1

Ability to undertake a comprehensive assessment

Comprehensive assessment competencies are not a ‘stand alone’ description of competencies, and should be read as part of the CAMHS competency framework. Effective delivery of comprehensive assessment competencies depends critically on their integration with:

a) the knowledge and skills encompassed in the domains of “core competences for work with children” and “generic therapeutic competences” b) other areas of skill in assessment and formulation (specifically, risk assessment, assessing the child’s functioning within multiple systems, formulation and giving feedback the results of assessment)

Knowledge of the assessment process

An ability to draw on knowledge that the aim of the assessment process is to create a formulation (including a possible diagnosis) which guides the choice of intervention and aims to improve the quality of life of the child and family.

An ability to draw on knowledge that the initial assessment generates working hypotheses which may need to be updated or corrected in response to obtaining further information during the course of contact with the family.

An ability to draw on knowledge that there are multiple perspectives when assessing a family, and that the child, parents’ and school perspectives on problems and aims for intervention can be significantly different.

An ability to draw on knowledge that the assessment process can in itself alter the views of family members towards a problem (e.g. by drawing attention to the links between historical factors or family stresses and the behaviours of the child).

Knowledge of standardised assessment frameworks

An ability to draw on knowledge of local and national assessment forms including those which can be completed by several different agencies working together (e.g. Integrated Assessment Framework (IAF) (Scotland) and Common Assessment Form (CAF) (England))

Ability to coordinate a multidimensional assessment

An ability to undertake a “multidimensional” assessment of the child or young person which is:

multimethod: including information from interviews, observations, and measures as well as any other methods which seem appropriate.

multisource: including information from the child, family, and school as well as other sources of particular relevance to an individual family.

multilevel: including information about their physical (including sexual), emotional, cognitive, social development, along with cultural and spiritual influences on them and their family.

2

Ability to identify people and agencies who need to be included in the assessment

An ability to identify and involve the individuals and agencies who constitute the child/young person’s network of carers, including:

identifying the primary carers (e.g. parents, foster parents, residential childcare staff)

identifying who has parental rights and responsibilities (e.g. parent, family member, social work department)

identifying the professionals and agencies involved with the child/young person (e.g. social work, youth justice)

Ability to focus assessment

An ability to develop initial hypotheses on the basis of information gleaned from the referral, and an ability to use these to plan the assessment

where appropriate, an ability to obtain information from agencies involved with the child prior to an initial appointment in order to determine agency roles and help plan further assessment.

An ability to adapt assessments in response to information that emerges and which appears to be of particular significance:

an ability to draw on knowledge of theory and research around child and family development, mental health, and child protection in order to:

focus on topics which appear to be problematic or of particular significance for the child/young person and family (e.g. taking a more detailed developmental history if there are indicators of developmental delays)

move away from areas which do not appear problematic for, or salient to, the child/young person and family

Ability to engage the young person and their family in the assessment process

An ability to identify (with the family/young person/carer) who should attend assessment sessions.

An ability to explore the family’s expectations of their involvement with CAMHS and to identify any concerns they may have about engaging with services.

An ability to discuss confidentiality and its limits (e.g. the potential for child protection information which emerges to be shared with other agencies)

An ability to explain the structure of the assessment and the areas that it will cover.

An ability to explain the relevance of particular areas of the assessment (e.g. the importance of gathering information about family history).

An ability to respond non-judgmentally to information which emerges during the assessment

An ability to balance problem-focussed questioning with questions that elicit areas of strength and resilience in the family e.g.:

attending to the potential for the language used in assessment to convey a negative connotation, and making appropriate adjustments to counter this (e.g. describing a task as a challenge rather than difficult)

helping the child/young person and family to portray a balanced view of themselves rather than feeling defined by their problems

recognising the potential impact on engagement of “relentless” questioning of problems and difficulties

3

Ability to adapt the assessment to match the abilities and capacities of the family

An ability to tailor the language used to match the abilities and capacities of the child and their family

An ability to engage families with physical and sensory impairment (for example by offering them a choice in assessment venue, or altering the pace and content of the session)

An ability to make use of interpreters when working with families who do not speak the same language as the interviewer.

Ability to assess risk of harm*

Ability to assess risk of harm to self and others

Ability to identify child protection concerns *Described in detail under ‘ability to recognise and respond to concerns about child protection’ and ‘risk assessment and management’

Ability to take a history

An ability to make appropriate use of basic interview techniques (e.g. appropriate range of questioning formats, facilitation, empathy, clarification, and summary statements)

An ability consistently to obtain the views of all the members of the family

An ability to elicit specific detailed and concrete examples of behaviour when assessing and exploring the concerns of family members

Problem history

An ability to identify and explore the behaviours/symptoms/risks that are causing concern to the child/young person and their family, including:

emotional symptoms (including their somatic expressions and any self-harming behaviours)

conduct problems (including harm to others)

developmental delays

relationship difficulties

An ability to help the child and family elaborate the details of problems that concern them including the frequency, duration and intensity of problems.

An ability to analyse the function of specific problematic behaviours by identifying:

the settings in which the problematic behaviours or symptoms manifest.(including the people who are present, and specific details of places and times)

the situations or events which occur immediately before the behaviour, and which appear to trigger it.

the consequences that immediately follow the behaviour (such as the reactions of the parents).

