A Workforce Competency Framework

for

Newcastle’s Drug and Alcohol Treatment Providers

Contents Page

Introduction 6

Section A: Psychosocial Interventions7

A1. Competences to deliverPsychosocial Interventions8

A1.1Generic Competences

A1.2Basic Competences

A1.3Specific (technical) Competences

A1.4Metacompetences

A2.Motivational Interventions 9

A2.1Generic competences

A2.2Basic motivational interviewing competencies

A2.3Specific motivational interviewing techniques

A2.4Monitoring in motivational interviewing

A2.5Metacompetences in motivational interviewing

A3.Contingency Management12

A3.1Generic competences

A3.2Basic contingency management competences

A3.3Specific contingency management competences

A3.4Metacompetences in contingency management

A4.Family and social network interventions14

A4.1Treatments/Interventions involving family members

A4.1.1Working with family members (to engage relation in treatment

A4.1.2Joint involvement of family members (and their relatives in treatment)

A4.2Social Behaviour and Network Therapy

A4.3Competences for Behavioural Couples Therapy (BCT)

A4.3.1Generic Competences

A4.3.2Basic BCT competences

A4.3.3Specific BCT competences

A4.3.4Metacompetences in BCT

A4.4Competences for Community Reinforcement Approach (CRA)

A5.Cognitive and behavioural based relapse prevention16

interventions(substance misuse focused)

A5.1Competences for CBT-based guided self help interventions

A5.1.1Generic Competences

A5.1.2Basic CBT competences

A5.1.3Metacompetences in CBT

A6.Evidence Based psychological interventions for co-existing mental21health problems

A6.1Generic competences

A6.2Basic CBT competences

A6.3Specific behavioural and cognitive therapy

A6.4Problem specific competences

A6.5Metacompetences in CBT for depression and anxiety

A6.5.1Generic competences

A6.5.2CBT specific Metacompetences

A7.Psychodynamic Therapy (substance use focused)24

A7.1Outline model for psychoanalytic/psychodynamic therapy competences

A8.12 Step Work25

A9.Counselling – BACP Accredited26

A9.1Accreditation for individuals

A9.2Accreditation for services

A10.Other33

Section BRecovery Support Interventions34

B1.Defining addiction and recovery35

B2.Peer Support Involvement36

B2.1Volunteer Peer Meeting and Greeting

B2.2Informal Support or “Buddying”

B2.3Volunteer Peer Mentoring

B3.Facilitated access to mutual aid38

B3.1Three essential steps for keyworkers facilitating accessto mutual aid

B4.Family support39

B4.1Drug sector partnership

B4.2Core competencies

B4.3Additional competencies

B5.Parenting support42

B5.1Competences

B5.1.1Qualities and Experience

B5.1.2Skills

B5.1.3Knowledge

B5.2Parenting support programmes

B6.Housing Support44

B7.Employment Support45

B8.Education and Training Support46

B9.Supported work projects47

B10.Recovery Checkups48

B11.Behavioural based relapse prevention49

B12.Evidence based mental health focused psychosocial interventions50

B13.Complementary therapies51

B13.1Acupuncture

B13.1.1Competencies to deliver acupuncture

B13.2Reiki

B13.2.1Competencies to deliver reiki

B13.3ReflexologyB13.3.1Competencies to deliver reflexology

B13.4Yoga

B13.4.1Competencies to deliver yoga

B14.Other54

Section CBasis of Pharmacological interventions55

C1.Prescribing56

C1.1Non-medical prescribing

C1.2 Independent prescribing

C1.3 Supplementary prescribing

C1.4The regulators of non-medical prescribers

C2.The Prescribing Competency Framework58

C2.1Domain A:The consultation (competencies)

C2.2Domain B:Prescribing effectively (competencies)

C2.3Domain C:Prescribing in context (competencies)

C2.4Competencies for supplementary prescribers

C3.Competencies for doctors62

C3.1Specialist doctors (3)

C3.1.1Supporting people to recover C3.1.2 Clinical leadership

C3.2Intermediate doctors (2)

C3.2.1Supporting people to recover C3.2.2 Clinical leadership

C3.3Generalist doctors (1)

C3.3.1Supporting people to recover C3.3.2 Clinical leadership

C3.4Competencies

C3.5 Training

C3.5.1Specialist doctors C3.5.2 Intermediate doctors C3.5.3 Generalist doctors

Appendices65

Appendix 1:Competences to deliver cognitive and behavioural based

relapseprevention interventions (substance misuse focused)

