Developing competence frameworks for working with people with: psychosis and bipolar disorder personality disorder

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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)

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Some principles
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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 dont prescribe
• it is for therapists to choose how they implement
  competences

whether when how
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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
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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  published and unpublished)

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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 therapists think about
  their practice

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Structure of competence maps
underpinning generic skills common to all
approaches
packages of interventions with evidence of
efficacy
meta-competences
specific skills needed to apply the therapy
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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

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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
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Framework for people with psychosis and bipolar
disorder
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Expert Reference Group

• Katie Ashcroft
• Alison Brabban
• Frank Burbach
• Prof Tom Craig
• Grainne Faden
• Prof Philippa Garety
• Prof Andrew Gumley
• Andrew Harrison
• Elizabeth Holford
• Ian Hulatt

• Suzanne Jolley
• Steve Jones
• David Kingdon
• Prof Elizabeth Kuipers
• Thomas Meyer
• Prof Anthony Morrison
• Emmanuelle Peters
• Prof Jan Scott
• Craig Steele
• Prof Graham Turpin

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Core competences
knowledge of presenting issues
ethical legal issues
professional issues (work with difference working
with and within organisations)
working with families/ carers
knowledge of pharmacology
knowledge of physical health problems
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Core competences
Therapist stance and values
knowledge of presenting issues
ethical legal issues
professional issues (work with difference working
with and within organisations)
working with families/ carers
knowledge of pharmacology
knowledge of physical health problems
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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 clients experience
  from a psychological perspective

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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

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Therapeutic stance, therapist values and
therapist style

• Therapist style, e.g.

• open, responsive and transparent
• focused on maintaining mutual respect between
  client and therapist

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Therapist stance and values
Core competences
Generic therapy skills
ethical legal issues
basic therapy skills and knowledge
professional issues (work with difference working
with and within organisations)
engagement assessment alliance
building managing emotional content
working with families/ carers
knowledge of pharmacology
knowledge of physical health problems
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Therapist stance and values
Core competences
generic therapy skills
Assessment formulation
ethical legal issues
comprehensive assessment
basic therapy skills and knowledge
professional issues (work with difference working
with and within organisations)
assessment functioning within multiple systems
engagement assessment alliance
building managing emotional content
risk assessment
working with families/ carers
develop formulation and intervention plan
knowledge of pharmacology
f/back assessment and agree plan
knowledge of physical health problems
co-ordinate casework
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Therapist stance and values
Core competences
generic therapy skills
Assessment formulation
Specific interventions
ethical legal issues
cprehensive assessment
Bipolar disorder
basic therapy skills and knowledge
professional issues (work with difference working
with and within organisations)
assessment functioning in multiple systems
CBTfor BD
Family Interventions
IPT/ Social Rhythm Therapy
risk assessment
engagement assessment alliance
building managing emotional content
Psychoed/ relapse prevention
working with families/ carers
develop formulation intervention plan
psychosis
knowledge of pharmacology
CBT for psychosis
f/back assessment
knowledge of physical health problems
Family Interventions
co-ordinate casework
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Therapist stance and values
Core competences
generic therapy skills
Assessment formulation
Specific interventions
ethical legal issues
cprehensive assessment
basic therapy skills and knowledge
professional issues (work with difference working
with and within organisations)
Co-existing issues (depression, anxiety,
substance misuse, personality disorder, trauma,
learning disability, autistic spectrum disorder)
assessment functioning in multiple systems
Bipolar Disorder
risk assessment
engagement assessment alliance
building managing emotional content
working with families/ carers
develop formulation intervention plan
psychosis
knowledge of pharmacology
f/back assessment
knowledge of physical health problems
co-ordinate casework
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Therapist stance and values
Core competences
generic therapy skills
Assessment formulation
Specific interventions
Meta-competences
ethical legal issues
cprehensive assessment
basic therapy skills and knowledge
professional issues (work with difference working
with and within organisations)
assessment functioning in multiple systems
Bipolar Disorder
co-existing issues
psychosis
risk assessment
engagement assessment alliance
building managing emotional content
working with families/ carers
develop formulation intervention plan
knowledge of pharmacology
f/back assessment
knowledge of physical health problems
co-ordinate casework
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Framework for individuals with personality
disorder
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Expert Reference Group