An ability to assess the broader impact of symptoms or problems including:

the degree of social impairment

the degree of distress for the child

the degree of disruption to others.

4

An ability to assess the child/young person’s current functioning

An ability to assess the child/ young person’s use of drugs and alcohol.

An ability to identify the child/young person’s current and past contact with legal services

An ability to assess the family’s previous attempts to solve the problems or manage symptoms (including any previous contacts with services).

An ability to identify the family and young person’s explanations of how behaviours/symptoms have developed.

Developmental history

An ability to obtain information on the child’s development, including both strengths and interests as well as any delayed or unexpected developmental processes.

An ability to undertake a detailed developmental assessment across biological, cognitive, communicative, emotional and social domains, including for example:

the pregnancy and birth

developmental milestones

the child’s reactions to past separations from caregivers

the child’s temperament, concentration and activity levels

the child’s sleep, eating and toileting history

the child’s play, communication and social skills

Medical history

An ability to elicit details of the child/young person’s physical health history, including:

immunisations, infections, allergies, illnesses, operations.

prescribed and non-prescribed medication

fits/faints, loss of consciousness, head injury

hearing and vision problems

contact with hospitals and specialist child health services.

Family history

An ability to identify areas of resilience within the family, as well as any stresses that may contribute to the problem presentation, or to difficulties in the relationships between parent and child or within the family .

An ability to draw a family tree and obtain demographic details about each family member

An ability to ask about family relationships, extended family, social networks and social support

An ability to ask about both recent and past transitions experienced by the family (e.g. marriage, divorce, loss of family members, new additions to the family).

An ability to ask parents about their own history, including:

their own experience of being parented

school and employment

stressful life events, loss, trauma, neglect or abandonment

mental ill health, learning difficulties, drugs and alcohol

5

Nursery and school history

An ability to obtain details of the strengths and interests shown by the child/young person within the school system as well as any difficulties.

An ability to obtain a comprehensive school history from the child, parent, and from teachers, including:

pattern of attendance including information on absences from school

pattern of contacts with school professionals such as teachers, educational psychologists, classroom assistants, special educational needs assistants

academic ability and achievement

pattern of social relationships, play, and any experiences of bullying

emotional/behavioural, concentration or social difficulties displayed in the class or playground.

Ability to assess the family’s cultural and social context Social

An ability to draw on knowledge of the incidence and prevalence of mental health concerns across different cultures/ethnicities/social classes

An ability to ask about potential protective factors in the family’s social environment e.g. social support, proximity to extended family or access to community resources.

An ability to ask about any potential stresses in the family’s physical or social environment (e.g. overcrowding, poor housing, neighbourhood harassment, problems with gangs).

An ability to ask about the child/young person’s membership of peer groups (e.g. friendship groups, clubs).

An ability to ask about the child/young person’s experience and membership of gangs.

Cultural

An ability to draw on knowledge of the family’s cultural, racial and religious background when carrying out an assessment of the family’s behaviours, beliefs, and the potential impact of this perspective on their views of problems.

An ability to understand the cultural influences on gender roles, parenting practices, and family values.

An ability to identify the limits of ones own cultural understanding.

An ability to seek out further information about the family’s religious, racial and cultural background from the family and other sources.

6

Ability to make use of observation of the child, and of interactions between the child and their carers/family during assessment

Knowledge

An ability to draw on relevant knowledge to help structure observations:

knowledge of the usual trajectories of child development

knowledge of common neurodevelopmental conditions and mental health difficulties .

knowledge of theories relevant to understanding the child’s interactions with caregivers (e.g. attachment theory)

Observation of the child/young person

An ability to observe the child in relation to domains which include:

physical appearance

levels of activity and attention

quality of social interactions and communication

emotional state

complexity of language, drawings, imaginative play

play themes

An ability to observe and consider the impact of the assessment situation on the child’s presentation and behaviour when evaluating the validity and generalisability of the observations.

Observation of the interactions between child/young person, carer, and family

An ability to observe the interactions between the child and caregiver (e.g. during play and interview sessions, and during separations and reunions that take place in the waiting room).

An ability to observe how family members interact with each other, including:

the degree of sensitivity and warmth shown by family members to each other.

the degree of criticism shown by family members.

the ways in which parents monitor their child and set limits, and the ways in which the child reacts to limit setting.

whether the child’s behaviours appear to be reinforced by other family members.

whether there are particular “alignments” or hierarchies within the family.

the language family members use to describe one another (i.e. as an indicator of their attitudes and feelings towards each other)

An ability to include knowledge of the family’s social and cultural background in any consideration of family interaction patterns.

Ability to draw on information obtained from other agencies

An ability to identify any agencies and/or key professionals currently or previously involved with the child and family.

An ability to obtain consent from the family prior to seeking information from an agency

an ability to draw on knowledge of local policies on confidentiality and information sharing when obtaining (and sharing) information about the child and their family

An ability to obtain relevant records from involved agencies and identify and draw on information likely to be relevant to the present referral.

7

Ability to undertake separate (individual) sessions with the child/young person

An ability to conduct assessment sessions in which the child is seen alone, including an ability to discuss with the child:

the reasons for them being seen alone

confidentiality and its limits

An ability to take the child’s developmental level into account when deciding on the session format (e.g. whether the session will be playbased or centred around directed questioning and worksheets).