Appendix 2:Competences needed to relate to people and carry out any

formof psychosocial intervention

Appendix 3:Parenting support programmes in Newcastle

Appendix 4:Entry to education and employment support

Appendix 5:The prescribing competency framework

Domain A: The consultation

Appendix 6:The prescribing competency framework

Domain B: Prescribing effectively

Appendix 7:The prescribing competency framework

Domain C:Prescribing in context

Appendix 8:Competencies for supplementary prescribers

Appendix 9:The three levels of competency for doctors working

with people using drugs and alcohol

Introduction

The quality and effectiveness of service provision depends upon the ability of staff to deliver interventions and their managers to support them. A competent member of staff consistently applies relevant knowledge and skills to meet the standards of performance required.

Competent staff benefit organisations and services, or in this case the treatment system by supporting it to achieve its aim of delivering effective interventions and by allowing the system to be assured of the quality of its services

A treatment system which has competent staff also provides protection to its service users as they can be assured that staff are performing to an agreed level and are consistently demonstrating effective practice

There are also benefits for staff within commissioned services within the treatment system; working within agreed national occupational standards and locally agreed standards means that they can clearly understand what the expected levels of performance are intheir own and in other commissioned services within the system.

The recent introduction of Dataset J has specifically defined a number of interventions relating to the treatment and recovery of users of drugs and alcohol under the headings pharmacological, psychosocial and recovery support

This paper define the competences required from staff to safely and effectively deliver these interventions, as defined by Dataset J, using existing standards and requirements which might include

  • NHS Knowledge and Skills Framework
  • Drug and Alcohol National Occupational Standards
  • Professional Standards and Codes of Ethics
  • Supporting People
  • Skills for Health
  • NICE guidelines (2012)
  • RoyalCollege of Psychiatrists
  • RoyalCollege of General Practitioners
  • National Treatment Agency for Substance Misuse
  • Department of Health
  • Action for Children

Section A

Psychosocial Interventions

A1: Competences to deliver Psychosocial Interventions

The competences required to effectively deliver psychosocial intervention can, according to the British Psychological Society (2010)[1], be broken down into the following competences.

A1.1 Generic Competences

The competences needed to relate to people and to carry out any form of psychological intervention.

A1.2 Basic Competences

Basic intervention specific competences that are used in most sessions.

A1.3 Specific (technical) competences

Specific intervention competences that are employed in most sessions

(usuallyassociated with high intensity interventions).

A1.4 Metacompetences

Competences used by therapists to work across all levels and to adapt the intervention to the needs of each individual service users. These competences are abstract as they usually reflect the intentions of the person delivering the intervention and can be difficult to observe directly but can be inferred from the therapists actions.

These four categories of competences have been applied throughout this section to describe the necessary competences for staff to deliver psychosocial interventions as defined by Dataset J.

A2.Motivational Interventions

Dataset J definition: Motivational interventions aim to help service users resolve ambivalence for change, and increase intrinsic motivation for change and self-efficacy through a semi-directive style and may involve normative feedback on problems and progress. They may be focused on substance specific changes and/or on building recovery capital. Motivational interventions can be delivered in group or individual format and may involve the use of mapping tools. Motivational interventions require additional competences for the worker and delivery within a clinical governance framework including appropriate supervision. Motivational Interviewing and Motivational Enhancement Therapy are both forms of motivational interventions.[2]

A2.1Generic competences

  • Knowledge of drug misuse and mental health problems
  • Establishing a positive relationship with the service user
  • Establishing good relationships with relevant professionals
  • Gathering background information
  • Giving service users information about drug misuse

A2.2Basic motivational interviewing competencies

An ability to:

  • Adopt an empathetic, non-confrontational, collaborative and non-judgmental approach
  • Adopt an evocative tone throughout the intervention which draws out the service user’s ideas, feeling and wants
  • Draw out, identify and discuss the service user’s intrinsic motivation for change
  • Draw from the service user a distinction between how important it is for the service user to change and how confident they are they can maintain this change
  • Respect the individual autonomy of the service user and responsibility for change
  • Communicate to the service user a sense of safety and support
  • Convey acceptance of the service user and to avoid confrontation or the use of persuasion
  • Assist the service user in developing discrepancy between their current situation and future goals
  • ‘Roll with the resistance’ and avoid direct confrontation of resistance
  • Support and enhance a service user’s belief in their ability to carry out a specific activity
  • Help the service user explore and resolve their ambivalence in favour of change
  • A knowledge of basic principles of stages of change (pre-contemplation; contemplation; preparation; action and maintenance).

