strategy in England
www.kingsfund.org.uk Improving end of life care for older people.
www.ncpc.org.uk>priorityissues National Council for Palliative Care
https://www.alzheimers.org.ul>scripts End of Life Care by T Hubbard-Green (2007)
www.eolc.bmj.com>endoflifecare>26abstract
End of life care for Older People in the Acute Hospital Setting Onslow 3 (3) 26
www.dyingmatters.org>gp_page Identifying end of life patients
www.endoflifecareambitions.org.uk Ambitions for palliative and end of life care: a
national framework for local action 2015-2020
www.helpguide.org>articles>latestage-and-end-of-life-care
https://www.alzheimers.org.uk>scripts End of Life Care for People with Dementia a
best practice guide
www.nhs.uk>dementia guide
www.scie.org.uk>files>briefing40 End of Life Care for People with dementia living in
care homes. Social Scare Institute for Excellence.
www.ncpc.org.uk>dementia The Power of Partnership
www.ncpc.org.uk>dementia Out of the Shadows
www.mariecurie.org.uk
www.journals.rcni.com>doi>abs>ns2011 End of life care for a best practice guide
people with dementia Nursing Standard Vol.25 No 34 RCNI
www.ncbi.nlm.nih.gov>PMC2600060 Forget me not: palliative care for people with
dementia NCBI.
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14.2 Best Practice Guidelines, Service Guidelines and
Commissioning Frameworks
14.2.1 Severe and Enduring Mental Health
Department of Health (2001). National service framework for older people. London:
Department of Health
Health and Care Professions Council. (2011). Your guide to standards for continuing
professional development. London: HCPC
National Health Service Haringey (2010). Moving forward: Joint mental health and
well-being strategy for adults. NHS Haringey and Haringey Adult Services
Mental Health Foundation (2007). Better prepared to care: The training needs of nonspecialist staff working with older people with mental ill health
14.2.2 Psychosis
Andresen, R., Oades, L., & Caputi, P. (2003). The experience of recovery from
schizophrenia: Towards an empirically validated stage model. Australian and New
Zealand Journal of Psychiatry, 37(5), 586-594.
Bird, V., Leamy, M., Le Boutillier, C., Williams, J. & Slade, M. (2011). Refocus:
Promoting recovery in community mental health services, London: Rethink
Boardman, J. & Friedli, L. (2012). Recovery, mental health and wellbeing. London:
Centre for Mental Health
Cupitt, C. (2010). Reaching out: The psychology of assertive outreach. London:
Routledge
Farkas, M., Gagne, C., Anthony, W., & Chamberlin, J. (2005). Implementing recovery
oriented evidence based programs: Identifying the critical dimensions. Community
Mental Health Journal, 41(2), 141-158.
Health Quality Improvement Partnership & the Royal College of Psychiatrists. (2014).
Final report for the second round of the national audit of schizophrenia. London: The
Royal College of Psychiatrists.
International Early Psychosis Association Writing Group. (2005). International clinical
practice guidelines for early psychosis. The British Journal of Psychiatry, 187(48),
120-124
IRIS, Rethink Mental Illness & NHS Confederation Mental Health Network (2012).
IRIS guidelines update. London: Rethink
Kalidindi, S., Killaspy, H. and Edwards, T. (2012). Community psychosis services:
The role of community mental health rehabilitation teams. London: Royal College of
Psychiatrists.
Mind (2013). Understanding psychosis
National Health Service England. (2016). Guidance to support the introduction of
access and waiting time standards for mental health services. London: NHS England
NICE (2015). Psychosis and schizophrenia in adults: Quality standard
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National Institute for Mental Health in England. (2005). Guiding statement on
recovery. London: NIMHE
National Institute for Mental Health in England. (2008). Laying the foundations for
better acute mental healthcare. London: NIMHE
Orygen: The National Centre of Excellence in Youth Mental Health. (2010).