An ability to show sensitivity to the inevitable power differential between the interviewer and child and attempt to address it, for example by:.

providing them with information on the assessment session and by giving them some choice of activities.

emphasising that their views and questions are important and useful

acknowledging when they have superior knowledge or expertise (e.g. in relation to a particular activity or hobby)

An ability to tailor the language used to match the child/young person’s developmental level.

An ability to develop a sense of the child’s view of their world by taking into account what they say, draw, and produce during play.

An ability to ask the child about their:

strengths, interests and aspirations at home and at school.

friends and relationships

current and past life situation

perception of any difficulties, including related physical symptoms, cognitions and feelings.

An ability to ask the child about their aims for any potential intervention work.

An ability to encourage the child to ask questions, and talk about any worries that they have about engaging with the CAMHS service.

Sources/References Brent, D, A., Poling, K.L.S.W (1997) Cognitive Therapy Treatment Manual for Depressed and Suicidal Youth. Star Center Publications. Carr, A (2006) The Handbook of Child and Adolescent Clinical Psychology: A Contextual Approach (Second Edition) London: Routledge. Children’s Workforce Development Council (2010) The Common Core of Skills and Knowledge: At the Heart of What You Do Clarke, Lewinsohn, Hops (1990) Leader’s Manual for Adolescent Groups Adolescent Coping with Depression Course. Goodman, R., & Scott, S (2005) Child Psychiatry (Second Edition) Blackwell HeadsUpScotland (2006). New-to-CAMHS Teaching Package HeadsUpScotland: National Project for Children and Young people’s Mental Health: Scotland

8

March, J.S., & Mulle, K. (1998) OCD in Children and Adolescents: A CognitiveBehavioural Treatment Manual. The Guilford Press Nixon, B. (2011). NCSS National Workforce Programme. Essential Capabilities for Effective Emotional and Mental Health Support. Rutter, M., & Taylor, E. (2002) Child and Adolescent Psychiatry (Fourth Edition). Oxford: Blackwell. Skills for Health Core Functions Child and Adolescent Mental Health Services Tiers 3, 4 Werry Centre (2009) Real Skills Plus: A Competency Framework for the Infant, Child and Youth Mental Health and Alcohol and other Drug Workforce Wilkinson, I (1993) Child and Family Assessment: Clinical Guidelines for Practioners (Second Edition) London: Routledge.

1

Clinical risk assessment and management

Competences associated with the assessment of clinical risk are not ‘stand alone’ competencies and should be read as part of the CAMHS competency framework. Effective delivery of competences associated with the assessment of clinical risk depends on their integration with the knowledge and skills set out in the core competency and generic therapeutic competency columns as well as being dependent on comprehensive assessment skills. Risks related to harm from others are described in the child protection section of the competency framework

Knowledge of policies and legislation

An ability to draw on knowledge of national and local strategies standards, policies and procedures regarding clinical risk assessment and risk management.

An ability to draw on knowledge of national and local child protection standards, policies and procedures

An ability to draw on knowledge of the principles of the relevant mental health Acts (e.g. Mental Health and Treatment Act/ Mental Heath Act, Mental Capacity Act)

An ability to draw on knowledge of local policies on confidentiality and information sharing.

An ability to draw on knowledge of the statutory responsibilities of adults (e.g. parents, carers, school staff) to keep children and young people safe from harm)

Knowledge of risks

An ability to draw on knowledge of the different forms of clinical risk routinely assessed for in clinical practice, including:

risk of harm to self:

suicide risk

self-harm without apparent suicidal intent e.g.: deliberate self-poisoning or self-injury, self-harm related to eating disorders or substance abuse, impulsive behaviour, sexual behaviour that puts the individual at risk,

risk of self-neglect

risk of harm to others (e.g. violent, and challenging behaviour)

Knowledge of the risk assessment and management process

An ability to draw on knowledge that the aim of the risk assessment is to develop a formulation and management plan which improves the quality of life of the child and family, and prevents or minimises the risk of negative events or harm.

An ability to draw on knowledge of the benefit of a structured approach to risk assessment which combines clinical and actuarial information so that systemisation and clinical flexibility are included.

An ability to draw on knowledge of the limitations of assessing risk and making predictions in relation to an individual because of the multiple and interrelated factors underlying their behaviour

An ability to draw on knowledge that the assessment of risk may need to be an ongoing process.

2

An ability to draw on knowledge of the main risk factors for self-harm, self-neglect, and harm to others

An ability to draw on knowledge that there are different types of risk factor which can be:

static and unchangeable historical events (e.g. a history of child abuse).

dynamic but chronic, with only slow change over time (e.g. social deprivation).

dynamic and acute, and can change rapidly (e.g. access to lethal weapons, or conflict with parents and/or peers).

An ability to draw on knowledge that risk assessment tools may be a useful part of risk assessment.

An ability to draw on knowledge of the benefits, limitations and training requirements of risk assessment tools or measures.

An ability to draw on knowledge that there are different stages and forms of risk assessment which may include:

identification of risks during an initial assessment

an in-depth structured risk assessment which includes a systematic evaluation of known risk factors.

a highly specialised structured assessment of risk of violence to others (usually conducted in a forensic service, and which may include the use of specialised risk assessment tools)

An ability to draw on knowledge that the different stages and forms of risk assessment can be carried out by different clinicians and agencies.

