Consultation on the implementation of the competency framework for training the future UK clinical neuropsychology profession

Transcription

1 Consultation on the implementation of the competency framework for training the future UK clinical neuropsychology profession DoN Professional Standards Unit May 2013

2 Contents SECTION 1. Executive Summary... 3 SECTION 2. Brief History and Outline of the Qualification in Clinical Neuropsychology (QiCN)... 5 SECTION 3. Summary of Key Issues Relevant to the Future of the QiCN... 7 SECTION 4. Development of a Competency Framework for the UK Clinical Neuropsychology Profession SECTION 5. Implementation of a Competency Framework for Training the UK Clinical Neuropsychology Profession SECTION 6. Proposed Framework SECTION 7. Implications of the Proposed Framework SECTION 8. Consultation Process Appendix 1. Joint Statement from the Division of Neuropsychology and Division of Clinical Psychology Appendix 2. Competency Framework Items Divided into Levels 1B and

3 SECTION 1. Executive Summary This report describes a proposed broad framework for the implementation of the UK Clinical Neuropsychology Competency Framework into current and future training practices. The aims of developing the proposed framework were to: Maintain, if not enhance, standards of UK Clinical Neuropsychology practice. Respond to the conclusion of the Competency Framework for Training the UK Clinical Neuropsychology Profession report by actively considering how training processes could be aligned with the desired competency outcomes. Review the positive aspects and challenges facing the candidates, education providers and examiners of the BPS Qualification in Clinical Neuropsychology (QiCN) following its 9 years of operation. Provide a template for wide consultation with DoN members and other stakeholders that education providers and representatives from across neuropsychology training believe is flexible enough to be adapted to local needs and resources as well as changing demands over time. Provide a formal mechanism for acknowledging and supporting the development of other applied psychologists who wish to develop specialist advanced skills in psychometric and cognitive assessment but who do not wish to undertake the full BPS Qualification in Clinical Neuropsychology. Act as a mechanism for eliciting feedback from members prior to any document being presented for consideration to the BPS Membership Standards Board and other appropriate governance procedures. As a result of the DoN executive and training committees being aware of challenges facing the QiCN and the decision of the government not to offer a regulated protected title of Clinical Neuropsychologist the DoN commissioned a significant piece of work in 2010 to produce a Competency Framework for the UK Clinical Neuropsychology Profession. The full details can be found in the report published on the DoN website in June This project took almost two years to complete and involved significant consultation with the membership and relevant stakeholders. The project was overseen by an appointed working party and two competency frameworks were developed, one for paediatric neuropsychology and one for adult neuropsychology. One of the conclusions of the report raised the possibility of facilitating developments in training alongside clinical, educational or other applied psychology. It was noted that the implementation of the competency framework would be useful in addressing the need to maintain the quality of the neuropsychology training while also allowing greater diversity of training provision to deliver requisite competencies consistent with the QiCN. 3

4 The DoN Professional Standards Unit (PSU) has been considering the latter issue since June The PSU is specifically responsible for developing the DoN s national training, workforce and standards strategy. It brings together heads of the two groups responsible for training issues; the Committee for Training in Clinical Neuropsychology (CTCN) and the Clinical Neuropsychology Qualifications Board (CNQB), the DoN Workforce Planning Representative, the DoN QiCN Trainee Representative as well as the Directors of the DoN accredited university training providers who are de facto members of the CTCN. The PSU has also had initial consultations with representatives from the Division of Clinical Psychology Professional Standards Unit, the Division of Counselling Psychology and various training providers from D. Clin. Psych. and D. Ed. Psych. programmes. The PSU have formulated a possible training framework that recognises explicit foundation stages and components leading to attainment of the QiCN competencies. The stages are Undergraduate training in Psychology Level 1A: Core Applied Psychology Skills Level 1B: Advanced Psychometric and Cognitive Assessment Skills Level 2: Specialist Neuropsychological Assessment and Intervention Skills By identifying discrete stages in the competency framework for training we can recognise the levels of competence that are attained via the QiCN but also allow education providers to develop training routes in a more flexible manner according to local resource provision, funding for training places and local demand from client groups, employers and candidates. It also allows more candidates to benefit from stages of the QiCN in a formally recognised manner should they choose not to complete the full QiCN as well as acknowledging the significant role that clinical neuropsychologists and other applied psychologists should have in disseminating brain-behaviour knowledge via training and consultation to non-psychology professionals and stakeholders. This document is an initial proposal to the DoN membership that will involve a wide consultation process with all members and other stakeholders. Feedback received will be collated and reported publicly. The DoN Executive and Training Committees recognise that there is due BPS governance process to follow once we receive feedback from our members on future potential changes to training procedures. 4

