Standards for the accreditation of psychological wellbeing practitioner training programmes May 2016 0
Contents Introduction Benefits of Society membership What is accreditation? Benefits of accreditation Our standards: an introduction Our standards for Psychological Wellbeing Practitioner training programmes Programme standard 1: Learning, research and practice A. Required core competencies 1. Core training of the Psychological Wellbeing Practitioner a statement of intent 2. Required learning outcomes for accredited PWP training programmes B. Teaching and learning 1. Programme specification 2. Curriculum C. Supervised practice D. Assessment and progression Programme standard 2: Working ethically Programme standard 3: Selection and entry Programme standard 4: Society membership Programme standard 5: Personal and professional development Programme standard 6: Staffing Programme standard 7: Leadership and co-ordination Programme standard 8: Physical resources Programme standard 9: Quality management 1
Additional information Information for trainees Studying abroad as part of an accredited programme Accreditation of programmes offered outside of the UK Governance Complaints about accredited programmes 2
Introduction The British Psychological Society ( the Society ) is the learned and professional body, incorporated by Royal Charter, for psychologists in the United Kingdom. The Society has a total membership of approximately 48,000 and is a registered charity. Under its Royal Charter, the key objective of the Society is to promote the advancement and diffusion of the knowledge of psychology pure and applied and especially to promote the efficiency and usefulness of members by setting up a high standard of professional education and knowledge. The Society has been involved in the accreditation of programmes of education and training in psychology since the early 1970s. The Society currently accredits programmes at both undergraduate (and equivalent) and postgraduate levels. Undergraduate, conversion, and integrated Masters programmes are accredited against the requirements for the Society s Graduate Basis for Chartered Membership (GBC), the curriculum requirements for which are derived from the Quality Assurance Agency s subject benchmark statement for psychology (which is due to be reviewed in 2015). Postgraduate programmes are accredited against the knowledge, practice and research requirements for Chartered Psychologist (CPsychol) status in a range of domains of practice. A number of the postgraduate programmes that are accredited by the Society are also approved by the Health and Care Professions Council (HCPC), the statutory regulator of practitioner psychologists in the UK. Benefits of belonging to the Society Our standards include an expectation that education providers offering accredited programmes provide their trainees with information on Society subscribership and membership and its benefits. Those trainees entering PWP training who have completed an accredited psychology undergraduate degree will be eligible for Graduate Membership of the Society; all other trainees are able to join the Society as Affiliate Subscribers. We encourage you to reproduce the following pages within your Trainee Handbooks or share them with trainees via your virtual learning environment. 3
[insert Benefits of membership PG flyer] [insert Benefits of affiliate subscribership flyer] [insert PsyPAG flyer] 4
What is accreditation? Accreditation through Partnership is the process by which the British Psychological Society works with education providers to ensure that its quality standards in education and training are met by all programmes on an ongoing basis. Our approach to accreditation is based on partnership rather than policing, and we emphasise working collaboratively with programme providers through open, constructive dialogue that allows space for exploration, development and quality enhancement. If you are submitting a new programme for accreditation, or are preparing for an accreditation visit or review, you should read these standards in conjunction with the relevant process handbook. All handbooks can be downloaded from www.bps.org.uk/accreditationdownloads. Benefits of accreditation Delivering a programme that meets the high quality standards required for accreditation is a significant commitment, and there are lots of reasons why Society accreditation is worth your investment of time and money: It is a highly regarded marker of quality that prospective trainees and employers understand and value as a reflection of nationally-agreed curriculum and training requirements. It enhances the marketability of your programmes in a competitive market place. It gives your graduates a professional home. Belonging to the Society is an integral part of trainees development, as it recognises their qualifications and reflects their aspiration to achieve the highest possible professional standards. It is a high quality benchmarking process that is defined, developed and delivered in partnership with psychologists and other highly skilled and experienced psychological practitioners. It is aimed at getting the best out of programmes, through promoting psychological science and practice, facilitating quality enhancement and providing solution-focused support. It provides a direct opportunity for you and your trainees to influence the Society, its support for education providers and trainees, and its policies for the future. Together we have a powerful voice in raising the profile of psychology and psychological practice in the UK and internationally, developing standards and advancing the discipline. 5
