10 30% This section must achieve a minimum mark of 5/10 independently to pass the assessment overall. A score of 4 or

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1 Student instructions: This is a practical clinical competency assessment in undertaking a patient-centred Low Intensity CBT (LICBT) patient assessment. The purpose of the assessment is to ensure that a minimum level of clinical competency is ; that would enable safe and effective clinical practice. It is vitally important that practitioners can assess competently using the LICBT structure. Practitioners should gather sufficient information using the funnelling process to be able to come to an accurate probable diagnosis; give relevant information to the patient; and enable them to make an informed decision about treatment options. To pass the competency assessment a minimum percentage of 50% must be achieved overall across the four sections; a thorough risk assessment must be undertaken and both the interpersonal skills and information gathering sections must be passed independently with at least 5/10. Section Marks Percentage Essential Requirements available Weighting Introduction 10 10% Interpersonal Skills 10 30% This section must achieve a minimum mark of 5/10 independently to pass the assessment overall. A score of 4 or Information Gathering Information Giving & Shared Decision Making below in this section will result in an overall fail % This section must achieve a minimum mark of 5/10 independently to pass the assessment overall and a thorough risk assessment must be completed. An inadequate or missing risk assessment will lead to automatic failure. A mark of 4 or below in this section will result in an overall fail 10 20% Your will be filmed undertaking a clinical simulation of an LICBT assessment. The assessment will be undertaken in the clinical filming rooms in the CEDAR training suite. There is up to 35 minutes duration for the assessment. At 35 minutes the assessment will stop being filmed/marked. No marks will be awarded for anything undertaken after the time allocated. You will receive a GP referral letter a minimum of two weeks prior to the assessment but you will not know the presenting problem as this is for you to ascertain using your clinical skills of assessment. An actor who has received specific training in undertaking the role of the patient and the assessment procedure will play the patient. They are trained to know the disorder specific condition and symptoms that they are playing and they will have clear instructions on the scenario for them to follow. This allows the scenarios being assessed to be consistent between students. They will respond fairly to the quality of questioning they receive from each student individually and they may ask you for clarification if a question is unclear or they do not understand. The answers that they give you will be dependant upon the questions that you ask. You should use the full funnelling process to elicit the depth of information you feel that you require. You should expect that the actor will play a case of depression or anxiety disorder true to the symptom patterns of that disorder, and as such they may, for Marie Chellingsworth, David Richards & Kathryn Rayson (2014). Clinical Education Development & Research (CEDAR). The University of Exeter. 1

2 example, have reduced eye contact or display visible signs of anxiety. You will be required to demonstrate your common factor skills to engage them in the process of the assessment. The clinical assessments you undertake will be subject to double blind marking by trained competency assessors and then meet the University regulations for moderation and external examiner scrutiny. As each section has multiple criteria, the overall percentage ratings are indicative only and allow you to see which areas could still be improved. Unless full marks are achieved in any area, there are still aspects within that competency section that could be further improved to benefit your clinical work. We recommend that you seek feedback on these areas, even if the assessment is passed overall so that you can use this to benefit your work with patients in practice. Further feedback can be achieved through the personal tutor system and during the assessment feedback session provided by the team. Overall Marks Section Section Percentage Weighting Marks Awarded Total Percentage Awarded Overall Section Result Introduction 10% /10 % PASS/FAIL Interpersonal Skills 30% /10 % PASS/FAIL Information Gathering 40% /10 % PASS/FAIL/AUTO FAIL RISK Information Giving & Shared Decision Making 20% /10 % PASS/FAIL TOTAL ASSESSMENT SCORE % PASS/FAIL Marie Chellingsworth, David Richards & Kathryn Rayson (2014). Clinical Education Development & Research (CEDAR). The University of Exeter. 2

