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.

Essential Ethics

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You have a keen interest in a particular area of study and you're chomping at the bit to get going with some original research - it's hard enough as it is to come up with an original idea to follow up and you know that the more time you spend getting geared up for the research, the greater the risk of someone else getting to publication first.  At this point, before you go any further, you have to pause and think - does this project fall within ethical guidelines?

Ethical approval is essential in any sort of research.  The coulds, shoulds and woulds of research must fall within the boundaries of scientific investigation and ethical norms in order to carry validity.

With Stage 2 training, as with any advanced degree such as a Masters, students have to go that extra mile in order to demonstrate impeccable ethical practice; arranging for an ethics committee to sign off a project alone is not enough.

There are guidelines for trainees to follow, including the BPS Code of Ethics and Guidance, and the DFP Resources pages, which provide ethical guidelines specific to Forensic Psychology.  These are the rule books which should provide the background to whatever work you carry out on any aspects of competence in the Stage 2 training.

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It helps to extend your thinking when planning your research in order to ensure that it falls within the guidelines. With technological advancements moving at lightning speed and within the easy grasp of trainees, the ethical guidelines agreed by committees may very quickly be left behind or fall short.  Trainees should demonstrate that they have applied the principles of ethical research to each situation and taken ethical issues into account regardless of whether committee guidelines have allowed for innovation.

For example, if using online survey tools, you should be checking what the survey providers do with the data submitted, how long this is kept, how secure it is and is the data sold on to third parties.  Their policies on the use of cookies or privacy will have to be looked into, always with a view on how these might affect the participants.

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The best way to cover as many of the ethical issues as possible is to associate the research with an organisation that has an ethical board who will consider and agree the project.  Without this, you and your supervisor will need to demonstrate thoroughly that all ethical issues have been considered and that they have been managed within overall guidelines.  In addition to this, I would recommend that you obtain permission or a statement from your particular governing body, such as the DFP or BPS before proceeding with the research project as this can be submitted as evidence that you have applied ethical consideration to your work and that you have been permitted to proceed.

Although I have focused on ethics in research, it is wise to remember that ethics permeates every core role in the Forensic Psychology Stage 2 training, and your approach and consideration to the principles of ethics will apply to training, assessment, intervention and consultation.  Ethics, in other words, is essential.

If at first you don't succeed.....keep going!

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While networking will certainly go a long way to helping a chartership trainee towards finding those opportunities to work towards the required competencies, the Stage 2 experience will definitely tease creative thinking out of you and intensly test your initiative.

Just take Core Role 3: Communicating psychological knowledge and advice to other professionals.  I have found one of the greatest challenges is to find work that would enable me to meet the requirements and the standards.  There were times when I was able to use work contacts, or my supervisor, or university contacts to help me meet and talk to people who might just help me give life to some of the projects I had in mind that would move my training forward.  But on numerous occasions, despite initially being greeted with enthusiasm, numerous projects never actually got off the ground or fizzled out because a lack of resources such as staff or funding.

 Inevitably I would end up feeling disappointed, frustrated and that I would never get the work finished.  But I quickly realised that these barriers were simply the sorts of contra-temps that professionals in most fields encounter and have to overcome.  So I began to look more closely at the work that I had carried out in order to get as far as I did in some of the projects.  It was soon obvious that a good deal of the preparation work could evidence some of the competencies and I was able to work this into my portfolio.  The moment I realised I could still use the work from failed projects was the moment I realised that there was always a silver lining.   

The projects I had developed had come from a number of different organisations where I had voluntary placements, for example from volunteering on a youth offender panel and also in an approved premises for male mentally disordered offenders.  Volunteering is a tremendously useful way of building up experience and a reputation in the field.  As I got to know staff and service users, attended volunteer meetings, read volunteer newsletters and got involved with the services, I was able to see what needs the service had and what fell within my remit.  I was then able to develop my thinking on the projects and planned these out in writing.  I wrote proposals to carry out the projects to both the youth offender panel and to the approved premises, through the usual volunteer systems.  I explained who I was, my background, my idea, the evidence for the idea from a needs analysis of the service and what I could offer them as a volunteer as part of continuing to evidence my practice.  I was also able to obtain letters of support written by my supervisor.

Having made plans and presented my ideas to the relevant managers, the projects fell through because of lack of funding or because the organisations in questions did not have sufficient staff resources to be able to bring the projects to full fruition.  However, by that point, I had been able to gather enough evidence to attribute some of the work to the core competencies.  For example, by making presentations of my ideas to the managers of these organisations, I was able to demonstrate the benefits of a psychological perspective on different projects.  I needed to make a formal needs analysis of each of my ideas and formalise these into a proposal, which resulted in my creating opportunities to advise and guide other professionals using phsychological advice.  I also needed to submit formal proposals, attend and minute any meetings held to discuss the proposals and their design and eventual evaluation, as well as the potential benefits, and I had to present the proposals formally.

In order to make sure that your experiences can be used to evidence the competencies, I would strongly suggest keeping a log of any psychological advice that you give, for example, how to select appropriate outcome measures and evaluating any programme that you design.  It is also essential for this particular core competency to record and provide evidence of any feedback that you give staff members and professionals.  Through the use of collating evidence from even failed projects, it is even possible to evidence Core competency 3.3, which deals with providing advice and guidance in the formulation of policy.  I am at a stage now with this core role that I will be ready to submit for assessment in the next 6 months.  The collection of evidence has taken almost four years of some failed projects and some successful.  And my suggestions of how to present evidence has come from my supervisor and trainees who have recently passed this core role.

It is so easy to be disheartened when projects fall through, especially if several fall through one after the other - there is an inevitability to this that we all have to face.  But the secret to getting through it is to evaluate your work, apply the requirements of the competencies to it - always checking with your supervisor who will keep your feet firmly on the ground on the production of evidence.  It is worth always being open to opportunities and always to approach each project with the competencies you have not yet evidenced in mind.  This certainly helped me to feel that I was ticking off the boxes rather than feeling that I was having to start everything from scratch.  

Best of luck everyone and happy reading.