My experience of Core Role 1 Assessment and Intervention

It has been a while since I have posted; a pause while I focused on completing the Stage 2 training, and I am happy to say that I am now qualified.

The space of time that I have taken between completing the training and returning to this blog has enabled me to look back at my posts and reflect on the wider training process.  I am going to write a few more posts on my reflections on each of the Core Roles for the Stage 2 training and write a final post at the end marking the culmination of my journey.  I hope these posts are helpful to trainees coming after me and continue to be of use to other colleagues and peers who are interested in this field.

Core Role 1

Core Role 1 in the Stage 2 Training is all about Assessment and Treatment.  This is the bread and butter of the work of any Forensic Psychologist; assessing a person's needs and developing suitable treatment options.  However, considering the nature of the cases and conditions that the people we work with bring to us, the complexities of the criminal justice system and the uncertainties of appropriate treatments, this task is not as simple as it sounds.

Demonstrating this knowledge and skill to the assessors is also not so simple a task.  When I started Core Role 1, it was acceptable to have separate exemplars for assessment and treatment and one could use a number of sessions of individual or group therapy to provide evidence of assessment skill, psychological theory and techniques and outcomes.  Towards the end of my training there was a shift towards the use of a Case Study approach for this Core Role and, although more prescriptive, it is actually the best approach for presenting competence to the assessors, as it can be done by following the Handbook exactly so that nothing is missed out.

The key messages in this Core Role are:

• to embed your work in the literature, 
• to evaluate your practice in as many ways possible, and,
• to demonstrate how you and your practice has changed and grown through this process.  

My key learning points were as follows:

Assessment:

Use the literature.  Demonstrate that you have read the literature and demonstrate that any decisions that you make regarding appropriate assessment methods and tools refer back to that literature.  Show that you have weighed up the literature and the options, and discussed this in peer supervision and with your supervisors.  Demonstrate that you have considered the patient or offender's needs and thoughts of their own needs, and considered any barriers to assessment and treatment and how you might overcome these. In your reflections, evaluate your practice as you go, what have you learnt, how could you do better.

Also an important factor in assessment is the demonstration of independent thinking and illustrating that you have checked the literature and are aware of the range of tools and methods appropriate to the person you are working with. Furthermore, you should have evaluated the pros and cons of using these and come to a decision.  Demonstrate that you have evaluated this decision afterwards and what you have learnt.  

Formulation:

This is also guided by literature and there is an excellent book; Forensic Case Formulation, by Sturmey and McMurran, that evaluates the different theories and models of formulation relevant to specific offenders such as violent, sexual or youth.  Demonstrate how your assessment has linked to your formulation and how your formulation changes over time as new information and evidence comes to light through the assessment and through your treatment programme.

The formulation should clearly identify treatment needs, and plans developed using the treatment or therapeutic literature of the most appropriate techniques to meet these needs.  The assessor should be able to follow a clear line from your assessment outcome, through needs identification, in the formulation to how each treatment session you hold addresses those needs and what the final outcomes are at the end of treatment.

Evidencing treatment needs and how they are met in each session:

From your session notes and reflective notes, an assessor should be able to see  how a patient or offender's needs have been addressed in the session: what did you do; what techniques were used; how did you agree these techniques with the patient; how did they react; if their reaction was negative, how did you respond and manage this; how did you manage the therapeutic relationship and what literature did you use to help you do this?  Whilst this may seem over the top, this is actually an excellent lesson in defensible, evidence-based practice.  If you are doing this properly, it should be the case that another professional could pick up your work and see exactly how and what you have done.  This creates space to check the reliability and validity of your work as well as demonstrating ethical practice. Your practice can only be ethical if it is based in evidence which demonstrates your techniques are safe and appropriate to use and that the patient understands and consents to those techniques after an informed discussion.

How outcomes are demonstrated and how one evaluates their own practice:

As with all evidence-based practice, you have to be able to demonstrate how you have evaluated your practice.  I made the mistake of thinking that the only outcomes that mattered were patient improvement. Through feedback and re-submission, I learnt that it is as important to evaluate my own practice within this.  How you plan to evaluate outcomes and practice should be agreed at the planning stage of your sessions and the assessors will then look to see if you have evaluated as you planned and evaluated appropriately.  Outcome measures are of course vital, but you also need to consider how you evaluate your own practice through supervision and peer supervision perhaps, what criteria you set to check your learning and development, whether you have met these and how you have grown and changed in the process.

Working with others:

Within this, you need to demonstrate to the assessors that you will be ready to start supervising people when you qualify, so reviewing and using the supervision literature and how you apply this to colleagues and how you evaluate your application of the theory is vital to demonstrating that you are ready to supervise others.

Whilst this is a brief summary of my learning and generic to both risk assessment and mental health assessment, I found these points to be the most salient in my learning.  I also found that being able to complete training in Structured Professional Judgement (SPJ) approaches really improved my skills in assessment and formulation, especially in considering scenarios of increased and decreased risk and how I advised other professionals of these issues.

Core Role 1 is exceptionally daunting and difficult but it is highly rewarding once completed.  The focus of having ethical, defensible, evidenced based psychological practice was important for my future learning.