Our standards: an introduction The Society publishes standards for the accreditation of undergraduate and postgraduate programmes. Our standards for undergraduate, conversion and integrated Masters programmes represent the requirements for Graduate Membership of the Society and the Graduate Basis for Chartered Membership (GBC). Our postgraduate standards for professional training in psychology span eight domains of practice, seven of which relate to pre-qualification training leading to Chartered Membership of the Society, and full membership of one or more of the Society s Divisions (the Division of Clinical Psychology, the Division of Counselling Psychology, the Division of Educational and Child Psychology or the Scottish Division of Educational Psychology, the Division of Forensic Psychology, the Division of Health Psychology, the Division of Occupational Psychology and the Division of Sport and Exercise Psychology). These correspond to the seven protected titles regulated by the Health and Care Professions Council. We also accredit specialist post-qualification training programmes in Clinical Neuropsychology. In addition, we publish standards for the accreditation of Psychological Wellbeing Practitioner training programmes. These programmes are typically offered at level 6 and/or level 7. The Society is keen to create flexibility for programmes to develop distinctive identities, by making the most of particular strengths around research and practice shared by their staff team, or those that are reflected in the strategic priorities of their Department or University. This document sets out our accreditation standards for Psychological Wellbeing Practitioner training programmes. The standards were approved by the Society s Membership Standards Board in February 2016, and came into operation on 1 May 2016. 6
Our standards for Psychological Wellbeing Practitioner training programmes Our standards are organised around nine overarching areas, and have been derived following extensive consultation between the Society and education providers; these comprise our programme standards, and must be achieved by all accredited programmes. Each overarching standard is followed by a rationale for its inclusion, together with an outline of the factors that education providers might wish to consider in confirming their achievement of each standard. The information provided is not intended to prescribe a particular approach to meeting our standards; rather it is intended to reflect the likely areas of interest for visiting teams or reviewers when exploring achievement of the standards with education providers, trainees, employers, and other stakeholders. During partnership visits, the questions that visiting teams will ask will be designed specifically to give education providers every opportunity to confirm their achievement of the standards. Some of our nine overarching standards are complemented by a series of further standards that are of specific relevance to Psychological Wellbeing Practitioner (PWP) training programmes. These represent the benchmark level of quality that the Society expects all accredited programmes of this kind to attain. However, we recognise that different programmes will aim to meet these standards in different ways and our overall approach is to encourage flexibility in the methods used in meeting the standards. Our standards framework is organised as follows: Psychological science 1. Learning, research and practice 2. Working ethically Quality management 9. Periodic review Access to education & training 3. Selection and entry 4. Society membership Resourcing 6. Staffing 7. Leadership and co-ordination 8. Physical resources Developing psychological practitioners 5. Personal and professional development Overall, our standards support education providers offering programmes that are designed to meet the requirements for entry to the Society s Register of Psychological Wellbeing Practitioners. The British Association for Behavioural and Cognitive Psychotherapies also offers a voluntary individual registration scheme for qualified PWPs who have completed an accredited training programme. Providers may also wish to put forward undergraduate or integrated Masters programmes that seek to combine the requirements for the GBC and for PWP training. Where this is the case, programmes will be evaluated against the two separate sets of standards they are seeking to meet (i.e. the standards contained in this handbook, and those applying to undergraduate programmes which are outlined separately). 7
Programme standard 1: Learning, research and practice The programme must reflect contemporary learning, research and practice. The programme must be able to document its intended learning outcomes, the ways in which these reflect the relevant training requirements, the learning and teaching strategies that will be used to support trainees achievement of the learning outcomes, and the assessment strategies that will enable trainees to demonstrate those achievements. Trainees successful fulfilment of the programme s requirements must be marked by the conferment of a named HE award at the appropriate level. Education providers will normally demonstrate their achievement of this standard through production of a programme specification. Whilst programme specifications are a standard feature of quality monitoring for education providers, inclusion of this standard here offers an opportunity for the Society to identify innovative and creative practice in relation to teaching, learning and assessment. A Training requirements 1. Core training of the Psychological Wellbeing Practitioner a statement of intent Psychological Wellbeing Practitioner training programmes provide the knowledge and professional skills for people to work as Psychological Wellbeing Practitioners (PWPs) with people with common mental health problems. The PWP role was originally developed to work within Improving Access to Psychological Therapies (IAPT) services in England, providing assessment and low-intensity interventions, and PWP training programmes accordingly prepare people to work as PWPs in IAPT services. PWP training programmes in other nations may prepare people to work in analogous roles in primary care mental health services. Psychological Wellbeing Practitioners are trained to assess and support people with common mental health problems principally anxiety disorders and depression in the self-management of their recovery. Interventions are designed to aid clinical improvement and social inclusion, including return to work, meaningful activity or other occupational activities. PWPs do this through the provision of information and support for evidence-based low-intensity psychological treatments, mainly informed by cognitive-behavioural principles, but also include physical exercise and supporting medication adherence. Behaviour change theory and models provide the framework which support an integrated approach to the choice and delivery of the interventions that PWPs provide. National Institute for Health and Care Excellence (NICE) guidance for common mental health disorders 8