Australian clinical guidelines for early psychosis 2nd Ed: A brief summary for
practitioners. Canberra, AUS: The National Centre of Excellence in Youth Mental
Health
Repper, J., & Perkins, R. (2013). The team recovery Implementation plan: A
framework for creating recovery-focused services. Centre for Mental Health, Mental
Health Network NHS Confederation
Rethink Mental Illness (2014). Investing in recovery: Making the business case for
effective interventions for people with schizophrenia and psychosis. London: Rethink
Rethink Mental Illness (2014). Pathways to recovery. London: Rethink
Shepherd, G., Boardman, J., & Burns, M. (2014). Implementing recovery: A
methodology for organizational change. London: Centre for Mental Health
Shepherd, G., Boardman, J., & Slade, M. (2014). Making recovery a reality. London:
Centre for Mental Health
Slade, M. (2013). 100 ways to support recovery. London: Rethink
The American Psychiatric Association (2011). Practice Guidelines for the Psychiatric
Evaluation of Adults
The British Psychological Society. (2011). Understanding bipolar disorder: Why some
people experience extreme mood states and what can help. Leicester: BPS
The Division of Clinical Psychology. (2005). Early intervention in psychosis services:
The role clinical psychologists can play. Leicester: BPS
The Division of Clinical Psychology. (2014). Understanding psychosis and
schizophrenia. Leicester: BPS
The Mental Health Foundation (2008). National Standards for Crisis Services
The Royal College of Psychiatrists. (2009). Enabling recovery for people with
complex mental health needs: A template for rehabilitation services. London: Faculty
of Rehabilitation and Social Psychiatry of the Royal College of Psychiatrists
The Schizophrenia Commission (2012). The abandoned Illness: A report by the
schizophrenia commission, London: Rethink
Walker, L., Perkins, R., & Repper, J. (2014). Creating a recovery focused workforce:
Supporting staff well-being and valuing the expertise of lived experience. London:
Rethink
14.2.3 Guidelines, Standards and Job Profiles/Roles for Clinical Psychologists
Division of Clinical Psychology (2010). Clinical psychology leadership framework.
Leicester: British Psychological Society.
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Division of Clinical Psychology (2012). Guidelines on activities for clinical
psychologists: Relevant factors and the role and utility of job plans. Leicester: British
Psychological Society.
National Health Service (2013). OP psychology job planning & service planning
guide. Cambridgeshire and Peterborough NHS Foundation Trust: NHS
Health and Care Professions Council (2011). Standards of proficiency for practitioner
psychologists. London: HCPC
14.3 Transfer of Training
Crawford-Docherty A (2013) From Classroom to clinic: A study in achieving the
transfer of new clinical skills into everyday mental health practice. Paper presented at
RCN Mental Health Nursing Conference, Warwick University, 2013
Greenhalgh, Robert, MacFarlane, Bate and Kyriakidou (2004) Diffusion of
Innovations in service organizations: systematic review and recommendations. The
Millbank Quarterly, 82, 4, 581-629.
Kirkpatrick D (1976) Evaluation of training IN Craig R (ed) Training and Development
Handbook NY: McGraw-Hill
Kirwan (2009) Improving Learning Transfer – a guide to getting more out of what you
put into your training. Farnham: Gower Publishing
Michie S, Johnston M, Francis J, Hardeman W and Eccles M (2008) From theory to
intervention: Mapping theoretically derived behavioural determinants to behaviour
change techniques. Applied Psychology, 57(4), 660-680
Miller W and Mount K (2001) A small study of training in motivational interviewing:
Does one workshop change clinician and client behaviour? Behavioural and
Cognitive Psychotherapy, 29, 457-471
Quinones M (1997) Contextual Influences on Training Effectiveness. IN Quinones M
and Ehrenstein A (Eds) Training for a Rapidly Changing Workplace: Applications of
Psychological Research. Washington DC: American Psychological Association
Salas E, Almeida S, Salisbury M, King H, Lazzara E, Lyons R, McQuillan R (2009)
What are the critical success factors for team training in health care? Joint
Commission Journal on Quality and Patient Safety, 35(8), 398-405.
Tannenbaum S and Yukl G (1992) Training and Development in Work Organizations.
Annual review of Psychology, 43, 399-441
i
Department of Health (2014). Mental Health Clustering Booklet V3.0 (2013/14).
ii
World Health Organisation. Investing in Mental Health: Evidence for Action. 2013.
iii
Health & Consumer Protection Directorate-General. Green Paper: Improving the mental
health of the population: Towards a strategy on mental health for the European Union. October
2005
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iv
Department of Health. Mental Health National Service Frameworks. 1999.
v
Department of Health. No Health without Mental Health: A Call to Action 2011.
vi
Department of Health. No health without mental health: A Cross-Government mental health
outcomes strategy for people of all ages. 2011
vii
Andrew, A, Knapp, M. et al. Effective Interventions in Schizophrenia: The Economic Case.