5 SECTION 2. Brief History and Outline of the Qualification in Clinical Neuropsychology (QiCN) The BPS Division of Neuropsychology (DoN) was established in 1999 from the original BPS Special Group in Clinical Neuropsychology. Similar to all other BPS applied divisions, the DoN sought to establish its own professional training route and qualification. The objective of the qualification was to establish a standard of practice in clinical neuropsychology that would ensure the essential skills and underpinning knowledge for the expert and professional application of psychology in this field (QiCN Candidate Handbook 2013). This qualification was set up in 2004 and was originally known as the Practitioner Full Membership Qualification (PFMQ) and is now known as the Qualification in Clinical Neuropsychology (QiCN). Successful completion of the QiCN entitles an individual to join the BPS Specialist Register of Clinical Neuropsychologists (SRCN). The QiCN has two routes: the adult and paediatric qualifications. The entry criteria to the QiCN are currently set at the eligibility for Full Membership of the Division of Clinical Psychology for entry onto the adult route and Full Membership of the Division of Clinical Psychology, the Division of Educational and Child Psychology (DECP) or the Scottish Division of Educational Psychology for entry onto the paediatric route. The detailed features of the QiCN are available in the candidate handbook (QiCN Candidate Handbook 2013) but briefly the qualification requires successful completion of three components: i) Knowledge dimension ii) Practice dimension iii) Research dimension Competencies within these dimensions are examined independently although at the final viva candidates are expected to be able to demonstrate their ability to integrate all three dimensions by providing examples of their practice and clinical reasoning. For the Knowledge dimension candidates may undertake one of the BPS accredited university post-graduate diploma courses to gain exemption. Currently there are two adult courses, delivered by the University of Bristol and University of Glasgow, and one paediatric course at the UCL Institute of Child Health. Alternatively, candidates can choose to sit the BPS examinations independent of an accredited course to pass the Knowledge dimension (known as the independent route). In order to complete the Practice dimension candidates are required to organise the equivalent of two years of full-time clinical work supervised by a member of the SRCN and produce a portfolio of clinical competence that is examined by the BPS Clinical Neuropsychology Qualifications Board. This portfolio involves submission of a case log, a clinical supervision log and six case studies, all defended by viva examination. Most Clinical and Educational psychologists who have already completed research projects to a doctoral level and who can demonstrate that they have kept their skills up to date can apply to the BPS for exemption from the Research dimension. A very small group still choose to study an MSc at one of the accredited courses so that they can gain research experience within this specialist area. 5

6 The general pathway that candidates follow to completion of the QiCN is displayed in Figure 1. Figure 1. QiCN pathway and timeline QiCN%pathway! BSc (Hons) Psychology 3-4%years% Voluntary Work 2-3%years% Assistant Psychologist / Research Assistant / PhD 3%years% Doctorate in Clinical or Educational Psychology 3%-%4%years% Qualification in Clinical Neuropsychology Total%average%~%12%years% Research Dimension Knowledge Dimension Practice Dimension V I V A 6

7 SECTION 3. Summary of Key Issues Relevant to the Future of the QiCN After 9 years of QiCN operation, the DoN is well aware of strengths and weaknesses of the process and changing professional and economic circumstances over that period. A comprehensive but not exhaustive list of some of the main issues facing the QiCN is provided here- i. There are a potentially large number of candidates with an interest in clinical neuropsychology training. However, over the past nine years the QiCN has produced only a limited number of qualified clinical neuropsychologists. Within the UK, psychology undergraduate courses are the second most popular degree of study, second only to law. There are over 48,000 members of the BPS, which contains 10 divisions, the largest of which is the Division of Clinical Psychology with over 10,000 members. In relation to other divisions for membership numbers the size of the DoN ranks about halfway with over 1,200 members. As of 9 th May 2013, 401 DoN members are listed on the Specialist Register of Clinical Neuropsychologists (SRCN). Each year approximately candidates enrol on each of the QiCN accredited university courses and they usually take 2 years to complete the courses on a part-time basis. About 20% of these university candidates have also registered and completed the full BPS QiCN with a handful following the BPS independent route. Within 9 years of operation of the QiCN, approximately 80 candidates have successfully completed the full qualification. Currently we do not have precise workforce data but given the low number of candidates obtaining the QiCN it appears likely that there are insufficient numbers to replace the natural retirement of existing members on the SRCN. Notwithstanding this, there will also be an increase in demand for services due to the general growth in neurosciences services, the UK s ageing population and associated increase in neurodegenerative disorders. ii. iii. Previous surveys of QiCN candidates and feedback from university accreditation visits demonstrate that the university courses are largely described very positively and as providing valuable learning experiences. Candidates and their managers can identify tangible benefits for their clinical practice from undertaking the university courses. Often cited as a further major advantage of the current training route is the pre-requisite Clinical or Educational Psychology Training that provides core clinical and transferable skills. Such training programmes are supported with significant infrastructure, NHS or Department for Education funding for both staff and trainees, and a 46 year history since the first training courses were created. Many colleagues are concerned that any future training proposals should respect the value of core generic clinical skills, facilitating a breadth of assessment, formulation and intervention skills that are characteristic of UK clinical neuropsychology practice. The DoN is keen to ensure that these skills remain central to neuropsychological training. 7