and for each of the anxiety disorders and depression sets out the range of different types of lowintensity evidence-based interventions appropriate for delivery by PWPs 1. Principal among these are support for low-intensity self-help interventions informed by cognitive-behavioural principles. Typically these are supported by the use of self-help materials which can be provided in written or digital form (e.g. computerised cognitive behavioural therapy (ccbt)). Treatment is provided to groups of people as well as one-to-one to individual patients, and is provided by telephone and increasingly through electronic media as well as face-to-face. Low-intensity psychological treatments place a greater emphasis on patient self-management and are less burdensome than traditional psychological treatments. Support is specifically designed to enable patients to optimise their use of self-management recovery information and may be delivered through face-to-face, telephone, email or other contact methods. PWPs also provide information on common pharmacological treatments and support patients in decisions that optimise their use of such treatments. They also provide information on and support for the promotion of physical activity. PWPs normally operate within a stepped care service delivery model, such as Improving Access to Psychological Therapies (IAPT, www.iapt.nhs.uk) services in England, or similar service delivery models elsewhere 2. Stepped care operates on the principle of offering the least intrusive most effective treatment in the first instance; patients can then be stepped up to a more intensive treatment if required. In the IAPT service delivery model, PWPs provide care at step 2 of the stepped care model supporting low-intensity interventions. They work alongside high-intensity workers and other clinicians delivering CBT and other evidence-based step 3 treatments across the therapeutic modalities. Knowledge of IAPT services including the stepped care model of service delivery, regular and routine clinical outcomes measurement, case management and supervision are accordingly generic competencies that PWPs need for the satisfactory performance of their duties. 2. Required learning and practice outcomes for Psychological Wellbeing Practitioner training programmes Learning and practice outcomes for PWP training programmes relate to three core areas of competence: Engagement and assessment of patients with common mental health problems Evidence-based low-intensity treatment for common mental health disorders Values, diversity and context, including working with diversity from an inclusive values base, and working in the context of IAPT and related primary care mental health services Specific learning outcomes are set out in the paragraphs below. Individual providers may adapt the wording of the learning outcomes to suit their own needs, provided that they can demonstrate that the learning outcomes are reflected within their programme in their entirety. 1 2 For programmes operating outside of England, other equivalent evidence-based national guidance may apply. Programmes should ensure that, regardless of their geographical location, trainees are familiar with the NICE guidance for common mental health disorders and for each of the anxiety disorders and depression. Programmes working with services that operate outside of IAPT (including those based outside of England) will need to demonstrate that their trainees are able to take an approach to their work that offers equivalence to the specific characteristics of the IAPT service delivery model, as outlined in this document. 9
2.1. Engagement and assessment of patients with common mental health problems PWPs assess and support people with common mental health problems in the selfmanagement of their recovery. To do so they must be able to undertake a range of patientcentred assessments and be able to identify the main areas of concern relevant to the assessment undertaken. They need to have knowledge and competence to be able to apply these in a range of different assessment formats and settings. These different elements or types of assessment include screening/triage assessment; risk assessment; provisional diagnostic assessment; mental health clustering assessment; psychometric assessment (using the IAPT standardised symptoms measures); problem focused assessment; and intervention planning assessment. In all these assessments they need to be able to engage patients and establish an appropriate relationship whilst gathering information in a collaborative manner. They must have knowledge of mental health disorders and the evidence-based therapeutic options available and be able to communicate this knowledge in a clear and unambiguous way so that people can make informed treatment choices. In addition, they must have knowledge of behaviour change models and how these can inform choice of goals and interventions. Specific learning outcomes to be demonstrated are as follows: 1. Demonstrate knowledge, understanding and critical awareness of concepts of mental health and mental illness, diagnostic category systems in mental health and a range of social, medical and psychological explanatory models. 2. Demonstrate knowledge of, and competence in applying the principles, purposes and different types of assessment undertaken with people with common mental health disorders. 3. Demonstrate knowledge of, and competence in using common factors to engage patients, gather information, build a therapeutic alliance with people with common mental health problems, manage the emotional content of sessions and grasp the patient s perspective or world view. 4. Demonstrate knowledge of, and competence in patient-centred information gathering to arrive at a succinct and collaborative definition of the person s main mental health difficulties and the impact this has on their daily living. 5. Demonstrate knowledge of, and competence in recognising patterns of symptoms consistent with diagnostic categories of mental disorder from a patient-centred interview. 6. Demonstrate knowledge of, and competence in accurate risk assessment of patient or others. 7. Demonstrate knowledge of, and competence in the use of standardised assessment tools including symptom and other psychometric instruments to aid problem recognition and definition and subsequent decision making. 8. Demonstrate knowledge, understanding and competence in using behaviour change models in identifying intervention goals and choice of appropriate interventions 9. Demonstrate knowledge of, and competence in giving evidence-based information about 10