LSE/PSSRU November 2012.
viii
9
Department of Health. Talking Therapies: A four-year plan of action February 2011.
Centre for Mental Health. Briefing Note: Parity of Esteem. October 2013.
10
NHS
England
Mandate
2014/15content/uploads/2014/04/nhse-mandate-wa.pdf
2016/17
http://www.england.nhs.uk/wp-
11
Department of Health Closing the Gap: Priorities for essential change in mental health.
February 2014
12
Department of Health. Achieving Better Access to Mental Health Services by 2020. 2014
13
Department of Health. Costing: Introducing the Access and Waiting Time Standard for
Children with Eating Disorder
14
NHS England. Improving Access to Psychological Therapies (IAPT) Waiting Times. 2015.
15
NHS England. Guidance to support the introduction of access and waiting time standards for
mental health services in 2016/16.
16
Royal College of Psychiatrists. National Audit of Psychological Therapies. November 2013.
17
National Statistics Publication for Scotland. Psychology Services Workforce in NHS Scotland
May 2014.
18
HM Government. Mental Health Crisis Care Concordat: Improving outcomes for people
experiencing mental health crisis. February 2014.
19
Gibson, S. Et al. Evaluation of the Crisis Care Concordat implementation: Final Report. Mc
Pin Foundation for Mind. January 2016.
20
Department of Health. Annual Report of the Chief Medical Officer 2013: Public Mental Health
Priorities – Investing in the Evidence.
21
Royal College of Psychiatrists. No health without public mental health: the case for action:
Parliamentary briefing.2010.
22
Royal College of Psychiatrists. Improving the physical health of people with serious mental
illness: A practical toolkit. May 2016.
23
NHS Five Year Forward View October 2014
24
NHS England. Delivering the Forward View: NHS planning guidance 2016/17-2020/21.
December 2015.
25
NHS England. STP aide-memoire: Mental Health and Dementia. May 2016.
26
Centre for Mental Health. Briefing Note: Parity of esteem. October 2013.
27
NHS England. Our 2016/17 Business Plan
28
NHS England. Mental Health and Dementia Focus and Delivery Group. 32013.
Department of Health. Prime Minister’s Challenge on Dementia 2020: Implementation Plan.
March 2016.
29
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CONFIDENTIAL
Department of Health. Prime Minister’s challenge on dementia 2020.
31
NHS England. Dementia Diagnosis and Care in England: Learning from Clinical
Commissioning Groups. April 2014.
32
NHS England. Models of Dementia Assessment and Diagnosis: Indicative Cost Review.
33
Health Foundation. Fit for purpose? Workforce policy in the English NHS. 2016.
34
Mental Health Task Force. The Five Year Forward View Mental Health Taskforce: public
engagement findings. September 2015
35NHS
England Local Transformation Plans for Children and Young People’s Mental Health
and
Wellbeing
Guidance
and
support
for
local
areas.
August
2015.
https://www.england.nhs.uk/2015/08/03/cyp-mh-prog-launch/
36
NICE & NHS England. Implementing the Early Intervention in Psychosis Access and Waiting
Time Standard: Guidance. April 2016.
37
NHS England. Access and Waiting Time Standard for Children and Young People with an
Eating Disorder Commissioning Guide. July 2015
38
https://www.england.nhs.uk/ourwork/qual-clin-lead/chd/
39
NHS England. Report of Independent Mental Health Taskforce. The Five Year Forward View
for Mental Health. February 2016.
40
NHS England. Implementing The Five Year Forward View for Mental Health. July 2016.
41
MHS England. Improving the physical health of people with mental health problems: Actions
for mental health nurses. May 2016.
42
NHS England. Setting 5 year ambitions for improving outcomes: A how-to guide for
commissioners. December 2013
43
Department of Health. NHS Outcomes Framework: at-a-glance. April 2016.
44Department
of Health the Mandate: A mandate from the Government to the NHS
Commissioning Board: April 2013 to March 2015
45
Department of Health. NHS Outcomes Framework at a glance. April 2016.
46
Department of Health. No health without mental health: Mental health dashboard. December
2013.
47
NHS Institute for Innovation and Improvement. The Fifteen Steps Challenge: Quality from a
patient’s perspective. 2012.
48
NHS England & NHS Improvement. Delivering the Five Year Forward View for Mental Health:
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