8 iv. One of the major challenges within the current climate is the time and expense that it takes to complete the QiCN as currently configured. From enrolment as an undergraduate it takes approximately 12 years to complete training as a Clinical Neuropsychologist and considerably longer for those who work part-time and/or take time out for maternity leave and/or carer responsibilities. v. A further barrier to undertaking the QiCN is gaining access to supervision from one of the 401 colleagues listed on the SRCN, particularly within one s own NHS Trust or organisation, or in paediatrics. vi. vii. viii. ix. Some candidates work in specialist services with appropriate supervision for particular client groups but can have difficulty gaining access to a suitable range of cases required for their QiCN clinical portfolio. A further concern since the requirement for a neuropsychology-specific research project on the QiCN was dropped is the lack of neuropsychological research being conducted in the UK. A major concern for potential candidates is the ability to gain access to funding for the QiCN and in particular the QiCN fees that are additional to university course fees. The BPS set the fees according to the administration costs of running the QiCN but candidates often report that it is difficult to see the tangible benefit of remaining on a training register for a number of years whilst they complete the practice component of the QiCN. There are also concerns that for the QiCN, unlike university tuition fees, part-time workers pay the same annual fees as full-time workers. This is clearly a particular disadvantage to primary carers of young children. There is some concern often expressed at QiCN workshops and course accreditation visits that the QiCN viva process has in the past been highly variable depending on the examiners that are appointed. It is fair to acknowledge that there appears to be a perceived anxiety regarding potential heterogeneity amongst examiners styles and approaches to assessment. In the past, this perception may have been compounded by examiners working in a wide range of different practices who were grand-parented onto the SRCN so did not therefore have experience themselves of undertaking the QiCN as candidates. It s important to recognize that in any examining process examiners will vary in personal style, approach and, to a certain extent, expectations. Therefore the Board has worked hard to improve consistency and understanding of the viva process with the introduction of training and workshops for examiners, supervisors and candidates as well as explicit competency based criteria. Vivas are now also recorded in the event of an appeal or so that the Chief Examiner and External Examiner have this as a resource for moderating. x. The economic viability of courses to the universities has always been a challenge and circumstances have changed significantly since the initial development of courses in the English universities. xi. In total 7 university courses have been set up to deliver the Knowledge and Research dimensions of the QiCN. Four courses have since closed due to economic and staffing challenges, namely the adult courses provided by the Institute of Psychiatry, University of Bangor and University of Nottingham as well as Nottingham s paediatric course. The courses that are currently open 8

9 are the adult courses at the University of Glasgow and University of Bristol, and the paediatric course at the UCL Institute of Child Health. xii. xiii. xiv. When the QiCN was developed there was no business plan or clear funding stream identified for the direct and indirect costs of completing the QiCN. DoN CPD events were extremely popular and perhaps it was anticipated that the QiCN would be an extension of CPD in terms of funding and time permitted from employers. It is clearly difficult in the current climate for candidates to obtain funding and the time permitted from employers to complete the full QiCN. The current English courses are largely dependent on the parallel Applied courses that run alongside them to make them financially viable. Applied courses contain the same content and examinations as the Clinical Neuropsychology courses but are open to psychology graduates and are very popular. The Glasgow course receives funding from NHS Education for Scotland (NES) via a training contract that is renegotiated every two years xv. Circumstances for the English courses were altered significantly in 2008 when the Innovation, Universities, Science and Skills Committee recommended the withdrawal of HEFCE funding for students undertaking equivalent or lower level qualifications to ones they already possessed. In effect this meant that the English universities lost two thirds of their income for anyone who already had a doctorate in clinical or educational psychology studying for the post-graduate diplomas in clinical neuropsychology. xvi. xvii. xviii. Further to this, tuition fees were introduced and recently allowed to increase significantly for undergraduate programmes. This means that most top universities have plans to raise their post-graduate tuition fees to similar or higher levels of 9k per year. So for example, UCL proposed a 60% increase in the paediatric clinical neuropsychology course fees for 2012/13 entry. This was negotiated down to a 35% increase but will have to come in-line with the new 10k fee per year within 3 years. Bristol is under similar pressure to raise its fees. The neuropsychology courses are clinical in nature but as they do not have attached NHS funding there are some logistical challenges to employing and promoting clinically qualified staff. Universities typically expect post-graduate diploma and MSc courses to be run by staff on academic terms and conditions and promoted according to their research output. Therefore, (unlike clinical psychology courses) the Bristol, UCL and former Nottingham neuropsychology courses have all been dependent on local agreements with NHS organisations to employ the clinical staff to run the courses. Given the reorganisation of funding structures for training in the NHS and Department for Education it is difficult to predict the medium to long term funding of clinical psychology, educational psychology and clinical neuropsychology programmes. If some services continue to move from the public sector into the independent sector it also raises questions about public funding of training places. What does seem likely is that funding may come from more heterogeneous sources in the future and training programmes need to have the flexibility to adapt accordingly. 9