treatment choices and in making shared decisions with patients. 10. Demonstrate competence in understanding the patient s attitude to a range of mental health treatments including prescribed medication and evidence-based psychological treatments. 11. Demonstrate competence in accurate recording of interviews and questionnaire assessments using paper and electronic record keeping systems. 2.2. Evidence-based low-intensity treatment for common mental health disorders PWPs aid clinical improvement through the provision of information and support for evidence-based low-intensity psychological treatments and regularly used pharmacological treatments of common mental health problems. Low-intensity psychological treatments place a greater emphasis on patient self-management and are designed to be less burdensome to people undertaking them than traditional psychological treatments. The overall delivery of these interventions is informed by behaviour change models and strategies. Examples of interventions include providing support for a range of low-intensity self-help interventions (often with the use of written self-help materials) informed by cognitive-behavioural principles. Support is specifically designed to enable people to optimise their use of selfmanagement recovery information and pharmacological treatments and may be delivered individually or to groups of patients and through face-to-face, telephone, email or other contact methods. PWPs must also be able to manage any change in risk status. Specific learning outcomes to be demonstrated are as follows: 1. Critically evaluate a range of evidence-based interventions and strategies to assist patients manage their emotional distress and disturbance. 2. Demonstrate knowledge of, and competence in developing and maintaining a therapeutic alliance with patients during their treatment programme, including dealing with issues and events that threaten the alliance. 3. Demonstrate competence in planning a collaborative low-intensity psychological or pharmacological treatment programme for common mental health problems, including managing the ending of contact. 4. Demonstrate in-depth understanding of, and competence in the use of, a range of lowintensity, evidence-based psychological interventions for common mental health problems. 5. Demonstrate knowledge and understanding of, and competence in using behaviour change models and strategies in the delivery of low-intensity interventions. 6. Critically evaluate the role of case management and stepped care approaches to managing common mental health problems in primary care including ongoing risk management appropriate to service protocols. 7. Demonstrate knowledge of, and competence in supporting people with medication for 11
common mental disorders to help them optimise their use of pharmacological treatment and minimise any adverse effects. 8. Demonstrate competence in delivering low-intensity interventions using a range of methods including face-to-face, telephone and electronic communication. 2.3. Values, diversity and context PWPs operate at all times from an inclusive values base that promotes recovery and recognises and respects diversity. Diversity represents the range of cultural norms including personal, family, social and spiritual values held by the diverse communities served by the service within which the worker is operating. Workers must respect and value individual differences in age, sexuality, disability, gender, spirituality, race and culture. PWPs must also take into account any physical and sensory difficulties people may experience in accessing services and make provision in their work to ameliorate these. They must be able to respond to people s needs sensitively with regard to all aspects of diversity. They must demonstrate a commitment to equal opportunities for all and encourage people s active participation in every aspect of care and treatment. They must also demonstrate an understanding and awareness of the power issues in professional/patient relationships and take steps in their clinical practice to reduce any potential for negative impact this may have. PWPs are expected to operate in a stepped care, high-volume environment. During training, trainee PWPs should carry a reduced caseload, with the number of cases seen depending on their stage in training, building up to a maximum of 60-80% of a qualified PWP s caseload before completion of the training. PWPs must be able to manage caseloads, operate safely and to high standards and use supervision to aid their clinical decision-making. PWPs need to recognise the limitations to their competence and role and direct people to resources appropriate to their needs, including step-up to high-intensity therapy, when beyond their competence and role. In addition, they must focus on social inclusion including return to work and meaningful activity or other occupational activities, physical activity promotion to address both psychological and/or physical health outcomes as well as clinical improvement. To do so they must have knowledge of a wide range of social and health resources available through statutory and community agencies. They must have a clear understanding of what constitutes the range of high-intensity psychological treatments which includes CBT and the other IAPT approved high-intensity therapies and how high-intensity treatments differ from low-intensity working. Specific learning outcomes to be demonstrated are as follows: 1. Demonstrate knowledge of, and commitment to a non-discriminatory, recovery orientated values base to mental healthcare and to equal opportunities for all and encourage people s active participation in every aspect of care and treatment. 2. Demonstrate respect for and the value of individual differences in age, sexuality, disability, gender, spirituality, race and culture. 3. Demonstrate knowledge of, and competence in responding to peoples needs sensitively with regard to all aspects of diversity, including working with older people, the use of 12