• Mary McMurran
• Susan Mizen
• Tom Mullen
• Prof Glenys Parry
• Steve Pearce
• Alex Stirzaker
• Michaela Swales
• Heather Wood

• Carole Allen
• Prof Anthony Bateman
• Wyn Bolton
• Marco Chiesa
• Prof Susan Clarke
• Prof Kate Davidson
• Christine Dunkley
• Ian Kerr
• Prof Tom Lynch

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Therapist stance and values
Core competences
generic therapy skills
Assessment formulation
General clinical care
ethical legal issues
cprehensive assessment
Generic structured clinical care
basic therapy skills and knowledge
professional issues (work with difference working
with and within organisations)
assessment functioning in multiple systems
Psychoeducation and problem solving (PEPS and
STEPPS)
risk assessment
engagement assessment alliance
building managing emotional content
working with families/ carers
develop formulation intervention plan
Consulting to individuals and teams regarding
individuals with PD
knowledge of pharmacology
f/back assessment
knowledge of physical health problems
co-ordinate casework
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Therapist stance and values
Core competences
generic therapy skills
Assessment formulation
Specific Psychological therapies
Generic Clinical Care
ethical legal issues
cprehensive assessment
CBT for PD
basic therapy skills and knowledge
professional issues (work with difference working
with and within organisations)
assessment functioning in multiple systems
Schema-focused CBT for PD
Mentalisation-Based Therapy
risk assessment
engagement assessment alliance
building managing emotional content
working with families/ carers
develop formulation intervention plan
TransferenceFocused Psychotherapy
knowledge of pharmacology
f/back assessment
Interpersonal Group Psychotherapy
knowledge of physical health problems
co-ordinate casework
Cognitive Analytic Therapy
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Therapist stance and values
Core competences
generic therapy skills
Assessment formulation
Specific Psychological therapies
Generic Clinical Care
ethical legal issues
cprehensive assessment
co-existing issues (depression, anxiety,
substance misuse, personality disorder, trauma,
learning disability, psychosis, other personality
disorders
CBT for PD
basic therapy skills and knowledge
professional issues (work with difference working
with and within organisations)
assessment functioning in multiple systems
Schema-focused CBT for PD
Mentalisation-Based Therapy
risk assessment
engagement assessment alliance
building managing emotional content
TransferenceFocused Psychotherapy
working with families/ carers
develop formulation intervention plan
knowledge of pharmacology
Interpersonal Group Psychotherapy
f/back assessment
knowledge of physical health problems
Cognitive Analytic Therapy
co-ordinate casework
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Therapist stance and values
Core competences
generic therapy skills
Assessment formulation
Specific Psychological therapies
Generic Clinical Care
Meta-competences
ethical legal issues
cprehensive assessment
CBT for PD
basic therapy skills and knowledge
professional issues (work with difference working
with and within organisations)
assessment functioning in multiple systems
Schema-focused CBT for PD
Mentalisation-Based Therapy
co-existing issues
risk assessment
engagement assessment alliance
building managing emotional content
TransferenceFocused Psychotherapy
working with families/ carers
develop formulation intervention plan
knowledge of pharmacology
Interpersonal Group Psychotherapy
f/back assessment
knowledge of physical health problems
Cognitive Analytic Therapy
co-ordinate casework
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Using the framework

• map of competences represents

• a curriculum for developing training programmes
• a benchmark for current trainings

• a procedure for identifying competent practice
• an agenda for supervision

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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

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all materials can be downloaded
fromwww.ucl.ac.uk/CORE/