10 xix. xx. xxi. xxii. xxiii. There are now formal requests from other Divisions for a number of their members to be able to access the QiCN. The present criteria for entry are historical and based on the background of individuals who expressed an interest in the QiCN at the time of its inception rather than being exclusive. The assumption has always been that the QiCN builds on core skills achieved in clinical psychology training for adult neuropsychology and either clinical or educational psychology training for paediatric neuropsychology. The common applied competencies across clinical and educational psychology were not made explicit. However, both clinical and educational psychologists have successfully completed the QiCN. Other areas of applied psychology may justifiably contest they have more in common with either clinical or educational psychology training than the latter two have in common with each other. To some extent the core applied skills were described as generic competencies in the Competency Framework report. Although clinical and educational psychology training is currently specified as pre-requisite to the QiCN it is readily acknowledged that trainees may leave with a range of neuro-heavy or neuro-light experiences based on the academic content of their courses, idiosyncratic placement opportunities and the choices that candidates make. Equally some trainees on other applied psychology training programmes choose their courses and placement experiences in neuroscience or neuro-heavy departments. Currently the DoN has no method of formally recognising or accrediting neuro-heavy experiences. It is clear that many applied psychology professions and indeed nonpsychologists wish to extend their knowledge and training in understanding cognitive models or brain-behaviour relationships. A more diverse workforce could increase patients access to services that can support individuals with cognitive, emotional, social and behavioural difficulties as a result of neurological or neurodevelopmental disorders. We are aware that there is a sensitive balance between diversifying a workforce to increase access to services and maintaining high standards of competent practice, particularly in a highly complex domain such as clinical neuropsychology. Therefore the DoN wishes to set high standards for specialist clinical neuropsychologists but would also like a framework that promotes realistic access to formal training and support for all professionals, carers and service users to ensure greater access to neuropsychological knowledge and skills for our client groups. Perhaps one of the most serious challenges to the profession since statutory regulation of psychologists was introduced is that the DoN was the only BPS applied professional training route that was not afforded a protected title because candidates entering the QiCN already had a preliminary protected title of clinical or educational psychologist. Overall, feedback from candidates undertaking the university courses is that the academic syllabus for the QiCN is strong, it significantly informs their practice and is well delivered by the accredited universities. They also clearly acknowledge the importance of accessing good placement supervision for their professional development. However, within the current health, education and economic context the QiCN as a whole and SRCN carry little professional credibility largely due to the lack of a protected title, intangible product and difficulties with completing the full QiCN. 10

11 SECTION 4. Development of a Competency Framework for the UK Clinical Neuropsychology Profession As a result of the DoN executive and training committees being made aware of the issues above the DoN commissioned a significant piece of work in 2010 to produce a Competency Framework for the UK Clinical Neuropsychology Profession. The purpose of developing a competency framework was to: Develop standards for Clinical Neuropsychology practice in the UK. Objectively and transparently regulate entry to the specialism of Clinical Neuropsychology in the UK (entry to the Division of Neuropsychology s specialist register). Identify the expected competencies developed by candidates undertaking the Qualification in Clinical Neuropsychology (QiCN). The full details of the competency framework can be found in the report published in June 2012 (Competency Framework for the UK Clinical Neuropsychology Profession, available on the BPS DoN Website). Briefly, two competency frameworks were developed; one for paediatric neuropsychology and the other for adult neuropsychology. Within the frameworks competencies are represented across four domains: I. Underpinning Knowledge and Skills II. Clinical Work III. Communication IV. Personal and Professional Practice Each of the four domains is further divided into the following competency types: a) Generic Clinical Competencies b) Neuropsychological Competencies Initial competencies were derived from key sources including syllabus material for the Qualification in Clinical Neuropsychology (QiCN), learning objectives from existing clinical neuropsychology training courses, published competencies for UK Clinical and Educational Psychology, and core neuropsychology textbooks. The frameworks were further enhanced via meetings with Expert Reference Groups. These groups were comprised of experts working in distinct areas of clinical neuropsychology practice. Feedback obtained was used to adapt the frameworks and develop the content previously underrepresented. The validity of the frameworks was assessed via QiCN vivas in order to ensure that competencies that were being assessed were appropriately represented within the frameworks. Clinical neuropsychologists, key stakeholders in neuropsychology and an Expert Consultation Group were then formally invited to comment on the draft frameworks. The frameworks were modified as a result of the feedback received during this consultation process. 11