3 Practitioner introduces themselves by name sufficiently to meet competency 0-3 Does not introduce self with full name Some evidence of competency (4-6 marks) (the worker demonstrates partial or limited skill) States first or last name only; or gives additional information such as beginning to explain their role or the purpose without checking the patients name Sufficient evidence of competency (7-10 marks) Clearly states own full name without giving additional information at this point Practitioner elicits the patient s full name and their preference to be called Fails to discover the patient s name or ascertains this later during the assessment Finds out only part of the patient s name or uses this prior to verbally checking; or does not ascertain the preferred name Finds out both the patient s full name and their preferred name including any prefix The practitioner explains their role clearly including relevant expertise and being situated in a wider team Practitioner does not state their role The practitioner is vague or provides a statement only, such as I work here as a PWP without providing clarification of their role, team or relevant expertise Full statement of role provided: My role is a Psychological Wellbeing Practitioner (PWP for short). I have specific training to work with difficulties such as depression and anxiety. I work as part of a wider team of practitioners who are also trained to work with these difficulties Describes purpose/agenda of the assessment No purpose stated Vague or unhelpful explanation e.g. I m going to be asking you lots of questions Full purpose stated which gives the collaborative structure of the assessment and helps the patient understand their role within it as active Defines times scale Time not stated Vague statement We have a short time Explicitly stated The interview will take up to 35 minutes, is that ok? Overall score for Introduction section /10 = % Marie Chellingsworth, David Richards & Kathryn Rayson (2014). Clinical Education Development & Research (CEDAR). The University of Exeter. 3

4 sufficiently to meet competency 0-3 marks Some evidence of competency 4-6 marks Sufficient evidence of competency 7-10 marks Displays verbal empathy e.g. It sounds like this is very distressing for you Displays engagement by nonverbal cues e.g. eye contact, posture, nods and facial expressions sufficiently (on less than 2 relevant occasions) sufficiently Limited use of verbal empathy (but more than two occasions) and/or opportunities missed or incongruent with non-verbal communication displayed; sympathy rather than empathy given Displays some or part of the time only; loses eye contact too often due to note taking etc.; does not display collaboration with posture sufficiently when giving information Appropriate verbal empathy statements used throughout the interview that are authentic; at appropriate times and congruent with non-verbal behaviour. Appropriately throughout the interview at a sufficient level Acknowledges the problem by using reflection sufficiently Displays some or part of the time but misses opportunities Uses reflection throughout the interview appropriately Acknowledges the problem by summarising e.g. you have told me that your difficulties are sufficiently Displays some or part of the time but misses opportunities and/or does not ensure they have understood correctly the patients own world view Uses summaries when appropriate throughout the interview and seeks patient confirmation that they have understood correctly Uses patient centred interviewing through the use of funnelling: -General open questions e.g. what is the problem -Specific open questions e.g. tell me more about feeling down -Specific and closed questions to clinch detail e.g. frequency, intensity, duration, closing funnels when all information gathered in that area/symptom -Summarising and clarification sufficiently (e.g. using mostly closed or leading questions; interrogative style; using a script or not asking questions in a patient centred way) Some evidence but not fully (e.g. not always closing funnels, not always following cues from the patient, using sufficient specific and closed questions to clinch detail, not using summaries to ensure all aspects of any area gathered etc.) Demonstrates the full process of funnelling throughout the information gathering section including completed funnels Overall score for section /10 = % Marie Chellingsworth, David Richards & Kathryn Rayson (2014). Clinical Education Development & Research (CEDAR). The University of Exeter. 4

