Appendix 5: competence based training Introduction

Participate in quality assurance programmes, where appropriate

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Participate in quality assurance programmes, where appropriate.
Understand the role of reflection on practice and the need to record the outcome of such reflection.
Recognise the value of case conferences and other methods of review
Understand models of supervision and their contribution to practice.

Personal and Professional Skills

Understanding of ethical issues and applying these in complex clinical contexts, ensuring that informed consent underpins all contact with clients and research participants
Able to exercise a professional duty of care and to maintain high standards of personal conduct.
Appreciating the inherent power imbalance between practitioners and clients and how abuse of this can be minimised
Recognition that relationships with service users would be based on mutual respect and trust, and be able to maintain high standards of care even in situations of personal incompatibility.
Understanding of the need to act in the best interest of the service users at all times.
Understanding of the need to respect, and so far as possible uphold, the rights, dignity, values and autonomy of every patient including their role in the diagnostic and therapeutic process and in maintaining health and wellbeing.
Understanding the impact of difference and diversity on people’s lives, and its implications for working practices
Understanding the impact of one’s own value base upon clinical practice.

Working effectively at an appropriate level of autonomy, with awareness of the limits of own competence, and to practise safely and effectively within this scope. Awareness as to when to seek advice or refer to another professional. Accepting accountability to relevant professional and service managers.

Managing own personal learning needs and developing strategies for meeting these
Using supervision to reflect on practice, and making appropriate use of feedback received
Developing strategies to handle the emotional and physical impact of own practice and seeking appropriate support when necessary, with good awareness of boundary issues
Understanding of the need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of the team, working collaboratively and constructively with fellow psychologists and other colleagues and users of services, respecting diverse viewpoints.
Understanding of the need to keep skills and knowledge up-to-date and the importance of career-long learning.
Monitoring and maintaining the health, safety, and security of self and others.

Communication and Teaching

Communicating effectively clinical and non-clinical information from a psychological perspective in a style appropriate to a variety of different audiences (e.g. to professional colleagues, non-specialist audiences, and to service users and their relatives and carers)
Understanding as to how communication skills affect the assessment of patients, clients and users, and how the means of communication should be adapted to address and take account of factors such as age, physical ability and learning ability.
Adapting style of communication to people with a wide range of levels of cognitive ability, sensory acuity and modes of communication and being able to select, move between and use appropriate forms of verbal and non-verbal communication with service users and others.

Awareness of the characteristics and consequences of non-verbal communication and how this can be affected by culture, age, ethnicity, gender, religious beliefs and socio-economic status.

Understanding of the explicit and implicit communications in a therapeutic relationship.
Ability to summarise and present complex ideas in an appropriate form.
Understanding of the need to provide service users (or people acting on their behalf) with the information necessary to enable them to make informed decisions.
Understanding of the need to use an appropriate interpreter to assist service users who first language is not English, wherever possible, and awareness of the limitations thereof.
Preparing and delivering teaching and training which takes into account the needs and goals of the participants (for example by appropriate adaptations to methods and content)
Understanding of the supervision process for both supervisee and supervisor roles
Understanding the process of providing expert psychological opinion and advice, including the preparation and presentation of evidence in formal settings.
Ability to support the learning of others in the application of psychological skills, knowledge, practices and procedures.
Ability to plan, design and deliver teaching and training which take into account the needs and goals of participants.
Understanding quality assurance principles and processes (see Quality Control and Assurance section).

Specific Knowledge & Understanding

Knowledge and understanding of the structure and function of the human body, relevant to practice, together with a knowledge of health, disease, disorder and dysfunction.
Be aware of the principles and applications of scientific enquiry, including the evaluation of treatment efficacy and the research process.
Recognise the role of other professions in health and social care

Understand the impact of differences such as gender, sexuality, ethnicity, culture, religion and age on psychological wellbeing or behaviour.

Understand the role of the clinical psychologist across a range of settings and services
Understand theories and evidence concerning psychological development and psychological difficulties across the lifespan and their assessment and remediation.
Understand more than one evidence-based model of formal psychological therapy
Understand psychological models related to how biological, sociological and circumstantial of life-event-related factors impinge on psychological processes to affect psychological wellbeing.
Understand psychological models related to a range of presentations including:

clients wtih presentations form acute to enduring and mild to severe

problems with biological or neuropsychological causation; and

problems with mainly psychological factors including problems of coping, adaptation and resilience to adverse circumstances and life events, including bereavement and other chronic physical and mental health conditions.

Understand psychological models related to clients:

from a range of social and cultural backgrounds

of all ages

across a range of intellectual functioning

with significant levels of challenging behaviour

with developmental learning disabilities and cognitive impairment

with communication difficulties

with substance misuse; and

with physical health problems
understand psychological models related to working:

with individual clients, couples, families, carers, groups and at the organisational and community level

in a variety of settings including in-patient or other residential facilities with high-dependency needs, secondary health care, and community or primary care.
Understand change in process in service-delivery systems.

Understand social approaches such as those informed by community, critical and social constructivist perspectives

Understand leadership theories and models, and their application to service-delivery and clinical practice
Understand the impact of psychopharmacological and other clinical intervention on psychological work with clients.