interpretation services and taking into account any physical and sensory difficulties patients may experience in accessing services. 4. Demonstrate awareness and understanding of the power issues in professional / patient relationships. 5. Demonstrate competence in managing a caseload of people with common mental health problems efficiently and safely. 6. Demonstrate knowledge of, and competence in using supervision to assist the worker s delivery of low-intensity psychological and/or pharmacological treatment programmes for common mental health problems. 7. Demonstrate knowledge of, and competence in gathering patient-centred information on employment needs, wellbeing and social inclusion and in liaison and signposting to other agencies delivering employment, occupational and other advice and services. 8. Demonstrate an appreciation of the worker s own level of competence and boundaries of competence and role, and an understanding of how to work within a team and with other agencies with additional specific roles which cannot be fulfilled by the worker alone. 9. Demonstrate a clear understanding of what constitutes high-intensity psychological treatment and how this differs from low-intensity work. 3. Structure of training 3.1. The curriculum is designed so that it can be available at both undergraduate (level 6) and postgraduate certificate level (level 7), normally based on three modules (see above) delivered over 45 days in total. It requires completion of 60 credits in accordance with the learning and practice outcomes specified above, typically resulting in the award of a Graduate Certificate or a Postgraduate Certificate. PWP training may also be incorporated into other undergraduate or postgraduate awards, provided that academic learning is supported by appropriate practice experience, and provided that those who have completed PWP training as part of their award may be readily distinguished from those who have not (normally through conferment of a distinctive award title). 3.2. The delivery of 45 days training is essential to meet the learning objectives specified within the curriculum. Although each module has a specific set of foci and learning outcomes, the clinical competencies build on each other and courses are expected to focus the majority of their teaching activity on clinical competence development through clinical simulation/role play. 3.3. The curriculum is normally organised into three modules. Modules and credit ratings can be adapted by education providers to comply with their academic timetable and tailored to suit local needs. Similarly, providers may choose how they wish to deliver these modules to best prepare trainees for the work they are undertaking in services; for example, they may choose to deliver modules one and two, relating to assessment and treatment, either concurrently (e.g. by frontloading teaching) or 13
consecutively. An indicative structure for module delivery is suggested in Table 1 on page 15. 3.4. The curriculum includes both theoretical learning and skills practice within the education provider, and practice-based learning (activities directed by the education provider that extend learning into practice). Over the 3 modules of 45 days, 25-30 days are delivered as theoretical learning and skills practice and 15-20 days as directed practice-based learning. Skills based competencies will be learnt through a combination of clinical simulation in small groups working intensively under close supervision with peer and tutor feedback, and supervised practice through supervised direct contact with patients in the workplace. Knowledge will be learnt through a combination of lectures, seminars, discussion groups, guided reading and independent study. Providers are encouraged to explore and keep abreast of developments and innovations in pedagogy that facilitate active learning 3. Directed practice-based learning tasks include shadowing/observation, role play/practice with peers/colleagues of assessment and interventions, self-practice of interventions with reflection (i.e. applying techniques to issues from own life), and directed problem-based learning. All 45 days should comprise a specified programme of learning directed by the education provider in accordance with the learning outcomes specified in section 2 above. It is acknowledged that some activities (e.g. flipped classroom approaches, problem-based learning) may relate to more than one of the three categories outlined in the bullet points above; in such cases, programmes should be able to provide a rationale for their particular delivery model. 3.5. Assessment focuses primarily on trainees practical demonstration of competencies. Skills based competency assessments are independent of academic level and must be passed. Trainees may not necessarily possess previous clinical or professional expertise in mental health and can undertake academic assessments at either undergraduate or postgraduate level, depending on their prior academic attainment. 3.6. Assessment strategies for each of the three modules are outlined in Table 2 on pages 16-17. Providers will be expected to demonstrate how their module assessments align with the specified strategies. All clinical skills should be assessed by practical tests of clinical competence using recognised competency assessment tools. While the assessment strategies for assessing practical clinical skills are set out for each module, the assessment of academic skills and knowledge may be in the form of a written exam(s), coursework (including seminars and presentations), case report or essay and will be expected to cover the academic content of all three modules. 3.7. The training programme requires trainees to learn from observation and skills practice under supervision while working in fully functioning IAPT services, or other services providing placements to trainee PWPs in line with the requirements set out in section C of this document (pages 20-22 below), as well as through the theoretical teaching, skills practice and practice-based learning directed by the education provider. Trainees should complete: 3 The Society s Education and Public Engagement Board runs an annual award for innovation in programmes. Society-accredited programmes are invited to submit for this award in recognition of particularly innovative and creative design, delivery, and/or assessment of programmes for the benefit of the trainee experience. For further information, see http://www.bps.org.uk/award-innovation-psychology-programmes. 14