5 Uses the four W s to structure questions throughout the gathering of here and now information along with the ABCs: What Where When With whom sufficiently to meet competency 0-3 marks Doesn t use the 4W s consistently throughout the interview to gather information; or gathers less than two areas Some evidence of competency 4-6 marks (the worker demonstrates limited skill) Uses the 4W s at least twice for the general problem but misses opportunities to gather accurate information within funnelling around symptoms Sufficient evidence of competency 7-10 marks Uses at least three of the 4W s competently and weaves their use with information gathered within the ABC areas to clinch detail and gain a deeper understanding/variance of symptoms not just the overall problem e.g. where they can go, as well as where they can t and what they do that makes the difference when they can go somewhere etc. Autonomic symptoms (Physical symptoms as a result of the presenting problem) Does not directly ask about physical symptoms; or relies on patient volunteered information only without finding out more Asks about physical symptoms at least once, but misses opportunities to follow up information or cues Funnels sufficiently around the area of physical symptoms including gaining further information on symptoms to clinch detail using W s, B s and C s as appropriate and following patient cues Behavioural symptoms (the ways in which the patient has adapted what they do as a result of their problem) Does not directly ask about behaviours that have changed as a result of the problem; or relies on patient volunteered information only without finding out more Asks about behaviours at least once, but misses opportunities to follow up information or cues; or does not gather variance information Funnels sufficiently around the area of altered behaviours (including both things they are doing more of or may be avoiding as a result of the problem; and what they do to manage the symptoms) including gaining further information to clinch detail using W s and A s and C s as appropriate and following patient cues Cognitive symptoms (the thoughts the patient has as a result of their problem in specific situations when they feel that way or related to the problem overall) Does not directly ask about thoughts; or relies on patient volunteered information only without finding out more Asks about thoughts at least once, but misses opportunities to follow up information or cues; situation specific thoughts related to other information gathered missed or only generic thoughts gathered Sufficiently gathers thoughts and situation specific thoughts related to other symptoms to clinch detail using W s and A s and B s as appropriate and following patient cues Triggers (what triggers them feeling that way on a day to day basis not the historical onset of the problem) Does not specifically ask about triggers or gathers onset of problem only Specifically asks about triggers but does not summarise any already gathered; or makes assumptions Specifically asks about triggers to the presenting problem on a day to day basis, reflecting and clarifying any triggers already gathered Marie Chellingsworth, David Richards & Kathryn Rayson (2014). Clinical Education Development & Research (CEDAR). The University of Exeter. 5

6 Determines the impact (consequences) of the problem on specific areas of the persons lifestyle Impact on domestic lifestyle Does not gather the impact area or gathers new or repeated behaviours instead of consequences of the problem in that area Gathers some of the impact in this area; but does not reflect back information gathered to gain the consequences or asks vaguely; gathers new behaviours rather than the consequences of the problem in that area Gathers the impact on this lifestyle area and accurately gathers the consequence of the problem in this area of the patient s life e.g. so you told me you are falling behind at work; what is the consequence of your difficulties on your work currently? Impact of the problem on work life Impact of the problem on social life/leisure Impact of the problem on private leisure/hobbies/interests Impact of the problem on family life/important relationships Risk Assessment: Does not undertake risk assessment or assessment is not adequately conducted to ensure patient safety, e.g. areas missed, cues not followed or patient safety not ascertained through funnelling when appropriate. Apologies or euphemises when asking the questions Risk assessment area undertaken with some competency e.g. does not use a bridging statement to move onto phase 2 of information gathering, does not fully summarise at the end, risk assessment is applied in a dogmatic style and/or without common factor skills or poorly phrased/leading questions. Risk is introduced by means of a bridging statement to move from impact onto phase 2 of information gathering. A comprehensive risk assessment is undertaken with all areas fully covered; patient cues are followed and appropriately funnelled as necessary. Patient safety is ascertained. A full summary of risk appropriate to the level of the patient is given at the end. Suicide current (thoughts, plans, actions, protective factors) Suicide past (thoughts, plans, actions) Self-harm current (thoughts, plans, actions, protective factors) Self-harm past (thoughts, plans, actions) Risk from others (vulnerability) Risk to others Self neglect Dependants Neglect to others Summary at end Marie Chellingsworth, David Richards & Kathryn Rayson (2014). Clinical Education Development & Research (CEDAR). The University of Exeter. 6