12 This project took almost two years to complete and involved significant consultation with the membership and relevant stakeholders. The project was overseen by an appointed working party and chaired by Dr Ingram Wright with the support of Dr Zoe Fisher who was specifically appointed to the project. The working party comprised of members of the Division of Neuropsychology including: Dr Jacki Bambrough, Dr Sal Connolly, Professor Jonathan Evans, Dr Philippa Griffiths, Dr Peter Rankin, Dr Tracey Ryan-Morgan, and Dr Arleta Starza- Smith. Professor Tony Roth from the DCP provided input to support the initial phases of the competency framework based on his lead in the development of a competency framework for CBT. The Adult Expert Reference Group included Dr Martin Bunnage, Ms Katherine Carpenter, Dr Rudi Coetzer, Dr Sal Connolly, Professor Jonathan Evans, Dr Fergus Gracey, Dr Philippa Griffiths, Dr Camilla Herbert, Dr Rupert Noad, Dr Tracey Ryan Morgan, Dr Andy Tyerman, Professor Julie Snowden, and Dr Giles Yeates. The Paediatric Expert Reference Group included Dr Fergus Gracey, Dr Judith Middleton, Dr Peter Rankin, Dr Arleta Starza-Smith and Mr Steve Whitfield. The Expert Consultation Group included Dr Susan Copstick, Professor Narinder Kapur, Ms Shauna Kearney, Dr Gavin Newby, Dr Kit Pleydell-Pearce, Dr Jody Warner-Rogers and Professor Rodger L Wood. Broader consultation included the invitation to feedback from all members of the Division of Neuropsychology, specifically members of the Committee for Training in Clinical Neuropsychology and examiners for the qualification in clinical neuropsychology. Key stakeholders also played a vital role in the validation of the framework, including clinical psychology and educational psychology training programmes, Clinical Psychologists, Educational Psychologists, and relevant voluntary sector organisations, professionals allied to clinical neuropsychology and special interest groups related to neuropsychology. The final report was approved by the DoN in June 2012 and concluded that: the development of a competencies framework will raise questions about possible training routes to deliver such competencies. There is currently an active debate regarding the fitness of existing applied psychology training to meet the workforce demands and financial pressures of the modern NHS. Training for Clinical Neuropsychologists is currently protracted and therefore costly. The possibility of more integrated training alongside clinical, educational or other applied psychology specialities is being considered. The implementation of the competency framework will, in this regard, be useful in addressing the need to maintain the quality of the speciality while also allowing a greater diversity of training provision to deliver competencies at a level of the QiCN. 12

13 SECTION 5. Implementation of a Competency Framework for Training the UK Clinical Neuropsychology Profession In 2012, the DoN Executive adopted a new structure similar to that of the Division of Clinical Psychology and other applied divisions with three new subunits to take on specific aspects of the DoN s work. One of the units set up was the Professional Standards Unit (PSU), which was approved by the Executive on 16 March The Professional Standards Unit is responsible for developing the DoN s national training, workforce and standards strategy. It brings together heads of the two groups responsible for training issues; Committee for Training in Clinical Neuropsychology (CTCN) and the Clinical Neuropsychology Qualifications Board (CNQB), the DoN Workforce Planning Representative, the DoN QiCN Trainee Representative as well as the Directors of the DoN accredited university training providers who are de facto members of the CTCN. As a result of the publication of the Competency Framework report and its conclusions, the issues listed in Section 3 and the remit that the DoN Executive set for the PSU (DoN Executive Minutes, 16 March 2012), the PSU immediately set about reviewing the current QiCN training framework once it was established in June What follows is a proposed framework that the PSU believes has the potential to address the issues listed in Section 3 by introducing a structure that reflects the DoN competency framework and allows increased flexibility in how one achieves the QiCN competencies whilst maintaining, or enhancing, professional standards across UK clinical neuropsychology practice. At this stage this is only a proposed framework for consultation with DoN members and other stakeholders and we are open to all suggestions and ideas for implementing the competency framework. However, the PSU believed it was important to have a potential framework that current education providers consider flexible enough to be realistically adapted and delivered according to local university conditions whilst maintaining national standards across a choice of training routes. Essentially the framework that this document proposes had to be considered fit for purpose by all representatives from the DoN CTCN, CNQB and DoN workforce and trainee groups. A draft of the framework has also been presented to and received constructive feedback from Dr Richard Pemberton, DCP Chair, Dr Catherine Dooley, DCP Professional Standards Unit Chair, and representatives from the D. Clin. Psych. Course providers of Exeter University and UCL as well as D. Ed. Psych. Course providers at UCL and Dr Sylvia Dillon as representative of the Division of Counselling Psychology. The overall framework, potential implications and the process of consultation was also discussed with Professor Ann Colley, BPS Chief Executive. 13

14 SECTION 6. Proposed Framework Figure 2 highlights the current levels of training that candidates proceed through to the final QiCN. This includes undergraduate training, applied training as a clinical or educational psychologist followed by the current QiCN. The competency framework assumes elements of all these stages, in particular the post-graduate steps of training. Figure 2. Current stages of training in relation to the QiCN and competencies map Broad& Category& CURRENT&TRAINING& & DoN&COMPETENCIES&MAP& Elementary&/& Founda?on&/& BPS&GBC& BSc&Psychology&&& Assistant&Psychologist& Experience&or&PhD& Basic&training&in&psychological&models&&& some& aspects &of&acquired&or& developmental&brain&disorders& Applied& Training&/& Full& Membership& of&dcp&or& DECP/SDEP& Clinical& Neuropsych& & QiCN & D.&Clin&Psych&or& D.&Ed.&Psych.&courses& Clinical&or&Educa?onal& Psychologists& registering&for&the& QiCN&Knowledge&&& Prac?ce&& Core&Applied&generic&skills&(inc&research)& necessary&for&professional&& neuropsychology& GeneralV&Advanced&Psychometric& Cogni?ve&&&Behavioural&Assessment& SpecialistV&Neuropsychological& Assessment,&Interpreta?on&Formula?on& &&Interven?on&Skills& Entry on the QiCN and stages of the process are rather restrictive as they depend entirely on eligibility for full membership of the applied divisions of clinical or educational psychology via their own accredited training courses. To introduce greater flexibility into our training framework the PSU proposes that we instead label the prerequisite clinical competencies as Level 1A (Core Applied Skills), with current QiCN training comprising Level 1B (Advanced Psychometric and Cognitive Assessment) and Level 2 (Specialist Neuropsychological Assessment and Intervention Skills) and base those stages on specified competencies as in Figure 3. 14

