JOB DESCRIPTION. To develop capacity for delivering Psychological Interventions to Older People in primary care and/or acute hospital settings.

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1 JOB DESCRIPTION 1. JOB IDENTIFICATION Job Title: Department(s): Job Holder Reference: No of Job Holders: Clinical Psychologist Highly Specialist Psychological services Older Adult Mental Health MHS JOB PURPOSE To develop capacity for delivering Psychological Interventions to Older People in primary care and/or acute hospital settings. Liaison, joint working, consultation, expert advice and supervision of other professionals in statutory and independent care settings. Day to day clinical supervision of less experienced psychologists, counsellors, assistant psychologists, community psychiatric nurses, support workers and postgraduate trainee clinical psychologists. Assess need for low intensity psychological interventions within staff groups and train/supervise other staff to deliver. Work with teams to increase psychological awareness and adapt treatment plans to reflect this. Evaluate effectiveness of psychological interventions delivered and staff training. Carry out a scoping exercise to determine the maximum likely impact across different settings, which have been identified as areas where psychological interventions for older people are currently lacking. Produce a report within 3 months of start date detailing results of scoping, and in conjunction with the Head of Psychological Services and Lead Psychologist for Older People produce a plan which sets out where and how the post holder will implement a programme which develops capacity to deliver evidence based psychological interventions for older people. 3. ORGANISATIONAL POSITION Head Of Psychological Services: Professional Advisor Lead for Older Adult Psychology: Line Manager Post sits within Older Adult Mental Health Psychology with close links to other Applied Psychologists in Adult CMHT s

2 4. SCOPE AND RANGE 1. Accountable for own professional actions, adhering to local policies and professional guidelines. 2. Use of highly specialist clinical skills within the Adult Psychology Service. 3. Assessment, treatment and management of a wide range of psychological problems, from moderate psychological distress to severe and enduring mental health problems, neurological disorders and personality disorder. 4. Liaison with GP s, Primary Care staff, community mental health team members, Geriatricians, Acute Hospital staff and other clinicians regarding the care and management of clinical cases. 5. Advise Head of Service, Psychological Services on the planning of psychological services for specified sub-groups of the population. 6. Liaise with Head of Speciality, Older Adult Mental Health with regard to service issues, including identifying unmet need and opportunities for service development. 7. Provision of expert advice and knowledge in clinical supervision. 8. Specific allocation of time and duties as decided by Head of Adult Psychological Services. OUR VALUES IN ACTION Care and Compassion Quality and Teamwork Dignity and Respect Openness, honesty and responsibility 5. MAIN DUTIES/RESPONSIBILITIES Provision of highly specialist clinical psychological knowledge and skills to adults referred to the service. 1. Provide highly specialist assessment, formulation and treatment. 2. Assessment of risk to patients, relatives, staff and members of the public, implementing agreed policies where appropriate. 3. Decisions regarding suitability of treatment, appropriateness and priority of referrals. 4. Determining the aims and duration of treatment 5. Interpretation of specialist psychometric tests. 6. Making recommendations regarding treatment for collaborative interventions and for those cases not accepted for therapy 7. Provide advice, consultancy and training to colleagues within Health, Social Work and the Voluntary Sector 8. Receive regular individual clinical supervision and contribute to peer supervision in accordance with good practice guidelines. 9. Prepare complex clinical reports 10. Maintaining accurate records of patient contact and activity. Direct clinical supervision of specialist Clinical Psychologists, Assistant Psychologists and postgraduate Trainee Clinical Psychologists on placement as well as nursing staff and community mental health team members as appropriate. Planning, organising and delivering staff training in the practice of clinical supervision, psychological therapies and applying psychology to mental health.

3 6. SYSTEMS AND EQUIPMENT A range of specialist psychometric tests measuring: Intellectual and cognitive capacity and deficits Mood and emotional state Specific behaviours Routine recording and monitoring of: Clinical work and outcomes Patient contacts Use of a personal computer Word Excel Outlook PowerPoint SPSS 7. DECISIONS AND JUDGEMENTS Clinical judgements involving highly complex facts and situations, which require the analysis, interpretation and comparison of a range of response options. Determining the type and length of clinical interventions individual patients will receive. 8. COMMUNICATIONS AND RELATIONSHIPS 1. Communicates complex sensitive condition related information to clients, relatives referrers and other professions. 2. Duties require empathy, understanding and the ability to deal with barriers to understanding including hostile, antagonistic patients and a highly emotive atmosphere. 3. Clients may be at risk of suicide or self harm or are recently bereaved, seriously mentally ill and / or cognitively impaired. 4. Motivating staff and patients, some of whom may be reluctant to consider change. 5. Collaborative working relationships with all relevant agencies including; General Practitioners, Geriatricians, primary and secondary team members and other referring professionals. 6. Presentations and training workshops to other groups, contribution to training clinical psychologists 9. PHYSICAL DEMANDS OF THE JOB 1. Driving for up to an hour at a time, at least once during most working days. 2. Remaining seated for periods of up to 2 hours when with patients. 3. Administering practical tests of ability following very precise procedures with a specific requirement for accuracy. 10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB Requirement for highly developed analytical skills Emotional demands of the job exposure to psychological distress of others. Keeping abreast of the knowledge base and applying this to routine clinical practice.

