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Developing competence frameworks for working with people with: psychosis and bipolar disorder personality disorder. Prof Tony Roth (and Prof Stephen Pilling). Some principles. Developing the frameworks : Principles: R etaining the role of clinical judgment. - PowerPoint PPT Presentation
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Developing competence frameworks for working with people with:
psychosis and bipolar disorder personality disorder
Prof Tony Roth
(and Prof Stephen Pilling)
Developing the frameworks : Principles: Retaining the role of clinical judgment
• competence frameworks are intended to be indicative, not prescriptive – they spell-out how something is done – they indicate what would be helpful– but they don’t prescribe
• it is for therapists to choose how they implement competences:
whether when how
Methodology: An ‘evidence-based’ approach
• we want to identify the competences most likely to produce effective delivery of an intervention
• these competences:– are those used by therapists in research trials which
demonstrate efficacy– are described in the manuals used in these research
trials
yields information about “best practice”
Methodology
a) find the right trials
b) find the manuals associated with these trials
c) extract the competences
• identify ‘exemplar’ trials of interventions, based on: – reviews of the literature (e.g. NICE and SIGN)– oversight by an Expert Reference Group
• locate the manuals used in these trials (both published and unpublished)
Organising competence lists
• “undifferentiated” competence lists are rarely helpful
• an ‘architecture’ is needed to help users navigate through the lists– reflected in ‘competence maps’
• maps reflect the way that therapist’s think about their practice
Structure of competence maps
underpinning generic skills common to all approaches
‘packages’ of interventions with evidence of efficacy
specific skills needed to apply the therapy
meta-competences
How frameworks guide a specific intervention
• sets out competences in a structured and logical order
• set out theory / basic principles/ therapeutic stance
• show how to put principles into action across each phase of the intervention:
• engagement and assessment• formulation and planning• carrying out the intervention• completing the intervention
Supervision and training: a critical element
• supervision framework developed as part of IAPT– offers guidance on standards for supervision– (as far as possible) evidence-based
• sets out:– a generic model of supervision of all psychological
therapies– also specifies modality-supervision skills:
CBT psychodynamic
systemic humanistic
Expert Reference Group
Katie AshcroftAlison BrabbanFrank BurbachProf Tom CraigGrainne FadenProf Philippa GaretyProf Andrew GumleyAndrew HarrisonElizabeth HolfordIan Hulatt
Suzanne JolleySteve JonesDavid KingdonProf Elizabeth KuipersThomas MeyerProf Anthony MorrisonEmmanuelle PetersProf Jan ScottCraig SteeleProf Graham Turpin
Core competences
knowledge of presenting issues
working with families/ carers
ethical & legal issues
professional issues (work with differenceworking with and within organisations)
knowledge of pharmacology
knowledge of physical health problems
Core competences
knowledge of presenting issues
working with families/ carers
ethical & legal issues
professional issues (work with differenceworking with and within organisations)
knowledge of pharmacology
knowledge of physical health problems
Therapist stance and values
Therapeutic stance, therapist values and therapist style
Therapist stance, e.g.:
• committed to collaboration and choice • committed to drawing on client and carer strengths
• committed to understanding client’s experience from a psychological perspective
Therapeutic stance, therapist values and therapist style
Therapist values, e.g.:
• able to work with the person in their family/ social and cultural context
• able to reflect on own beliefs and assumptions about factors that relate to recovery and relapse
Therapeutic stance, therapist values and therapist style
Therapist style, e.g.:
• open, responsive and transparent
• focused on maintaining mutual respect between client and therapist
Core competences
working with families/ carers
ethical & legal issues
professional issues (work with differenceworking with and within organisations)
knowledge of pharmacology
knowledge of physical health problems
Therapist stance and values
Generic therapy skills
basic therapy skills and knowledge
engagement
assessment
alliance building
managing emotional content
Core competences
working with families/ carers
ethical & legal issues
professional issues (work with differenceworking with and within organisations)
knowledge of pharmacology
knowledge of physical health problems
Therapist stance and values
generic therapy skills
basic therapy skills and knowledge
engagement
assessment
alliance building
managing emotional content
Assessment & formulation
comprehensive assessment
assessment functioning within multiple systems
risk assessment
develop formulation and intervention plan
f/back assessment and agree plan
co-ordinate casework
Core competences
working with families/ carers
ethical & legal issues
professional issues (work with differenceworking with and within organisations)
knowledge of pharmacology
knowledge of physical health problems
Therapist stance and values
generic therapy skills
basic therapy skills and knowledge
engagement
assessment
alliance building
managing emotional content
Assessment & formulation
c’prehensive assessment
assessment functioning in multiple systems