15 Level 1A would apply to the core applied (clinical, educational or other transferable) skills that the membership believes are critical for neuropsychologists, i.e. training that is currently provided by undertaking either a Doctorate in Clinical or Educational Psychology but may also be provided by other training courses. Following consultation with a number of D. Clin. Psych. education providers (see section 8) we understand that a number of D. Clin. Psych. trainees have managed to attain the majority of their required competencies after 2 years of training before they choose their specialist placements and complete their research. Such a stepped QiCN framework may allow candidates who wish to pursue a career in clinical neuropsychology, or elect to gain more specialist cognitive assessment skills, to complete Level 1B in their final year of the D. Clin. Psych. Course, if courses choose to provide this training As noted above in Section 4, the original four domains of the Competency Framework are divided into general and specific skills. The PSU proposed that we identify more explicitly two levels within the QiCN pathway known as Level 1B (Advanced Psychometric and Cognitive Assessment) and Level 2 (Specialist Neuropsychological Assessment and Intervention Skills). The proposed division of these competencies is described in Appendix 2. Level 1B would include the introductory stages to neuropsychological training, including advanced principles of psychometric measurement, cognitive and behavioural assessment, as well as an introduction to basic neuroanatomy and neuroscience. A key element of Level 1B would be to identify the upper limits of one s competencies and understanding when referral to individuals trained in Level 2 is required. Level 2 would provide more specialist training in neuropsychological assessment, interpretation, formulation and intervention skills. Figure 3. Named changes to stages of training NEW$LEVELS$ CURRENT$TRAINING$ $ DoN$COMPETENCIES$MAP$ Elementary$/$ Founda@on$/$ BPS$GBC$ BSc$Psychology$&$ Assistant$Psychologist$ Experience$or$PhD$ Basic$training$in$psychological$models$&$ some$ aspects $of$acquired$or$ developmental$brain$disorders$ Applied$ Training$$ $ $ Level$1A$ Clinical$ Neuropsych$ $ Level$2$ $ QiCN $ D.$Clin$Psych$or$ D.$Ed.$Psych.$courses$ Clinical$or$Educa@onal$ Psychologists$ registering$for$the$ QiCN$Knowledge$&$ Prac@ce$$ Core$Applied$generic$skills$(inc$research)$ necessary$for$professional$$ neuropsychology$ General[$Advanced$Psychometric$ Cogni@ve$&$Behavioural$Assessment$ Specialist[$Neuropsychological$ Assessment,$Interpreta@on$Formula@on$ &$Interven@on$Skills$ Name$the$required$entry$level$to$the$QiCN[$Level$1A$ Divide$the$QiCN$into$two$further$levels[$1B$&$2$ 15

16 By adopting the new stages in the competency framework it explicitly identifies the levels of competence that must be reached towards the final QiCN but allows education providers the ability to develop training routes in a more flexible manner according to what may be available regionally in terms of resource provision, funding for training places and local demand from client groups, employers and candidates. By adopting a more flexible framework it should allow training courses to adapt to local resources and demands whilst maintaining overall standards for the profession. It also allows more candidates to benefit from stages of the QiCN in a formally recognised manner should they choose not to complete the full QiCN as well as acknowledging the significant role that clinical neuropsychologists and other applied psychologists should have in disseminating brain-behaviour knowledge via training and consultation to non-psychology professionals and stakeholders. The PSU proposes that the new framework should be adopted to ensure standards are met and training routes can be accredited against those explicit standards but it is not the role of the PSU to be prescriptive about how an education provider should propose to deliver those standards in order to apply for accreditation. However, potential broad examples that the current education providers suggest might be considered are outlined in Figure 4. 16

17 PATHWAY 4- Fast-track direct route as a DUAL qualification: Clinical Neuropsychology & Clinical or Educational Psychology BSc Psychology & Experience or PhD. 4 year D. Clin Neuropsych Graduates complete QiCN Level 1A, 1B & 2 in one course Graduates complete QiCN Level 1A to the extent that it meets Clinical or Educational Psychology Criteria with neuro focus followed by Specialist Adult or Paediatric Neuropsychology Example pathways New Levels PATHWAY 1- Unchanged for Clinical /Educational Psychologists PATHWAY 2- Pathway 1 adapted for further Applied Psychologists (e.g., Counselling, Forensic, Occupational, Health) PATHWAY 3- Fast-track for Clinical/Educational/ (& potentially) Applied Psychologists PATHWAY 4- Fast-track direct route as a SINGLE qualification: Clinical Neuropsychology Foundation BSc Psychology & Experience or PhD. BSc Psychology & Experience or PhD. BSc Psychology & Experience or PhD. BSc Psychology & Experience or PhD. Level 1 A D. Clin Psych or D. Ed. Psych. courses Level 1 B Clinical or Educational Psychologists complete traditional QiCN Level 1B & 2 Applied Training qualification plus any further specifications from DoN Other Applied Psychologists complete traditional QiCN Level 1B & 2 Applied Training qualification plus any further specifications from DoN DoN Approved Level 1B within an Applied course Level 2 Applied Psychs Complete QiCN Level 2 3 year D. Clin Neuropsych Graduates complete QiCN Level 1A, 1B & 2 in one course Core Generic Clinical Psychology with neuro focus inc Adult, Paed & Older Adult followed by Specialist Adult or Paediatric Neuropsychology Figure 4. Examples of potential pathways to QiCN

