The paediatric framework for psychological interventions in a multidisciplinary context
The framework (and so the specific competences) should be viewed online (at www.ucl.ac.uk/core/competence-frameworks/); what follows is a synoptic guide to its content.
Figure 2 shows the map of competences for working in a paediatric context. It is organised into a series of domains, each containing a set of ‘boxes’ that identify each area of competence with a ‘headline’ that indicates its content. Users access the detailed competence lists associated with each ‘box’ by following the hyperlinks embedded in the map.
Figure 2Map of competences for psychological interventions in a multidisciplinary paediatric context. CYP, children/young people; MDT, multi disciplinary team.
Taken together, the skills in the initial two domains are relevant to all paediatric workers who are delivering psychologically informed care; their description as ‘underpinning’ skills draws attention to the fact that they secure the integrity of all subsequent assessments and interventions.
The first domain identifies ‘core competences for work with children and young people’, and includes the underpinning knowledge and skills needed to
Orient them to the styles of work that characterise contacts with children, young people and their families.
Liaise with colleagues and other agencies.
Apply the professional and legal frameworks that exercise governance over procedures with children and young people.
The second domain identifies ‘core knowledge and competences for working with children and young people with physical health problems’, including
Knowledge of presenting conditions and the impact of physical conditions at different developmental stages.
Knowledge of models of ‘medically unexplained’ symptoms, adjustment and behaviour change.
Knowledge of the ways in which self-management materials can be developed and employed.
The third domain (‘generic therapeutic competences’) identifies the competences required to manage clinical sessions and any form of psychological intervention, and outlines the repertoire of engagement and communication skills that underpin effective working across all interventions and therapy modalities.
The fourth domain relates to assessment, formulation, engagement and planning. It identifies the ‘assessment, formulation, engagement and planning’ skills expected of all caseholders who are delivering psychological therapies. Some of these competences are also relevant to all paediatric healthcare workers because they will aid psychological understanding of the problems presented by children and families in a paediatric context. A subsection of this domain focuses on skills needed to coordinate care within and across teams.
The fifth domain identifies a set of ‘specialist assessments’ conducted by staff with relevant roles and prior training; as such, there is no expectation that all members of a team will be able to carry them out.
The next domain details psychologically informed interventions and contains three subsections, all of which have relevance across multidisciplinary healthcare staff, but in differing degrees (dependent on their role). While the knowledge and assessment sections of these subdomains will be applicable to most healthcare staff, the more specific intervention skills will only be applicable to those trained to deliver the psychological therapy that the competency describes. This section identifies generic interventions for challenges that commonly arise in paediatric healthcare but also identifies potential differences in the psychological support requirements of children with different types of health problems, since these will bring with them specific psychological issues that paediatric healthcare staff should be aware of. As such, it is subdivided to cover
Interventions for challenges that commonly arise in a paediatric context and that are relevant across almost all physical health conditions (such as promoting self-management skills or responding to distress).
Specific challenges that arise in some, but not all, conditions (such as paediatric medical trauma, coping with visible difference or addressing procedural distress).
‘Exemplar condition-specific interventions’ for which there is research evidence of efficacy that points to the benefit of the ‘package’ of skills being described. These are ‘exemplars’ in the sense that they illustrate the ways in which care is tailored to a number of specific conditions, rather than being an exhaustive list of all possible condition-specific interventions.
The final domain of the framework focuses on metacompetences, so-called because they permeate all areas of practice, from underpinning skills through to specific interventions. They involve making procedural judgements and are important because effective implementation requires more than the rote application of a simple set of ‘rules’: metacompetences attempt to spell out some of the more important areas of judgement being made.
Also published on the website is a background document that details the methodology used to develop the framework and includes a synopsis of the competences included within it.
Applying the competence framework
Training
Training and supervision is a vital component in the effective delivery of psychologically informed approaches and psychological therapies. Practitioners need an appropriate orientation and attitude towards the work, as well as knowledge about a particular area of intervention and the repertoire of skills needed to execute it—in a sense, the capacity to do the right thing, in the right way. The framework can support this because it is relatively easy to translate into a curriculum—each area of competence is structured into a logical order that moves from basic areas of knowledge through to the specifics of application.
Supervision
Used in conjunction with the competence framework for supervision (accessed at www.ucl.ac.uk/clinical-psychology/CORE/supervision_framework.htm), the paediatric framework provides a useful tool to improve the quality of supervision by focusing it on a set of competences that are known to be associated with the delivery of effective treatments.
Commissioning
The framework can contribute to the effective use of healthcare resources by enabling commissioners to specify both the appropriate levels and the range of competences that need to be demonstrated by a particular paediatric service, as well as the appropriate skill mix of staff needed to be employed within it, in order to meet identified local needs.
Service organisation: the management and delivery of services
The framework identifies competences that (wherever possible) are evidence based, and describe best practice—the activities that individuals and teams should follow to deliver psychologically informed care and psychological interventions, and enables the identification of
Key competences required by a practitioner to deliver psychologically informed approaches and interventions across paediatric contexts.
The competences that a team would need to meet the scope of the service they aim to deliver and the needs of the populations with whom they work.
The likely training and supervision competences required by those delivering and the service.
Linking to clinical guidelines
Because the framework converts general descriptions of clinical practice into a set of concrete specifications, it can link the advice set out in clinical guidelines and national and local policy documents with the interventions actually delivered. Furthermore, this level of specification carries the promise that the interventions delivered will be closer in form and content to those of research trials on which claims for the efficacy of specific interventions rest. In this way, it could help to ensure that interventions are provided in a competent and effective manner.