risk assessment
develop formulation & intervention plan
f/back assessment
co-ordinate casework
Specific interventions
Bipolar disorder
CBTfor BD
Family Interventions
IPT/ Social Rhythm Therapy
Psychoed/ relapse prevention
psychosis
CBT for psychosis
Family Interventions
Core competences
working with families/ carers
ethical & legal issues
professional issues (work with differenceworking with and within organisations)
knowledge of pharmacology
knowledge of physical health problems
Therapist stance and values
generic therapy skills
basic therapy skills and knowledge
engagement
assessment
alliance building
managing emotional content
Assessment & formulation
c’prehensive assessment
assessment functioning in multiple systems
risk assessment
develop formulation & intervention plan
f/back assessment
co-ordinate casework
Specific interventions
Bipolar Disorder
psychosis
Co-existing issues (depression, anxiety, substance misuse, personality disorder, trauma, learning disability, autistic spectrum disorder)
Core competences
working with families/ carers
ethical & legal issues
professional issues (work with differenceworking with and within organisations)
knowledge of pharmacology
knowledge of physical health problems
Therapist stance and values
generic therapy skills
basic therapy skills and knowledge
engagement
assessment
alliance building
managing emotional content
Assessment & formulation
c’prehensive assessment
assessment functioning in multiple systems
risk assessment
develop formulation & intervention plan
f/back assessment
co-ordinate casework
Specific interventions
Bipolar Disorder
psychosis
co-existing issues
Meta-competences
Expert Reference Group
Carole Allen
Prof Anthony Bateman
Wyn Bolton
Marco Chiesa
Prof Susan Clarke
Prof Kate Davidson
Christine Dunkley
Ian Kerr
Prof Tom Lynch
Mary McMurran
Susan Mizen
Tom Mullen
Prof Glenys Parry
Steve Pearce
Alex Stirzaker
Michaela Swales
Heather Wood
Core competences
working with families/ carers
ethical & legal issues
professional issues (work with differenceworking with and within organisations)
knowledge of pharmacology
knowledge of physical health problems
Therapist stance and values
generic therapy skills
basic therapy skills and knowledge
engagement
assessment
alliance building
managing emotional content
Assessment & formulation
c’prehensive assessment
assessment functioning in multiple systems
risk assessment
develop formulation & intervention plan
f/back assessment
co-ordinate casework
General clinical care
Psychoeducation and problem solving(PEPS and STEPPS)
Consulting to individuals and teams regarding individuals with PD
Generic structured clinical care
Core competences
working with families/ carers
ethical & legal issues
professional issues (work with differenceworking with and within organisations)
knowledge of pharmacology
knowledge of physical health problems
Therapist stance and values
generic therapy skills
basic therapy skills and knowledge
engagement
assessment
alliance building
managing emotional content
Assessment & formulation
c’prehensive assessment
assessment functioning in multiple systems
risk assessment
develop formulation & intervention plan
f/back assessment
co-ordinate casework
Specific Psychological therapies
CBT for PD
Schema-focused CBT for PD
Mentalisation-Based Therapy
Transference–Focused Psychotherapy
Interpersonal Group Psychotherapy
Cognitive Analytic Therapy
Generic Clinical Care
Core competences
working with families/ carers
ethical & legal issues
professional issues (work with differenceworking with and within organisations)
knowledge of pharmacology
knowledge of physical health problems
Therapist stance and values
generic therapy skills
basic therapy skills and knowledge
engagement
assessment
alliance building
managing emotional content
Assessment & formulation
c’prehensive assessment
assessment functioning in multiple systems
risk assessment
develop formulation & intervention plan
f/back assessment
co-ordinate casework
Specific Psychological therapies
CBT for PD
Schema-focused CBT for PD
Mentalisation-Based Therapy
Transference–Focused Psychotherapy
Interpersonal Group Psychotherapy
Cognitive Analytic Therapy
Generic Clinical Care
co-existing issues (depression, anxiety, substance misuse, personality disorder, trauma, learning disability, psychosis, other personality disorders
Core competences
working with families/ carers
ethical & legal issues
professional issues (work with differenceworking with and within organisations)
knowledge of pharmacology
knowledge of physical health problems
Therapist stance and values
generic therapy skills
basic therapy skills and knowledge
engagement
assessment
alliance building
managing emotional content
Assessment & formulation
c’prehensive assessment
assessment functioning in multiple systems
risk assessment
develop formulation & intervention plan
f/back assessment
co-ordinate casework
Specific Psychological therapies
CBT for PD
Schema-focused CBT for PD
Mentalisation-Based Therapy
Transference–Focused Psychotherapy
Interpersonal Group Psychotherapy
Cognitive Analytic Therapy
Generic Clinical Care
co-existing issues
Meta-competences
Using the framework
map of competences represents:
• a procedure for identifying competent practice
• an agenda for supervision
• a curriculum for developing training programmes
• a benchmark for current trainings
Using the framework
• a way of linking the evidence-base to practice– identifying interventions with current evidence for
efficacy– setting standards for competence– setting standards for training
• a resource for planning psychological intervention services