a minimum of 80 clinical contact hours with patients (face-to-face 4 or on the telephone) within an IAPT service (or equivalent stepped care service) as a requirement of their training and should undertake a range of activities during this time; and a minimum of 40 hours of supervision of which at least 20 hours should be case management supervision 5 and at least 20 hours should be clinical skills supervision 6. These 80 clinical contact hours and 40 supervision hours are in addition to the 15-20 practicebased learning days directed by education providers. 4 5 6 Clinical contact hours should be calculated on the basis of the length of assessment and treatment sessions undertaken with clients, not on the number of clinical contacts, and should not be rounded up. For the purposes of calculating clinical contact hours, one hour spent working with a group counts as one hour of clinical contact, regardless of the number of participants in the group. Time spent on administrative tasks (e.g. contacting clients who have not attended an appointment/dna) should not be counted towards clinical contact hours. For example: a trainee completes a telephone screening of 20 minutes, an initial assessment of 35 minutes, has an extended treatment session because of use of translation services which takes 65 minutes, and also has 2 DNAs. The total clinical contact hours in this instance is 2 hours. Case management supervision is undertaken weekly for a minimum of one hour on a one-to-one basis with a suitably qualified member of staff. Case management supervision is supported by an IT system that enables outcomes to be effectively incorporated into clinical decision-making, often relating to the stepping-up of treatment intensity or offering alternative low-intensity treatments. Case management supervision is highly structured and should be a review of the current caseload held by the PWP, in which the PWP selects appropriate cases for supervision and presents the cases according to clinical and organisational criteria (e.g. scheduled reviews, risk). The PWP should demonstrate the competencies of being able to present clinical and demographic information about each patient in a succinct manner to enable discussion of key points and shared decision-making to take place. Case management supervision is key to effective clinical governance and ensuring patient safety. Clinical skills supervision for PWPs can be undertaken on a one-to-one basis or in a group, for a minimum of one hour per fortnight. Supervision is an accountable process which supports, assures and develops the knowledge, skills and values of the PWP. The purpose of clinical skills supervision is to provide a safe and confidential environment for PWPs to reflect on and discuss their work and their personal and professional development, providing an environment to enable reflection on their low-intensity practice and ensuring fidelity to the evidence base and clinical method. 15
Table 1: Module delivery Module Total days Teaching * Directed practicebased learning Engagement and assessment of patients with common mental health problems 15 10 * 5 This module will equip PWPs with a good understanding of the incidence, prevalence and presentation of common mental health problems and evidenced-based treatment choices. Skills teaching will develop PWPs core common factors competencies of active listening, engagement, alliance building, patient-centred information gathering, information giving and shared decision making. Evidence-based low-intensity treatment for common mental health disorders 15 10 * 5 This module will equip PWPs with a good understanding of the process of therapeutic support and the management of individuals and groups of patients including families, friends and carers. Skills teaching will develop PWPs general and disorder-defined specific factor competencies in the delivery of low-intensity treatments informed by cognitive-behavioural principles and in the support of medication concordance. Values, diversity and context 15 5-10 * 5-10 This module will expose PWPs to the concept of diversity, inclusion and multi-culturalism and equip workers with the necessary knowledge, attitudes and competencies to operate in an inclusive values driven service. They will be equipped with an understanding of the complexity of people s health, social and occupational needs and the services which can support people to recovery. The module will develop PWPs decision-making abilities and enable them to use supervision and to recognise when and where it is appropriate to seek further advice, a step up or a signposted service. Skills teaching will develop PWPs clinical management, liaison and decision-making competencies in the delivery of support to patients, particularly where people require intervention or advice outside the core low-intensity evidence-based interventions taught in module 2. * Includes theoretical teaching, skills practice in intensive workshops and clinical simulations 16
Table 2: Module assessment strategy Module Clinical competency assessment Academic assessment (see commentary on 3.6 above) Practice outcomes portfolio Engagement and assessment of patients with common mental health problems Standardised role-play scenario(s) where trainees are required to demonstrate skills in undertaking both triage and problemfocused assessments. This may be a single scenario, combining both triage and problem-focused assessments, or two shorter assessment scenarios 7. This (these) will be video-recorded and assessed by teaching staff using standardised assessment measures. 