Skills in Risk Assessment and Management Assessment of clinical risk

In the context of conducting a comprehensive assessment, an ability to carry out an in-depth structured risk assessment which combines information from clinical interviews, measures, observations and other agencies, comprising:

the development of a good working alliance with the child/young person and family and other significant members of the network.

a systematic assessment of the demographic, psychological, social and historical factors known to be risk factors for self harm, self neglect or harm to others

an ability to identify the child/young person and family’s view of their experience, including their view of possible trigger factors to harmful events, and ideas about interventions or changes in their environment that might be helpful in reducing the risk of future harm

an ability to consider how the child/young person’s developmental stage may affect their perception, understanding and behaviours in relation to risk.

an ability to identify the extent to which the adults involved in the child’s care (e.g. parents/ carers, school staff) are able to assess and manage risks).

An ability to integrate risk assessment with knowledge of the individual child and family and their social context, including their strengths and any resilience factors

An ability to conduct a risk assessment to gauge:

how likely it is that a harmful/negative event will occur.

the types of harmful/negative events

how soon a harmful/negative event is expected to occur.

how severe the outcome will be if the harmful/negative event does occur.

3

Ability to develop a risk management plan

An ability to develop a risk formulation which estimates the risk of harm by:

identifying factors which are likely to increase risk (including predisposing, perpetuating and precipitating factors)

identifying factors which are likely to decrease risk (i.e. protective factors)

An ability to create a risk management plan, in collaboration with the child and family, which:

is closely linked to the risk formulation.

takes into account the views of the child and family.

identifies the actions to be taken by the child and family and relevant services, should there be an acute increase in risk factors and/or the family perceives itself to be in crisis.

explicitly weighs up the potential benefits and harms of choosing one action or intervention over another.

details interventions or supports that reduce or eliminate risk factors for the harmful/negative event(s).

details interventions or supports that encourage the child/young person’s strengths and resilience factors.

manages any tensions arising from restrictions the plan places on the lifestyle of the child/young person or family,

An ability to identify when it is appropriate to employ interventions that involve an element of risk (usually because the potential positive benefits outweigh the risk).

An ability to use the risk formulation to judge whether and when to schedule a reassessment with the child and family.

An ability to communicate the risk management plan to children and families, including information on the potential benefits and risks of a decision, and the reasons for a particular plan.

Equality and Diversity

An ability to consider whether any assumptions or stereotypes about particular demographic groups (rather than knowledge of researched risk factors) lead to underestimation or over-estimation of actual risk.

Interagency working

An ability to collaborate with all potentially relevant agencies when undertaking a risk assessment

An ability to ensure that there is timely communication with all agencies involved in the case, both verbally and in writing.

An ability to communicate the risk management plan to other agencies including information on the potential benefits and risks of a decision, and the reasons for a particular plan.

4

An ability to maintain a clear and detailed record of assessments and of decisions regarding plans for managing risk, in line with local protocols for recording clinical information

an ability to identify and record the actions individuals within each agency will be undertaking

An ability to escalate concerns (within own or other agencies) when the implementation of the risk management plan is problematic.

An ability to refer to, and to work with, more specialised agencies (e.g. inpatient units or forensic teams) in line with local referral protocols.

Ability to seek advice and supervision

An ability to recognise the limits of one’s own expertise and to seek advice from appropriate individuals e.g.:

supervisors and/or other members of the clinical team.

specialist forensic teams (e.g. where there are threat of serious violence).

specialist self-harm teams

Caldicott Guardian (regarding complex confidentiality issues).

social workers (e.g. where there are possible child protection issues)

Sources/References Brent, D, A., Poling, K.L.S.W (1997) Cognitive Therapy Treatment Manual for Depressed and Suicidal Youth. Star Center Publications. Carr, A (2006) The Handbook of Child and Adolescent Clinicial Psychology: A Contextual Approach (Second Edition) London: Routledge. Department of Health (2007) Best Practice in Managing Risk: Principles and evidence for best practice in the assessment and management of risk to self and others in mental health services Doyle, M. & Dolan, M. (2002) Violence risk assessment: combining actuarial and clinical information to structure clinical judgements for the formulation and management of risk. Journal of Psychiatric and Mental Health Nursing, 9, 649–657. HeadsUpScotland (2006). New-to-CAMHS Teaching Package HeadsUpScotland: National Project for Children and Young people’s Mental Health: Scotland Mental Health Division Scottish Government (2010) Consultation on Responding to Self-Harm in Scotland National Institute for Clinical Excellence (2004) Self harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. Risk Management Authority (2007) Risk Assessment Tools Evaluation Directory

5

Royal College of Psychiatrists (2008) Rethinking risk to others in mental health services: Final report of a scoping group. Rutter, M., & Taylor, E. (2002). Child and Adolescent Psychiatry (Fourth Edition) Oxford: Blackwell Science. Subotsky, F. (2003) Clinical Risk Management and Child Mental Health. Advances in Psychiatric Treatment, 9, 319-326

Ability to assess the child’s functioning within multiple systems

Knowledge of the relevance of systems and the basic principles of social constructionism

An ability to draw on knowledge that psychological problems and emotional distress are usually better understood by taking into account the “systems” in which the child and their family are located

An ability to draw on knowledge that the patterns of relationships within systems may play a significant role in shaping and maintaining psychological problems