18 In the above examples, Pathway 1 is the current, traditional QiCN route that remains in place for clinical and educational psychologists who decide to undertake the QiCN as part of their job as a clinical or educational psychologist after their initial doctorate qualification. Pathway 2 is similar to Pathway 1 but entry onto the QiCN is open to other applied psychologists who can prove that they meet Level 1A competencies or undertake further training to attain such competencies. Generic clinical competencies were identified by the expert and consultation groups in the development of the Competency Framework. It maybe that these require further elucidation when mapping different training routes onto Level 1A. Pathway 3 is an example of fast track based on candidates undertaking a D. Clin. Psych. course that is recognised as neuro-heavy and for those who choose to focus on a neuropsychology pathway during their initial clinical training. This may involve undertaking an optional elective module on their D. Clin. Psych. course in their final year that the DoN accredits as satisfying Level 1B and completing a 6 month or 1 year placement that the DoN approves as counting towards their 2 years of supervised experience necessary for the QiCN. Pathway 4 is an example of a Doctorate in Clinical Neuropsychology that comprehensively meets Levels 1A, 1B and 2 of the QiCN. This final route may or may not meet the criteria to be dually qualified in another area of applied psychology depending on the length of training and extent of competencies acquired. For example, a 3 year Doctorate in Clinical Paediatric Neuropsychology may include the core applied skills common to educational and clinical psychology and also the competency levels within the paediatric QiCN. The same might apply for a 3 year Doctorate in Adult Clinical Neuropsychology containing the core skills from clinical psychology and the adult QiCN but not enough of the competencies to also qualify someone as a clinical psychologist. Such courses may stand-alone or alternatively have the flexibility to be extended into 4 year Doctorates so that they meet all of the competencies to provide a dual qualification. An example of such a course is the newly proposed 4-year Doctorate in Clinical Forensic Psychology at the University of Birmingham that has emerged out of the Doctorate in Clinical Psychology and MSc in Forensic Psychology. It has been developed because of demand from local services, it will allow dual qualification and has been given approval from the HCPC, Division of Clinical Psychology and Division of Forensic Psychology as a dual qualification. Successful candidates will qualify as both a Clinical and Forensic Psychologist. Similar flexible courses could develop for clinical neuropsychology and other areas of applied psychology according to local demand and resources available. Figure 5 illustrates a potential extension of the QiCN so that DoN accredited pre and post QiCN CPD certificates are available for short courses. Such courses may be offered to non-psychologists such as nurses, support workers, allied health professionals, SENCos and teachers in specific aspects of understanding and supporting people with brain disorders. Other courses may be more advanced and available as formal CPD for members of the Specialist Register of Clinical Neuropsychologists.

19 Figure 5. Potential for DoN formally to acknowledge different levels of Neuropsychological Training OVERVIEW'' Elementary'/' Founda8on'' Level'1'A' Level'1'B' Level'2' ' Conversion' CPD' ' DoN'Future'Awards/ Accredita8on' DoN'Cer8ficates'in'aspects' of'brainebehaviour' knowledge'or' management' DoN'Entry'Level'for'QiCN' specified'&'approved' Cer8ficate'in'Advanced' Psychometric'&'Cogni8ve' Assessment' Qualifica8on'in'Clinical' Neuropsychology' Lateral'transfer'between' Adult'&'Paediatric' neuropsychology' DoN'CPD'days'or'short' courses'(points'system?)' Poten8al'Training' Basic'training/supervision'projects'for'nonE neuropsychologists.'(significant'poten8al'to' increase'pa8ents 'access'to'work'informed' by'neuropsychological'models)' Training'could'be'offered'for'Applied' Psychologists'to'ensure'they'meet'QiCN' entry'level' Individual'Applied'courses'may'apply'to'the' DoN'to'offer'Level'1B'within'their'courses.'Or' students'can'study'tradi8onal'qicn'courses' Future'candidates'would'have'the'choice'to' undertake'a'number'of'pathways'developed' by'educa8on'providers'according'to'local' need,'funding'opportuni8es'&'resources' Conversion'training'courses'for:' QiCN'Adult'<E>'Paediatric'' (Shorter'than'full'QiCN)' Short'specialist'courses/consulta8on'or'CPD' dayse'delivered'at'a'variety'of'levels' 19