8 Trainees should also provide a reflective commentary on their performance on the competency assessment, or an alternative academic assignment could be set e.g. an exam, case report or essay. Successful completion of the following practice outcomes, to be assessed by means of a practice outcomes portfolio: Demonstrates competence in undertaking and recording a range of assessment formats. This should include both triage and problem focused assessments. Demonstrates experience and competence in the assessment of presenting problems across a range of indicative diagnoses including depression and two or more anxiety disorders. Demonstrates the common factor competencies necessary to engage patients across the range of assessment formats. Evidence-based low-intensity treatment for common mental health disorders A video-recorded standardised role-play scenario OR an audio or video-recording of a real low-intensity treatment session with a patient treated by the trainee, in either of which the trainee is required to demonstrate skills in planning and implementing a lowintensity treatment programme. This recording will be assessed by teaching staff using a standardised assessment measure. NB Either this or the module 3 clinical assessment (or both) need(s) to be a recorded session of a real patient seen by the trainee. Trainees should also provide a reflective commentary on their performance on the competency assessment, or an alternative academic assignment could be set e.g. an exam, case report or essay. Successful completion of the following practice outcomes, to be assessed by means of a practice outcomes portfolio: Demonstrates experience and competence in the selection and delivery of treatment of a range of presenting problems using evidence-based low-intensity interventions across a range of indicative diagnoses including depression and two or more anxiety disorders. Demonstrates the ability to use common factor competencies to manage emotional distress and maintain therapeutic alliances to support patients using low-intensity interventions. Demonstrates high-quality case recording and systematic evaluation of the process and outcomes of mental health interventions, adapting care on the basis of these evaluations. 7 8 Programmes are encouraged to refer to the document Principles and types of patient assessment in IAPT services issues for PWP training and competence assessment (March 2015), available from https://www.ucl.ac.uk/pwp-review/docs/pwpreviewpatientassessment. Programmes are encouraged to refer to the document Standards for competency assessment measures (March 2015), available from https://www.ucl.ac.uk/pwp-review/docs/pwpreview-competency. 17
Values, diversity and context A clinical planning scenario, real assessment or treatment case, or other clinical task in which trainees are required to demonstrate knowledge and skills in working with a person or people with a variety of needs from one or more of a range of diverse groups. This could be assessed by a case report, an oral presentation, a rated recording, or other method as appropriate to the task. NB Either this or the module 2 clinical assessment (or both) need(s) to be a recorded session of a real patient seen by the trainee. A case report, reflective commentary, essay or exam in which trainees are required to demonstrate knowledge and competence in using case management and clinical skills supervision. If a real treatment case has been used for the clinical assessment, this task could be an accompanying reflective commentary detailing how supervision was used to support working with this patient. Successful completion of the following practice outcomes, to be assessed by means of a practice outcomes portfolio: Demonstrates the ability to engage with people from diverse demographic, social and cultural backgrounds in assessment and low-intensity interventions. This could include adaptations to practice working with older people, using interpretation services/self-help materials for people whose first language is not English, and/or adapting self-help materials for people with learning or literacy difficulties. Demonstrates the ability to effectively manage a caseload including referral to step up, employment and signposted services. Demonstrates the ability to use supervision to the benefit of effective (a) case management and (b) clinical skills development. This should include: (a) a report on a case management supervision session demonstrating ability to review caseload, bring patients at agreed predetermined thresholds and provide comprehensive and succinct case material; and (b) a report on use of clinical skills supervision including details of clinical skills questions brought, learning and implementation. 18
B Teaching and learning 1. Programme specification 1.1. Programmes must have in place a programme specification document that provides a concise description of the programme s intended learning outcomes, and which helps trainees to understand the teaching and learning methods that enable the learning outcomes to be achieved, and the assessment methods that enable achievement to be demonstrated. This should be supplemented by outlines of each module contributing to the accredited award. 1.2. The programme specification and module outlines must reflect the learning outcomes and assessment strategies specified in section A2 above. Providers will need to provide a rationale for the design of their programme, highlighting any ways in which it varies from the suggested three-module structure that has been outlined in section A3. 2. Curriculum 2.1. A teaching timetable must be available to staff and trainees that identifies the module or programme unit to which each teaching session relates. Education providers will need to be able to demonstrate that at least 50% of the time is focused on the development of clinical skills. 2.2. As noted above, trainees must be provided with 15-20 days of directed practice-based learning which is timetabled in addition to the required 25-30 days of theoretical learning and skills practice. Programmes should have systems in place for monitoring the work that trainees have completed during their directed learning days. 2.3. The programme must include an appropriate induction programme, of a minimum of five days duration. This induction to the PWP role comprises part of the 25-30 days of theoretical learning and skills development, and should be focused on front-loaded skills development in assessment. Any induction or orientation to resources (library, IT) or formal registration with the education provider should be undertaken in addition to the induction to the PWP role as outlined above. 2.4. The education provider must outline the ways in which it supports trainee PWPs in understanding the role of high-intensity therapists as part of their learning. This should be addressed in relation to the learning outcomes specified for Module 3 to guard against potential drift towards high-intensity ways of working. Providers may also wish to consider how trainees understanding of the full range of other workers at step 3 can be supported, including those working in different modalities and in the context of the full range of IAPT extension programmes. 2.5. Trainees are entitled to expect a learning experience which meets their needs, and which is underpinned by evidence-led teaching, and a supportive and enabling learning environment. 2.6. Programmes should address matters relating to difference and diversity within all teaching, not only within the module where values and diversity are the specific focus. 19