An ability to draw on knowledge of the basic principles of social constructionism:

that people understand themselves and the world around them through a process of social construction

that meaning is generated through social interactions, and the language used in different social interactions

that power relationships (e.g. an individual’s position in a system) and different cultural contexts (such as gender, religion, age, ethnicity) have an important influence of the development of meaning, relationships, feelings and behaviour

Assessment competencies are not a ‘stand alone’ description of competencies, and should be read as part of the CAMHS competency framework. Effective delivery of assessment competencies depends critically on their integration with the knowledge and skills set out in the core competency and generic therapeutic competency columns

The competences set out in this section describe basic systemic assessment skills that should be held in mind by clinicians from all therapeutic backgrounds. A substantial body of systemic theory and research informs the practice of more specialised family therapy assessments and interventions. These are described elsewhere in the CAMHS map and in the framework for Systemic Psychotherapy (available at: www.ucl.ac.uk/clinical-psychology/CORE/competence_frameworks.htm).

Assessment

An ability to draw on knowledge that the multiple contexts in which the child/young person and their family is located need to be considered taken in any assessment, and that these will include:

family, peer group, and other significant relationships

school or place of employment

social and community setting

professional network(s) involved with them

their cultural setting

their socio-political environment

an ability to draw on knowledge that these different contexts are connected and are likely to interact

An ability to draw on knowledge of the contexts/environments of which the child/young person is a part and which may be relevant to their presentation (e.g. the beliefs and practices of a particular school, or the beliefs associated with their peer group).

An ability to gather further information from relevant individuals in the system to help determine:

whether and how to proceed with a CAMHS intervention

who to involve

when and where to meet

An ability to gather and clarify information from relevant members of the system, including information about the decision to seek help and any concerns/dilemmas about engaging with CAMHS.

An ability to use the assessment process to engage with relevant members of the system including, where appropriate, the wider team, referring agencies, education services and support services.

An ability to identify in conjunction with the child/young person, family and the wider system:

perceived problem areas and the beliefs concerning them

the potential strengths of the child/young person (and the wider system) which may support therapeutic change

the solutions that have been tried or have been thought about

the achievements in the child/young person’s life

An ability to draw on knowledge that different members of the system will describe the child/young person differently as:

there are always multiple perspectives and descriptions of any interaction/ relationship.

the child/young person’s behaviour is influenced by the different set of contextual factors present in each setting.

Ability to formulate the child’s problem

Formulation competencies are not a ‘stand alone’ description of competencies, and should be read as part of the CAMHS competency framework.

Effective delivery of formulation competencies depends critically on their integration with the knowledge and skills set out in the core competency column, generic therapeutic competency column as well as assessment activities set out in the assessment column

Knowledge

An ability to draw on knowledge that the aim of a formulation is to explain the development and maintenance of the child’s difficulties, and that formulations:

are tailored to the individual child and their family

comprise a set of hypotheses or plausible explanations which draw on theory and research to explain the details of the clinical presentation obtained through an assessment

An ability to draw on knowledge that models of formulation include:

“generic” formulations, which draw on biological, psychological and social theory and research

“model-specific” formulations, which conceptualise a presentation in relation to a specific therapeutic model (e.g. psychodynamic, cognitive- behavioural or, systemic models) and which usually overlap the generic formulation

An ability to draw on knowledge that different therapeutic models vary in the extent to which the formulation is explicitly shared and constructed with the family

An ability to draw on knowledge that formulations should be reviewed and revised as further information emerges during ongoing contact with the child and family.

An ability to draw on knowledge that a generic formulation usually includes consideration of:

risk factors that might predispose to the development of psychological problems (e.g. low IQ, insecure attachment to caregiver, caregiver marital difficulties).

precipitating factors that might trigger the onset or exacerbation of difficulties (e.g. acute life stresses such as illnesses or bereavements, or developmental transitions such as starting school or the birth of a new child in the family).

maintaining factors that might perpetuate psychological problems once they have developed (e.g. poor coping strategies, inadvertent reinforcement of problem behaviours).

protective factors that might prevent a problem from becoming worse or may be enlisted to ameliorate the presenting problems (e.g. high IQ, good family communication, high parental self-efficacy).

An ability to draw on knowledge that one of the main functions of a formulation is to help guide the development of an intervention plan.

an ability to draw on knowledge that the intervention plan usually aims to reduce the effects of identified maintaining factors, and to promote protective factors.

Ability to construct a formulation:

An ability to generate a comprehensive list of all the presenting problems.

An ability to appraise and resolve any apparently contradictory reports of a problem, e.g.:

when informants focus on different aspects of a problem or situation, or represent it differently, e.g.:

self-reports of emotional difficulties made by child and adolescents (which are often higher than those made by parents or teachers).

parent or teacher ratings of conduct problems (which are often higher than those made by the child/young person)

when a young person’s behaviour differs depending on the context .

An ability to understand the child’s inner world, affective and interpersonal experiences and frame them in a developmental and contextual perspective.