A2.3Specific motivational interviewing techniques

Anability to:

  • Use affirmative statements to acknowledge service user efforts and strength
  • Use open-ended questions
  • Avoid the use of ‘traps’ including: question-answer traps; labelling traps; premature focus traps; talking side traps; blaming traps; and expert traps
  • A knowledge of the levels of reflection including: repeating; re-phrasing; paraphrasing; and reflecting feeling
  • An ability to use reflective listening through:
  • Forming hypotheses about the meaning of service user statements
  • Testing hypotheses by reflective statements to the service user
  • Using different types of reflective statements including simple reflection, amplified reflection; double-sided reflection
  • An ability to elicit ‘change talk’ in a collaborative manner through:
  • Recognising, empathising and reflecting on desire, ability, reasons and need focused change statements
  • Recognising and strengthening commitment language

An ability to:

  • Build rapport through identifying the service user’s concerns
  • Centre discussion around the service user’s concerns and needs
  • Reframe discussion positively
  • Conclude a session with summaries and open-ended discussion on behaviour change
  • Use decisional balance tools to facilitate the exploration of ambivalence
  • Elicit discrepancy between current behaviour and future goals
  • Elicit dissonance between beliefs and behaviours
  • Enhance the service user’s perception of the importance for change and their confidence they can make this change
  • Diffuse blame
  • Invite service users in a non-confrontational manner to consider new perspectives
  • Support self-efficacy via affirmation and positive reinforcement
  • Offer specific information and advice, but only when solicited
  • Elicit discussion of the benefits and drawbacks of changing problem behaviour
  • Develop, in collaboration with the service user, a plan for behaviour change.

A2.4Monitoring in motivational interviewing

An ability to identify the service user’s readiness for change, both from structured assessment and open-ended discussion through:

  • Using informal measures of change such as readiness, importance and confidence rulers and other basic measures of change
  • Using key questions to assess readiness to change both to assess and facilitate readiness to change

An ability to:

  • Provide summaries during sessions to demonstrate understanding of the service user’s problem, structure the intervention and emphasise positive change focused service user statements
  • Refer to, and elicit open-ended discussion from, assessment data
  • Provide positive and constructive feedback and open-ended discussion on behaviour change during and at the end of sessions
  • Make use of self-monitoring tools to reflect on and improve performance
  • Make use of supervision, and the associated assessment and feedback

A2.5Metacompetences in motivational interviewing

An ability to:

  • Adapt motivational interviewing according to the setting in which it is provided
  • Pace the rate of the intervention as relevant to service user needs
  • Set agendas on an ongoing basis in order to clarify session topics and behaviour change targets
  • Recognise service user need for motivational interviewing as it arises, and to deliver it opportunistically
  • Elicit and be responsive to service user’s feedback
  • Integrate motivational interviewing into routine assessment systems.

A3.Contingency Management

Dataset J definition: Contingency management (CM) provides a system of reinforcement or incentives designed to motivate behaviour change and/or facilitate recovery. CM aims to make target behaviours (such as drug use) less attractive and alternative behaviours (such as abstinence) more attractive. CM requires additional competences for the worker and delivery within a clinical governance framework including appropriate supervision.[3]

The following competences for contingency management has been derived from Routes to Recovery: Psychosocial Interventions for Drug Misuse – A framework and toolkit for implementing NICE recommended treatment interventions, pp. 28-30

A3.1Generic

  • Knowledge of drug misuse and mental health problems
  • Establishing a positive relationship with the service user
  • Establishing good relationships with relevant professionals
  • Gathering background information
  • Giving service users information about drug misuse

A3.2Basic contingency management competences

  • Knowledge of contingency management principles
  • Structuring a contingency management programme
  • Managing the relationship with a service user in a manner consistent with contingency management principles

A3.3Specific contingency management competences

  • Drug testing for a contingency management programme
  • Assessment for a contingency management programme
  • Establishing a contingency management programme
  • Delivering and monitoring contingency management programme
  • Managing relationships with external agencies concerning contingency management
  • Ending the intervention

A3.4Metacompetences in contingency management

An ability to:

  • Judge the level and approach of contingency management intervention required
  • Design a contingency management schedule in accordance with behavioural principles
  • Adapt a contingency management schedule to the characteristics and needs of individual service users including the nature of their drug misuse
  • Adapt the contingency management intervention according to the setting in which it is delivered
  • Identify barriers to effective intervention and to resolve these within the boundaries of the agreement with the service user and the overall objectives of the service setting
  • Make use of supervision, assessment and feedback on performance as a contingency management therapist