4 11. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB (summary see full person spec) Undergraduate honours degree in Psychology 2:1 or above Postgraduate Doctoral degree Clinical Psychology Clinical supervisory knowledge and skills Advanced post-qualification clinical training in relevant areas Postgraduate Course in Supervision Relevant qualified supervised experience working with adults with psychological problems Experience of multidisciplinary team working Experience of health and social care systems, agencies and professions.

5 PERSON SPECIFICATION Job Title: Clinical Psychologist Highly Specialist, Older Adult Mental Health (8A) Department: Psychological Services. ESSENTIAL DESIRABLE TRAINING & QUALIFICATIONS EXPERIENCE Undergraduate degree in Psychology min 2:1 Postgraduate Doctoral degree Clinical Psychology Registered with HCPC as a Clinical Psychologist Experience of multidisciplinary team working at primary and secondary care levels. Experience of providing teaching, training and/or professional and clinical supervision for psychologists and other professions. Experience of health and social care systems, agencies and professions. Experience of exercising full clinical responsibility for clients psychological care and treatment, both as a professionally qualified care co-ordinator and also within the context of a multidisciplinary care plan. Further accredited training in evidence based psychological therapies (e.g. IPT, CBT, CAT, EMDR etc.) completed or ongoing. NES accredited training in Supervision of psychological therapies/clinical psychology trainees. Relevant post qualification, supervised experience working with adults or older adults with psychological problems or a year or more as an aligned trainee in Adult or Older Adult Mental Health Experience of professional management of qualified and prequalified psychologists. KNOWLEDGE AND SKILLS Skills in the use of complex methods of psychological assessment intervention and management frequently requiring sustained and intense concentration. A high level ability to communicate effectively at both a written and oral level complex, highly technical and clinically sensitive information to clients, their families, carers and a wide range of lay and professional persons within and outside the NHS. Skills in providing consultation to other professional and non-professional groups. Knowledge of legislation and its implications for both clinical practice and Knowledge of the theory and practice of specialised psychological therapies in specific difficult to treat groups (e.g. personality disorder dual diagnoses, multimorbidities, people with additional disabilities and severely challenging behaviours etc.) Knowledge of the issues pertinent to working with older people and how to work with this patient group. An understanding of the principles of demand and capacity concepts as applied to the provision of

6 professional management in relation to the client group and mental health. psychological therapies. Evidence of continuing professional development as recommended by the BPS. PERSONAL OTHER Enthusiasm for a broad range of psychological phenomena, an interest in models of service delivery, and an ability to articulate the value added by clinical psychology services within the context of multi-disciplinary mental health services. Ability to contain and work with organisational stress and ability to hold the stress of others. Ability to identify, and employ, as appropriate, clinical governance mechanisms for the support and maintenance of clinical practice in the face of regular exposure to highly emotive material and challenging behaviour. Ability to articulate and interpret clearly the role of the profession of clinical psychology based upon a good understanding of the framework of government and national professional policy. Full driving licence A commitment to the evaluation of services, enthusiasm for both multi-professional and uniprofessional audit, and a wish to continue to develop expertise in the service area. Ability to demonstrate leadership and management skills. Experience of working within a multicultural and/or remote and rural setting. An understanding of DCAQ theory and methodology as applied to psychological therapies. Likely breakdown of post (0.5wte) = 5 sessions: 1 session admin and meetings 1 session training and supervision 3 sessions clinical work (direct and indirect)