An ability to evaluate and integrate assessment information obtained from multiple sources and methods, and to identify salient factors which significantly influence the development of the presenting problem(s), drawing on sources of information such as:

the child and family’s perception of significant factors and their explanation for the presenting problem(s).

theory and research that identifies biological, developmental, psychological and social factors associated with an increased risk of mental health difficulties.

theory and research that identifies biological, psychological and social factors associated with mental well-being (e.g. secure attachment with primary caregiver, good physical health, good parental adjustment, good social support network).

knowledge of normal child development and developmental processes (in order to identify delays in the child’s development).

associations between the onset, intensity and frequency of presenting problem(s) and the presence of factors in the child’s psychosocial environment (e.g. traumatic life events or parental ill health).

the results of a functional analysis which records the antecedents and consequences of a particular behaviour.

References Butler, G. (1998). Clinical Formulation pp 1-24 in A. S. Bellack., & M. Hersen (Eds.) Comprehensive Clinical Psychology (1-24). Carr, A (2006) The Handbook of Child and Adolescent Clinical Psychology: A Contextual Approach (Second Edition) London: Routledge. Heads Up Scotland New to CAMHS Teaching Package Rutter, M., & Taylor, E. (2002) Child and Adolescent Psychiatry (Fourth Edition). Oxford: Blackwell. Werry Centre (2009) Real Skills Plus: A Competency Framework for the Infant, Child and Youth Mental Health and Alcohol and other Drug Workforce

Ability to feedback the results of the assessment and formulation and agree a treatment plan

Assessment feedback competencies are not a ‘stand alone’ description of competencies, and should be read as part of the CAMHS competency framework.

Effective delivery of assessment feedback competencies depends critically on their integration with the knowledge and skills set out in the core competency and generic therapeutic competency columns as well as the assessment activities set out in the assessment column

Ability to provide feedback on the assessment and formulation Ability to provide information on the assessment and formulation

An ability to discuss with the child/young person and their family/carers how they would like information about the assessment and the formulation to be conveyed:

identifying whether they would like information to be conveyed to the family as a whole, or to parents/carers and the child/young person separately

identifying the most effective methods of conveying information for the family (e.g. verbal, written summaries, diagrams etc).

An ability to outline the presenting problem(s), as seen by different family members.

An ability to maintain an empathic, neutral and non-blaming stance when talking about the presenting problems.

An ability to describe predisposing, precipitating and maintaining factors for the presenting problem(s), explicitly linking this description to information gathered during the assessment

An ability clearly to explain any diagnoses, including information on aetiology, epidemiology and the usual course of the condition.

An ability to discuss protective factors and strengths shown by the child/young person and family/carers.

Ability to adapt feedback

An ability to adapt the pace, amount of information and level of complexity to:

the family’s level of understanding

the family’s emotional readiness to accept the information.

An ability to match feedback to the child/young person’s level of understanding (e.g. by simplifying the way in which concepts are expressed, or by explicitly and frequently checking their understanding).

An ability to adapt written information for younger people or children with a disability (e.g. by using pictures or child-friendly booklets)

Ability to seek the views of the child and their family/carers

An ability to check regularly that the child/young person and family/carers understand what is being said to them, and whether they agree with the information being conveyed.

An ability to ensure that sessions are structured so as to allow time for the family/carers to ask questions or make comments.

An ability to help the child/young person and family/carers feel comfortable and confident to ask questions when they are uncertain or confused (e.g. by responding positively to questions, validating the appropriateness of questions, or actively prompting them to ask questions).

An ability to provide answers to questions in an honest and straightforward manner:

an ability for the therapist to be clear when they need more information in order to answer questions, and to seek this information from an appropriate authority or source.

Ability to work towards and negotiate an agreed formulation

An ability to consider the reasons for any significant differences between the family’s and the clinician’s view of the diagnosis or the formulation, including whether:

information has been clearly explained in a sensitive non-blaming manner that highlights the family’s strengths as well as difficulties.

the links between contextual factors and the child’s behaviour have been made clear.

the family’s reaction to a diagnosis or aspect of a formulation is a normal adjustment reaction to difficult news.

there are factors in the parent/child’s presentation and history that may make it hard for them to accept difficult news or specific aspects of the formulation.

the assessment fully explored the concerns and/or beliefs of the family (e.g. a parent who strongly believes the child has ADHD and so rejects the idea that behavioural difficulties are inadvertently reinforced by parental reactions).

the assessment and formulation has taken into account the social and cultural context and its influence on the family’s belief system.

Ability to plan an intervention that draws on the agreed formulation

An ability to draw on the formulation constructed with the child/young person and family/carers (which includes their ideas about how aspects of themselves, or their environment could change).

Knowledge

An ability to draw on knowledge of research into the efficacy of psychological and pharmacological interventions, and the possible side-effects or negative effects of interventions.

An ability to draw on knowledge of the range of psychological interventions offered within the team and by other statutory and non-statutory agencies.

An ability to draw on knowledge of community resources and projects relevant to the promotion of mental health (e.g. youth clubs, drop-in centres, sports facilities etc).

Ability to identify when a CAMHS intervention is not required and/or not appropriate

An ability to recognise when no further intervention is required, and to discuss the reasons for this with the child and their family, for example:

when the process of assessment has (in itself) enabled the family to resolve the presenting problem

when the assessment process has helped the family resolve their concerns (e.g. when a child’s “problems” are actually recognised to be developmentally appropriate behaviour)

An ability to recognise and discuss with the child and family that (rather than a CAMHS intervention) their needs might be best met by other services (e.g. education, adult mental health, marital counselling)

Ability to identify when the child and family require more specialist assessment (from within the CAMHS team or by other agencies)

An ability to recognise when the child and their family require further, more specialist, assessment in order to determine the most appropriate intervention (e.g. referral for language assessment, cognitive assessment, or motor skills assessment).