C Supervised practice 9 1. Education providers should have a quality assurance process in place to evaluate the suitability and quality of the practice placement and/or supervised practice opportunities offered by service partners. This quality assurance process should be established with input and agreement from the local NHS education commissioner (where applicable), and should be communicated to service providers to ensure that they are aware of their responsibilities to ensure that the following standards are met: (i) IAPT services and other services providing placements to trainee PWPs in line with the Society s requirements must: follow a stepped care system with coherent integrated care pathways and clear protocols for initial allocation and stepping up/down; provide interventions that are in line with NICE guidance; have good quality CBT-based self-help materials and ccbt packages available for trainees to use; have suitable office and clinical accommodation for PWP trainees to use; and provide adequate equipment for routine audio and video recording of PWPs clinical work. (ii) IAPT services and other services providing placements to PWPs in line with our requirements must be able to provide an effective practice learning environment for trainees. A service provider is considered to offer an effective practice learning environment where trainee PWPs: access appropriate cases, materials and local service protocols to develop the skills they have been taught by the education provider; have access to the full range of presentations and modes of assessment and treatment that are required for completion of the programme; have caseloads that are compatible with an effective training experience (e.g. gradual build up of caseload; types of patients seen) services should commit to agreeing appropriate caseloads with the education provider; use their designated practice-based learning days for completing the directed learning assignments set by the education provider, rather than for routine clinical work; are able to complete 80 clinical contact hours and 40 supervision hours by the time they complete their training. (iii) IAPT services and other services providing placements to PWPs in line with our requirements must identify sufficient clinical and case management supervisors to work with trainees in the workplace. Supervisors must: have demonstrable knowledge and experience of delivering low-intensity interventions; be conversant with the service s CBT-based self-help and online materials and site protocols; have attended a PWP supervisor training course (see 2 below); and 9 Standards in this section draw from the document Roles in PWP training of NHS education commissioners, university training courses, IAPT service placement providers, and BPS as accreditation body (March 2015), available from http://www.ucl.ac.uk/pwp-review/the-pwp-review. 20
provide weekly case management supervision and fortnightly clinical skills supervision to their trainee PWPs. Supervision must be consistent with and reinforce taught content to ensure that trainee PWPs develop as competent practitioners. As such, services must work closely with the education provider to jointly deliver a coherent training experience that ensures PWPs achieve the learning outcomes specified in this document. 2. As indicated in 1 (iii) above, training should be made available to supervisors to enable them to adequately support trainees undertaking high volume, low-intensity psychological therapies with an appropriate range of patients. Supervisors should understand: (i) (ii) (iii) the course content; the clinical practice outcomes identified in relation to the three modules outlined above; and the expectations surrounding their role, including the essentials of clinical case management supervision. 3. Education providers must demonstrate that supervision meets the following standards: (i) (ii) (iii) (iv) (v) (vi) (vii) The supervisor must negotiate, sign and date a supervision contract 10 which clarifies boundaries and responsibilities of both the supervisor and the supervised trainee. This should include engagement in weekly case management supervision and fortnightly individual and group supervision aimed at case discussion and skills development. The supervisor must use a range of strategies to engage in the supervision process, including focused face-to-face contact, allocated telephone appointment time and email contact. The supervisor must facilitate ongoing practice learning and experience for the trainee to ensure that she or he has the opportunity to develop appropriate competence in clinical skills. The supervisor must carry out observation of the trainee s work, directly and indirectly, to develop and be able to evaluate the level of competence. The supervisor must identify the trainee s strengths and any shortfalls in development, identifying objectives with the trainee and how these may be achieved, and discussing with academic staff where difficulty is envisaged or issues regarding a trainee s progress are encountered. The supervisor must ensure that trainees complete the clinical practice outcomes outlined within the practical skills assessment document, within the required period, and that appropriate records are made. The supervisor must ensure with the trainee that supervision logs are completed so that there is a record of supervisory contacts in a format agreed by the education provider. This is to ensure that the trainee meets the requirement to undertake a minimum of 40 hours of supervision of which at least 20 hours should be case management supervision and at least 10 Clinical skills supervision and case management supervision are often provided by different supervisors, and should therefore normally be covered by separate supervision contracts. Where clinical skills supervision is conducted in a group, this should be addressed in a group contract. 21