7 Routine outcome Measures: Explains the routine outcome measures as a baseline and guides how to complete them. Gives an accurate score per measure and what this means and checks how this fits with how the patient is feeling Does not undertake at least two measures; or poorly e.g. gives wrong score Undertakes GAD-7 and PHQ-9 measures but does not give a full clear rationale or check the score fits with how the patient is currently feeling Explains a clear rationale to the patient about the measures and how each is scored in turn. Feeds back results and level indicated by score one by one and checks each with how the patient is currently feeling. Onset/duration of the current episode Checks if the level of the episode remained the same or got better/worse Checks what the patient feels has made it get better/get worse/remain the same since the onset Asks why seeking help now Asks what expectations for treatment the patient has Checks how the patient would know they were better What goals for treatment do they have Enquires clearly about any previous episodes, the duration and the treatment/what eventually made it better Medication: clearly enquires what medication may have been prescribed and funnels to gather relevant information on what/dose/side effects/how long they have been taking it, benefits etc. Marie Chellingsworth, David Richards & Kathryn Rayson (2014). Clinical Education Development & Research (CEDAR). The University of Exeter. 7

8 Asks about any herbal remedies used for the problem Asks about any over the counter remedies Asks about any other treatments for this episode Enquires about use of alcohol and funnels as appropriate, including ascertaining any change as a result of the problem Enquires about use of caffeine and funnels as appropriate, including ascertaining any change as a result of the problem Asks about use of illicit substances Asks the patient if there is anything else they wish to add that hasn t already been covered Overall score for section /10 = % Marie Chellingsworth, David Richards & Kathryn Rayson (2014). Clinical Education Development & Research (CEDAR). The University of Exeter. 8

9 Problem statement: A collaborative problem statement is created using summaries of information gathered; explaining the rationale for the statement and how it will be used/structured Practitioner seeks patient s view that created statement is accurate and opportunity to revise it given Practitioner checks with the patient that this summarises the problem the patient wishes to work on if they go onto treatment Practitioner uses a bridging statement to move onto information giving section Accurate probable diagnosis given sufficiently to meet competency 0-3 marks Vague or absent problem statement; not in patients own words or practitioner imposed; does not explain a clear rationale or structure; does not offer choice in writing it; gathers new information within the problem statement rather than summarising back e.g. Does not seek patient s view of the statement as accurately summarising a baseline of their difficulties currently e.g. Does not check the statement provides a baseline summary of the problem they would wish to work on if they enter into treatment Does not give the patient information about moving onto information giving e.g. Does not give a probable diagnosis; gives a vague diagnosis e.g. anxiety or gives a wrong diagnosis e.g. gives diagnosis of panic disorder to a social phobia scenario that would initiate the wrong treatment being applied Some evidence of competency 4-6 marks (the worker demonstrates limited skill) Explains the rationale but does not offer choice in completing it or gathers some new information rather than summarising back information gathered; limited use of patients own words or worker imposed e.g. Presents the statement but gives limited opportunity to revise and/or does not check that it accurately summarises a baseline of current difficulties e.g. Imposes view that this is the problem they will work on in treatment Is unclear or vague e.g. we will move on to the next section now e.g. Gives a probable diagnosis but does not give this in a fully competent way or does not give the severity level e.g. from what we have discussed your symptoms are indicative of something like, or sounds like generalised anxiety disorder, I think Sufficient evidence of competency 7-10 marks Explains the problem statement rationale and structure sufficiently. Offers choice in who will write the statement; accurately demonstrates summarising information gathered in the assessment and offering choice in what examples of each aspect to put into the statement; uses the patient s own words in appropriate language e.g. Gives the patient the opportunity to read back the statement/have the statement read back and checks that is gives an accurate baseline of their current difficulties; gives the opportunity to revise the statement e.g. Checks with the patient that this forms a baseline of current difficulties that if they decide to move onto treatment would be the problem that they would like to work on Gives the patient information about the next part of the assessment e.g. What I would like to do now, if ok with you, is to discuss the information we have gathered together today and for me to have the opportunity to tell you about what may be able to help with those difficulties e.g. Gives an accurate probable diagnosis from the symptoms gathered within the assessment e.g. from what we have discussed today and the symptoms you are experiencing, this is indicative of a moderate level of generalised anxiety disorder (GAD) for short). What do you know about.. Marie Chellingsworth, David Richards & Kathryn Rayson (2014). Clinical Education Development & Research (CEDAR). The University of Exeter. 9