20 SECTION 7. Implications of the Proposed Framework The proposed framework has implications for training and the dissemination of neuropsychological knowledge. Firstly, the framework acknowledges that many applied psychologists and indeed other health and education providers wish to gain some expertise or supervised experience in the understanding and management of brain-behaviour relationships for clinical and normally developing populations. Given the number of these professionals they could potentially provide access to excellent and diverse services for the public. However, the vast majority do not specifically intend, and would be unable to gain, the training required to become accredited Clinical Neuropsychologists. There is also considerable and justifiable public concern regularly expressed in the media at the amount of techniques or programmes claiming to have some neuroscientific basis without any true empirical support. It is exceptionally difficult for non-clinical Neuropsychologists to evaluate such programmes and therefore for the DoN to evaluate foundation and pre-qicn training courses or supervisory procedures for such professionals more explicitly would provide the public with a significant step forward in ensuring a form of expert quality assurance. However, we are also aware of the need to balance the growth of a more diverse workforce and ensure that high standards of practice are maintained. If the DoN training providers become more active in empowering a diverse workforce in neuropsychological skills then we anticipate it will be easier to educate different levels of the workforce about when there are limitations to their competence and to recognise when to seek consultation and refer on as appropriate. Secondly, the current route to the QiCN (Example Pathway 1) will remain in place for those candidates wishing to continue this pathway of training and will continue to be advantageous for many candidates. Pathway 1 will be open to clinical and educational psychologists registered with the HCPC who will follow all of the current requirements for the QiCN. Such candidates will complete Levels 1A (core applied skills necessary for neuropsychology) within their clinical or educational psychology training. After their clinical or educational psychology qualification they will complete 1B (advanced psychometric & cognitive assessment skills) and Level 2 (Specialist Neuropsychological Assessment and Intervention skills) of the QiCN. Currently accredited courses provide Level 1B and Level 2 as part of the Diploma in Clinical Neuropsychology. Thirdly, Pathway 1 may be adapted to form a new Pathway 2 so that BPS Applied Psychologists (who are not clinical or educational psychologists) can also enter the QiCN. Applied psychologists who do not meet entry criteria for Level 1A will have training requirements specified and will be supported to complete the entry Level 1A as a prerequisite prior to enrolment on a Level 1B/2 course. Fourthly, a new faster pathway (Pathway 3) may be developed for Applied Psychologists in Training who are committed to training as Clinical Neuropsychologists prior to completing their initial D. Clin. and D. Ed. Psych. Courses. This training could be undertaken within specific D. Clin. and D. Ed. Psych. courses. Pathway 3 will involve the candidates completing Levels 1A and 1B within their initial applied qualification with DoN Accreditation for the knowledge and practice parts of 1B. They would then only be required to complete Level 2 after their applied qualification to obtain the QiCN. This will significantly reduce the amount of 20

21 time spent acquiring the knowledge and supervised practice required after applied psychology training. Alternatively, many applied psychologists may be satisfied with this level of understanding of advanced psychometric and cognitive assessment skills for their particular area of practice without feeling the need to fully train in neural systems and the advanced principles of neuroscience necessary to qualify and practise as a Clinical Neuropsychologist. Fifthly, Pathway 4 would allow those psychology graduates or PhD holders who wish to train directly in clinical neuropsychology to complete one course that provides all essential elements of the competency framework at Levels 1A, 1B and 2. This will most likely be via a 3 or 4 year Doctorate in Clinical Neuropsychology. A 3 year course might only qualify someone as a Clinical Neuropsychologist and therefore the government and HCPC would need to revisit the possibility of protecting the title: Clinical Neuropsychologist. Alternatively such courses may be extended into 4 year doctorates so that they also meet the requirements to provide a dual qualification as in the Birmingham example described above. Therefore pathways 3 and 4 could potentially involve candidates undertaking a Doctorate in Clinical Psychology or Clinical Neuropsychology followed by a one-year top-up course to gain the other qualification. At this stage all of the above examples and subsequent implications are options that the education providers would like to consider and they may evolve according to the local resources, demands and detailed practicalities of implementation. The proposed competency framework outlined in Figures 3 and 5 provides the flexibility for education providers to explore the development of such training pathways. 21

22 SECTION 8. Consultation Process A significant amount of consultation has already taken place on the development of the competency framework as described under Section 4 and the PSU has started to consult major stakeholders as described under Section 5 to develop these initial proposals. This has resulted in the joint statement between the Division of Neuropsychology and Division of Clinical Psychology being released (Appendix 1). The DoN Professional Standards Unit now welcomes all feedback from DoN members and other relevant stakeholders around the potential implementation of the competency framework for training. In order to collate feedback the BPS has set up a Questback webpage that one can access at this address: The webpage will remain open until midnight Sunday 1 st September As well as requesting your opinion the website also requests some demographic information so that we can analyse the results according to different demographic variables. Once the feedback has been collated and analysed it will reported to the DoN Executive Committee for consideration on 13 th September and a summary of the results and responses to questions will appear in the following DoN newsletter. The relevant DoN training committees will then prepare a report outlining a way forward for consideration by the BPS Membership Standards Board in Autumn