7 TERMS & CONDITIONS Grade and salary: Hours of work: Annual leave: Public Holidays: Superannuation: Band 8a: 40,428-48,514 pro rata per annum hours per week, Permanent 27 days pro rata per annum Details of other types of leave entitlement (such as sick leave) are set out in the Agenda for Change handbooks. 8 days pro rata per annum on dates designated by NHS Borders Details of other types of leave entitlement (such as sick leave) are set out in the Agenda for Change handbook. The post-holder is entitled to join the NHS superannuation pension scheme. If Unsuccessful: If you have NOT heard from us within 4 WEEKS of the closing date, then we regret that your application has not been successful on this occasion. However, we appreciate your interest in working with NHS Borders and your time and effort in completing the application form. We would welcome your application for future posts. Equal Opportunities: In NHS Borders, we believe that all staff should be treated equally in employment. We will not discriminate against any member of staff, or job applicant, on grounds of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation. Trade Union membership. Disclosure checks: We carry out criminal record checks on new staff who fall within certain staff groups within NHS Borders, through Disclosure Scotland. We send out Disclosure Forms to all shortlisted candidates for these staff groups, and ask for these to be completed and returned at interview. If a successful-at-interview candidate forgets to bring their completed form to interview, then they will be required to return the form (and proofs of identity) within 7 days, otherwise the provisional job offer will be withdrawn. Unsuccessful candidates forms will be shredded. The Rehabilitation of Offenders Act does not apply to this post. Tobacco policy: We have a Tobacco policy in place. When selecting staff, we do not discriminate against applicants who smoke, but staff must observe our policy on smoking. Hepatitis B: We offer Hepatitis B immunisation through our Occupational Health Service (OHS). If you think you may be at risk of contracting Hepatitis B through your job, you should ask for this immunisation at OHS. If your work involves exposure-prone procedures, you must keep to the document Protecting Health Care Workers and Patients from Hepatitis B, and the NHSiS Management Executive Directive on this issue. You must be immune to Hepatitis B, and if you cannot prove that you are immune, OHS will investigate to find out whether you are Hepatitis B positive or not.

8 Health and Safety at Work: You must look after the health and safety of yourself and anyone else who may be affected by what you do at work. You must also co-operate with us to make sure that we keep to legal and organisational safety regulations. You can get more information from the NHS Borders Health & Safety Adviser. The closing date for completed application forms is: 5pm on Thursday 15 September 2016 Please see over for Supporting Information for applicants

9 SUPPORTING INFORMATION FOR APPLICANTS OPTION A Referral rates for psychological therapies for older people across Scotland have historically always been lower than those for working age adults, despite comparable prevalence rates of mental health problems. The Royal College of Psychiatrists reported that approximately 80% of older people with depression do not receive any treatment at all (RCP, 2009). Of the older people who are actively managed in primary care, treatment tends to be almost exclusively with antidepressant medication (Age Concern, 2007). Psychological Services in NHS Borders receive very low rates of referrals for older people for assessment and psychological intervention. NHS Borders Audit Data Data reported below came from an audit carried out in 2014 which included 38.5% of the GP practices in NHS Borders audit data covered a 5 year period ( ). Audit data collected and analysis by Victoria Thomson, Trainee Clinical Psychologist. Of the small number of older people who had their mental health symptoms diagnosed by the GP, the vast majority were managed with pharmacological intervention according to the audit. Further, over 80% of older people were not referred for psychological therapies. Comparing GP management of older and younger people with anxiety in the last 5 years (medication vs referral for psychological therapy)

10 Comparing GP management of older and younger people with depression in the last 5 years (medication vs referral for psychological therapy) Conclusion There is therefore an identified need in NHS Borders to work with GP s and all other primary care staff and social care colleagues who have clinical contact with older people, to increase knowledge and awareness of the efficacy of psychological interventions with older people, increase referral rates and build capacity for delivery within a tiered-care model. OPTION B Research evidence demonstrates that people with long-term conditions are two to three times more likely to experience mental health problems than the general population. The prevalence of long-term conditions and multi-morbidities increases with age. There is particularly strong evidence of a close association between late-life depression in Parkinson s Disease, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular diseases, and musculoskeletal disorders (Naylor et al 2012). Anxiety disorders are also more common in those with long-term conditions and are linked to decreased quality of life and increased mortality (Orrell & Bebbington, 1996). Overall, the evidence suggests that at least 30 per cent of all people with a long-term condition also have a mental health problem (Cimpean and Drake 2011). In addition to the higher prevalence of mental health problems in long-term conditions and multimorbidities, fear of falling is an added problem which is estimated to affect approximately 50% of people over 65 years. NHS GG&C Community Falls Prevention Programme found the employment of a clinical psychologist to deliver brief CBT, matched to the level of psychological need, was very effective in reducing fear of falling and enabled people to resume normal, previously-enjoyed activities by reducing the risk of future falls, injuries and admissions to hospital

11 (Conaghan 2014). The success of introducing psychological intervention as part of the falls prevention programme led to the continued funding of psychology input to the service. Conclusion There is therefore an identified need in NHS Borders, which currently has no psychology input in these areas, to increase capacity and access to psychological interventions for older people with co-morbid physical and mental health problems in out-patient hospital or community settings. SUMMARY Options A and B will be scoped more fully by the post holder and the likely impact to both patients and workforce assessed. This includes the impact of providing training and supervision to a range of staff to increase awareness of mental health problems in an older adult population and support staff to provide psychologically informed interventions in addition to increasing referral rates - thereby increasing capacity and access.