Ability to identify potential CAMHS interventions

An ability to draw on the formulation and decisions regarding diagnosis to identify the indicated evidence-based CAMHS interventions.

An ability to draw on the formulation and decisions regarding diagnosis to identify when interagency work is required, including:

work with schools

referral and parallel working, for example:

with adult mental health services

with social work services

with counselling services, community projects etc.

referral to and ongoing communication with the legal system (e.g. the Children’s Reporter System (Scotland) or Youth Justice System (England))

Ability to promote informed choice and agree a plan for intervention

An ability to provide the family with information on the various options for intervention, including information on their likely efficacy

An ability to discuss with the family any negative effects or side-effects of the intervention(s)

An ability to seek the family’s views on each intervention option.

An ability to gauge family members’ motivation and preference for particular intervention options.

An ability to discuss any differences in the intervention preferences of various family members, including those of children and young people.

An ability to discuss whether the family anticipates any difficulties with engaging with an intervention(s), including their attendance at a clinic.

An ability to reach agreement on an appropriate intervention plan

An ability to help the child/young person and family identify goals for the intervention(s)

an ability to identify goals that are shared by all family members, and to identify where family members have different goals in mind

An ability to reach agreement on the sequencing and timing of intervention(s)

An ability to plan the length of the intervention and/or to set a review date

Where an external agency is involved in the intervention plan, an ability:

to draw on knowledge of consent and confidentiality procedures, and to identify when the safeguarding needs of the child/young person take precedence over obtaining parental/carer consent.

to obtain consent to share information with external agencies e.g. school.

to obtain consent to refer to external agencies (e.g. adult mental health, social work).

to discuss with the family options for self-referral or access to community resources (e.g. advisors on employment, housing, benefits, debt, recreational activities, etc).

An ability to include evaluation procedures in the intervention plan, for example:

an ability to record the child/young person and family/carer’s identified goals for an intervention(s), with the aim of evaluating whether they have been met by review dates or at the end of the intervention.

an ability to identify suitable pre- and post-intervention measures and any arrangements required for their administration.

1

Ability to undertake a single-session screening assessment Knowledge of the brief/screening assessment process

An ability to draw on knowledge of the aims of a single-session screening assessment session:

to assess presenting problems and risks of harm

to identify the agency/agencies best placed to meet the needs of the child/young person and their family (i.e. CAMHS, other statutory services or non-statutory organisations or community projects),

to identify whether more comprehensive and/or specialist CAMHS assessments are required

to identify intervention options (if the presenting problems and context are clear, and an evidence based intervention(s) is indicated).

to identify when CAMHS interventions are not required or appropriate

An ability to draw on knowledge that the time constraint inherent in a single-session screening assessment will mean:

that the extent of any risk assessment will be limited.

that because service-users will have little time to build up engagement they may be less likely to disclose sensitive information

that it will be difficult to see the child/young person independently of carers

that direct observations of service users will be restricted to one setting and time and hence have limited generalisability.

that background information is likely to be limited to one agency or individual (e.g. if the referral is from the G.P the assessment will need to proceed without information from the school) .

that a diagnostic assessment of conditions such as neurodevelopmental disorders will not be feasible (because this is dependent on taking a very detailed history and conducting structured developmental assessments).

Knowledge of CAMHS services and external agencies

An ability to draw on knowledge of the services’ inclusion and exclusion criteria

An ability to draw on knowledge of the range of assessments and interventions offered within the team and by other statutory and non-statutory agencies.

an ability to draw on knowledge of community resources and projects relevant to the promotion of mental health (e.g. youth clubs, drop-in centres, sports facilities).

Ability to structure the interview

An ability to develop initial hypotheses on the basis of information gleaned from the referral, and an ability to use these to plan the assessment

An ability to inform service-users that the interview is a single-session screening which aims to discuss their needs and concerns, and the ways in which these can be met

An ability to explain issues relating to confidentiality with service users

An ability to make appropriate use of basic interview techniques (e.g. appropriate range of questioning formats, facilitation, empathy, clarification, and summary statements)

2

An ability to help the child/young person and family identify and discuss:

presenting difficulties

areas of risk which may require further assessment by CAMHS and/or other agencies.

the strengths of the child/young person and parents/carers to aid intervention planning.

the level of family and social support available to the child/young person and family.

significant interpersonal problems (e.g. at school, with peers, or with family)

concerns about the child/ young person’s development

the child/young person and family’s previous experience of CAMHS and other statutory services, and to identify whether this has any implication for their engagement with future support/interventions.

An ability to make use of observations of the child/young person and the interactions between family members to inform the assessment.

An ability to identify any significant areas which need further assessment in order to reach a decision about intervention.

An ability to ensure that at the close of the interview service users are clear about the plan for any future contact with CAMHS and/or the referral process to other agencies.

Ability to adapt the assessment to match the abilities and capacities of the family

An ability to tailor the language used to match the abilities and capacities of the child/young person and their carer/family

An ability to engage families with physical and sensory impairment (for example by offering them a choice in assessment venue, or altering the pace and content of the session)

An ability to make use of interpreters when working with families who do not speak the same language as the interviewer.