Service Delivery, Consultancy & Leadership

Understanding of the need to maintain the safety of both service users and those involved in their care.
Adapting practice to a range of organisational contexts, on the basis of an understanding of pertinent organisational and cultural issues.
Providing supervision at an appropriate level within own sphere of competence.
Understanding of consultancy models and the contribution of consultancy to practice; ability to conduct consultancy
Understanding of leadership theories and models, and their application to service development and delivery.
Awareness of the legislative and national planning context of service delivery and clinical practice.
Working effectively with formal service systems and procedures.
Working with users and carers to facilitate their involvement in service planning and delivery.
Ability to contribute effectively to work undertaken as part of a multi-disciplinary team.
Ability to provide psychological opinion and advice in formal setting, as appropriate.
Understanding of change processes in service delivery systems

Safe practice

Be aware of applicable health and safety legislation, and any relevant safety policies and procedures in force at the workplace, such as incident reporting, and be able to act in accordance with these

Be able to work safely, including being able to select appropriate hazard control and risk management, reduction or elimination techniques in a safe manger in accordance with health and safety

Be able to select appropriate personal protective equipment and use it correctly
Be able to establish safe environments for practice, which minimise risk to service users, those treating them, and others, including the use of hazard control and particularly infection control

Structure of training

It is essential that Programmes provide a holistic experience of training that enables trainees to develop an integrated set of learning outcomes.
Programmes must provide a balanced and developmental set of academic, research and clinical experiences throughout the three years of training. The academic component needs to provide an integrated curriculum supporting the clinical and research training. The research training needs to be carefully planned and have sufficient time devoted to it to enable trainees to conduct research at a postgraduate level and to be in a position to contribute to the knowledge base of the profession. The clinical experience component of training needs to be delivered within the following framework.
The framework for pathways through training, delineating client populations, clinical contexts and learning outcomes contribute to a generic training in Clinical Psychology.
It is important to recognise that the scope of clinical psychology is so great that initial training provides a foundation for the range of skills and knowledge demonstrated by the profession.
Further skills and knowledge will need to be acquired through continuing professional development appropriate to the specific employment pathways taken by newly qualified psychologists.

Clinical experience will be gained in service delivery systems that offer a coherent clinical context, usually:

a setting oriented towards a population defined by age (e.g. child, adult, older people)

by special needs (e.g. learning disabilities, serious mental health problems, health-related problems, substance abuse) or

by a service delivery focus (e.g. psychological therapy).

In addition, clinical experience will be gained in a range of service contexts (primary, secondary and tertiary care, in-patient, out-patient, community), with service delivery models ranging from independently organised work through to integrated inter-professional working.
Training patterns of their cohorts should reflect workforce-planning requirements within the NHS, shaped in part by National Service Frameworks and national policies, as well as by evidence of recruitment problems (for example, vacant posts) paying particular attention to specialities which have recruitment difficulties.
National standards as set out by the Division of Clinical Psychology’s Faculties and Special Interest Groups must also guide training patterns for each cohort of trainees.
Not all trainees will necessarily follow the same pathway through training. Programmes therefore need to ensure, in consultation with local Faculties and SIGs and local placement providers, that - across the trainee cohort – there is optimum, effective and efficient use of all available placements.
The learning objectives described above need to be demonstrated with a range of clients and across a range of settings. These are not defined prescriptively, and there are multiple pathways to the required goals.
A fundamental principle is that trainees must work with clients across the lifespan, such that they see a range of clients whose difficulties are representative of problems across all stages of development.

In this context, trainees must have experience of undertaking substantial clinical work with:

a wide breadth of presentations – from acute to enduring and from mild to severe

problems ranging from those with mainly biological causation to those emanating mainly from psychosocial factors

problems of coping / adaptation to adverse circumstances that are not themselves reversible by psychological intervention (e.g. physical disability, physical illness, bereavement)

clients from a range of backgrounds reflecting the demographic characteristics of the population. Trainees will need to understand the impact of difference and diversity on people’s lives, and their implications for working practices.

It is also essential that trainees work with:

clients with significant levels of challenging behaviour

clients across a range of levels of intellectual functioning over a range of ages

clients whose disability makes it difficult for them to communicate

carers and families
Trainees must undertake substantial pieces of clinical work over a substantial period of time in each of a range of settings, including:

in-patient or other residential facilities for individuals with high dependency needs, both acute and long term

secondary health care

community and primary care

Modes and type of work

direct work

indirect, through staff and/or carers

work within multi-disciplinary teams and specialist service systems, including some observation or other experience of change and planning in service systems

work (practice, teach, advise) in at least two evidence-based models of formal psychological therapy, of which one must be cognitive-behaviour therapy.

work with complexity across a range of perspectives, demonstrating flexibility in application of whichever approach is most appropriate for the client or system

be critical of their own approach, and aware of how to practice in the absence of reliable evidence, as well as being able to contribute from their work to the evidence base.

UK health care context and application of clinical psychology

Trainees’ work will need to be informed by a substantial appreciation of the legislative and organisational contexts within which clinical practice is undertaken.

These excerpts are based on

BPS Standards for the Accreditation of Doctoral Programmes in

Clinical Psychology (2014)

HCPC (2015), Standards of Proficiency for Practitioner Psychologists

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