10 Checks patient understanding of condition and fills gaps in understanding/gives relevant normalising information Does not give accurate or relevant information about the condition Gives information about the condition which is imposed without checking the patients existing knowledge; or without giving factually accurate normalising information Checks the patient s understanding of the probable diagnosis; fills any gaps or clarifies any misunderstanding the patient may have; gives relevant information e.g. 1 in 4 people will experience this problem at any one time; people experiencing this Introduces the ABC CBT model to the patient and checks patient understanding of CBT, then fills any gaps in understanding e.g. Does not introduce the ABC CBT model or check what the patient knows about CBT already e.g. Explains the model and teaches the patient without then making this specific to their difficulties; limited check of patient understanding; not set in context e.g. Explains the ABC CBT model in the context of the assessment e.g. you may have noticed I asked you about three areas; your physical symptoms ; checks what the patient already knows about CBT and fills any gaps. Explains to the patient the vicious circle maintenance cycle of ABC s and how treatment aims to break into the cycle and checks patient understanding Does not explain the maintenance cycle and/or how to break into this Explains the vicious circle but does not give examples and/or limited check of understanding, or explains this but a closed check of understanding taken e.g. does that make sense Explains the maintenance cycle of the ABCs vicious cycle and how this can be broken into; checks patient understanding by asking the patient to explain this back using their own example etc. Asks the patient if they would like to know about treatment options that could help them with the problem in this way Does not check out before giving information Asks vaguely Clearly checks that the patient would like to hear more about treatment options Discusses relevant treatment option(s) with the patient that are evidence based for that condition Does not give treatment information or information given is incorrect to the disorder Gives limited verbal information about treatment option Clearly discusses treatment option, how it can help with the problem identified and how it is undertaken Explains the way in which the practitioner works in a guided supported way using the intervention and checks patient would like to engage with the treatment/find out more/see them again Does not explain LICBT approach Gives limited information about a LICBT approach and self-help/support Gives clear information about LICBT approach and self-help/support Gives the patient relevant material to take away about the condition and treatment option that is a low-intensity CBT material and gives the patient specific advice on which parts to look at/what to do until the next appointment including any relevant and accurate medication information if applicable Does not give relevant LICBT material or material is not suitable for the presenting problem and/or does not explain what the patient should do until the next appointment Gives the patient relevant LICBT material but does not clearly advise the patient on what parts to look at Gives relevant LICBT material for the presenting problem, explains what the patient should do between assessment and next session which is relevant to the level of severity of the patients symptoms Marie Chellingsworth, David Richards & Kathryn Rayson (2014). Clinical Education Development & Research (CEDAR). The University of Exeter. 10

11 Checks patient understanding of what they will do between sessions Does not check understanding Vaguely checks or uses a closed question only Gets the patient to explain back to check their understanding and clarifies any misunderstandings Books an appointment to see the patient again at a convenient time and offers choice in how they can be seen e.g. face to face or telephone (as appropriate to the condition) Does not book an appointment Books a follow up appointment but without checking the patient wants to be seen again and/or does not offer a choice of contact type Books a follow up appointment, checking that the patient wishes to and offers a choice of how they wish to be seen Overall score for section /10 = % Marie Chellingsworth, David Richards & Kathryn Rayson (2014). Clinical Education Development & Research (CEDAR). The University of Exeter. 11