A4.Family and social network interventions

Dataset J definition: Family and social network interventions engage one or more of the client’s social network members who agree to support the client’s treatment and recovery. The interventions use specific psychosocial techniques which aim to increase family and social network support for change and decrease family and social support for continuing drug and/or alcohol use. These interventions may involve the use of mapping tools. They require additional competences for the worker and delivery within a clinical governance framework including appropriate supervision. Examples: Social behaviour network therapy (SBNT), Community Reinforcement Approach (CRA), Behavioural Couples Therapy (BCT) & formal Family Therapy[4]

A4.1Treatments/interventions involving family members

A4.1.1Working with family members (to engage relation in treatment)

  • Family intervention
  • Community reinforcement and family training
  • Unilateral family therapy
  • Cooperative counselling

A41.2Joint involvement of family members (and their relatives in treatment)

  • Conjoint family group therapy
  • Behavioural couples therapy
  • Family therapy
  • Network therapy
  • Social behaviour and network therapy

A4.2Social Behaviour and network therapy

  • No competences currently available (Skills Consortium)

A4.3Competences for Behavioural Couples Therapy (BCT)[5]

A4.3.1Generic competences

  • Knowledge of drug misuse and mental health problems
  • Engaging service users
  • Establishing good relationships with relevant professionals
  • Dealing with the emotional content of sessions
  • Gathering background information
  • Giving service users information about drug misuse

A4.3.2Basic BCTcompetences

  • Knowledge of family approaches to drug misuse and mental health problems
  • Assessment of couples with drug misuse problems
  • Knowledge and rationale of BCT

A4.3.3Specific BCT competences

  • Establishing the therapeutic approach in BCT
  • Monitoring of treatment progress in BCT
  • Monitoring of drug and alcohol misuse and associated risks in BCT
  • Ensuring effective delivery of BCT
  • Relapse prevention

A4.3.4Metacompetences in BCT

Ability to:

  • Adapt sessions responsively in relation to service user feedback
  • Implement BCT in a manner consonant with its underlying philosophy
  • Select and skilfully apply the most appropriate BCT intervention techniques
  • Structure sessions and maintain appropriate pacing
  • Identify and manage obstacles to treatment participation and goals both in and out of session
  • Identify and respond appropriately to non-substance related problems which may interfere with BCT or present increased risks for the couple, their family or the wider social network

A4.4Competences for Community Reinforcement Approach (CRA)

No competences currently available (Skills Consortium) but Dr Robert Myers, the recognised expert in this field states that a successful CRA therapist must have sound, fundamental counselling skills. In addition, supportiveness, empathy, and a genuinely caring attitude are key to establishing theconsumer-therapist relationship. CRA also requires that the therapist bedirective, energetic, and engaging. (Bob Myers)

Attendance at CRA course facilitated by Dr Myers (lead in this field)

A5.Cognitive and behavioural based relapse prevention interventions (substance misuse focused)

Dataset J definition:Cognitive and behavioural based relapse prevention interventions develop the service users’ abilities to recognise, avoid or cope with thoughts, feeling and situations that are triggers to substance use. They include a focus on coping with stress, boredom and relationship issues and the prevention of relapse through specific skills – e.g. drug refusal, craving management. They can be delivered in group or individual format and may involve the use of mapping tools. They require additional competences for the worker and delivery within a clinical governance framework including appropriate supervision. Examples: CBT based relapse prevention (which may include mindfulness and ‘third wave’ CBT), behavioural self control (alcohol)[6]

The following competences for CBT-based guided self help interventions have been derived from Routes to Recovery: Psychosocial Interventions for Drug Misuse – A framework and toolkit for implementing NICE recommended treatment interventions, pp. 35-36

A5.1Generic competences

Establishing a positive relationship with the service user

An ability to:

  • Develop an empathetic, warm and genuine relationship
  • Communicate effectively through appropriate use of empathic statements, reflection, clarification, verbal and non-verbal behaviours.

Establishing good relationships with relevant professionals

An ability to:

  • Communicate effectively with professionals about the nature of the service user’s difficulties, the intervention(s) offered and the resulting outcomes.

Gathering background information

An ability to:

  • Gain an overview of the service user’s current life situation, any specific stressors and level social support
  • Elicit information regarding diagnosis, past history and present life situation
  • Gather information relating to the impact of emotional distress including work, home, social and private leisure and close personal relationships.

Establishing a context for the service and providing rationale for the service user of the self-help model