Ability to adapt the interview in response to emerging information

An ability to adapt assessments in response to the emergence of significant information

An ability to draw on knowledge of child and family development*, child and adolescent mental health*, and child protection* in order to:

focus on topics which appear to be problematic or of particular significance for the child/young person and family (e.g. taking a more detailed developmental history if there are indicators of developmental delays)

move away from areas which do not appear problematic for, or salient to, the child/young person and family

* competences for these areas are detailed in the core competences column of this framework

Ability to identify tentative hypotheses and goals for intervention

An ability to identify the child/young person and the family’s goals for change.

An ability to develop initial tentative hypotheses (in collaboration with the child/young person and family) which may help to explain the presenting difficulties.

3

Ability to feedback the outcomes of the assessment and agree the next steps with service users

On the basis of the assessment, an ability to identify whether the presenting difficulties map to the inclusion criteria for the CAMHS service.

An ability to give the child/young person and their family clear information about the assessment and intervention options open to them both within and outwith CAMHS.

an ability to discuss assessment and intervention options with the child/young person and their family and to help them identify the options they wish to pursue

Sources/References Children’s Workforce Development Council (2010) The Common Core of Skills and Knowledge: At the Heart of What You Do Choice and Partnership approach: at http://www.camhsnetwork.co.uk/index.htm HeadsUpScotland (2006). New-to-CAMHS Teaching Package HeadsUpScotland: National Project for Children and Young people’s Mental Health: Scotland Skills for Health Core Functions Child and Adolescent Mental Health Services Tiers 3, 4 The Essential Capabilities for Effective Emotional and Mental Health Support (2010) Werry Centre (2009) Real Skills Plus: A Competency Framework for the Infant, Child and Youth Mental Health and Alcohol and other Drug Workforce

1

Ability to co-ordinate casework across different agencies and/or individuals

General principles

An ability to draw on knowledge that a focus on the welfare of the child or young person should be the overarching focus of all intra- and interagency work

An ability to ensure that communication with professionals both within and across agencies is effective by ensuring:

that their perspectives and concerns are listened to

that there is explicit acknowledgement of any areas where perspectives and concerns are held in common, and where there are differences

where differences in perspective or concern are identified, an ability to identify and act on any implications for the delivery of an effective intervention

When working with other agencies, ensuring that the perspectives and concerns of the CAMHS team are listened to

Case management Receiving referrals from other professionals/agencies

An ability to recognise when the referral contains sufficient information to make an informed decision about how to proceed with the identified client (including response to risk and identification of care pathways)

where there is insufficient information to make allocations decisions, an ability to identify the information required and to request this from the referrer and/or partner agencies

An ability to draw on knowledge of local policy and procedure to select the appropriate “pathway” to ensure the case is allocated at an appropriate risk/response level

Where a decision is taken to place a child on a CAMHS waiting list, an ability regularly to monitor risk levels of cases on the list

Competences associated with the coordination of casework are not ‘stand alone’ competencies and should be read as part of the CAMHS competency framework. Similar principles apply when working with fellow-professional from within the CAMHS team, and when working with professionals from other agencies. Effective delivery of these competences depends on their integration with many areas of the framework, but the sections on confidentiality and consent will be especially pertinent.

2

Initial contact phase (initiating cross-agency casework)

An ability to establish which partner agencies are also involved with the child/young person and their family

An ability to establish/clarify the roles/responsibilities of other agencies in relation to the various domains of the child/young person’s life

An ability to discuss issues of consent and confidentiality in relation to the sharing of information across agencies with the child and their family and to secure and record their consent to share information.

An ability to identify and record which service, and which individuals within that service, will carry a “co-ordination” role for the overall plan

An ability to gather relevant information from involved agencies and to enter this into the child/young person’s record

An ability to share relevant information with the appropriate agencies (based on the principle of a “need to know”)

an ability to assess when sharing of information is not necessary and/or when requests for sharing information should be refused

An ability to share assessment information in a manner which supports partner agencies in:

understanding and recognising areas of risk

understanding the implications of information held by CAMHS for their agency and the work in which they are engaged

understanding the potential impact of CAMHS interventions on the child’s functioning, and the ways in which this may manifest in other settings

understanding what it means for the child/young person to have an involvement with the multiple agencies

Where there are indications that agencies may employ different language and definitions from those employed in CAMHS, an ability to clarify this in order to identify:

the young person over whom there are concerns

the reasons for these concerns

the professionals and agencies who are best placed to respond to these concerns

the outcomes which are being sought from any planned response

An ability to draw on knowledge of custom and practise in each agency in order to ensure that there is a clear understanding of the ways in which each agency will respond to events (e.g. their procedures for following-up concerns, or for escalating their response in response to evidence of risk)

An ability to co-ordinate with other agencies using both verbal and written communication, and to agree with them:

the tasks assigned to each agency

the specific areas of responsibility for care and support assumed by each agency, and by individuals within each agency

An ability for all individuals within a CAMHS team to recognise when they are at risk of working beyond the boundaries of their clinical expertise and/or professional reach

Where a common assessment framework is used across agencies, an ability to:

record relevant information in the shared record

make active use of the shared record (to reduce redundancy in the assessment process)

maintain a shared record of current plans, goals and functioning

3

Involving the child/young person and their family

An ability to ensure that the young person and/or family are informed of any interagency discussions and the associated outcomes.

When deemed appropriate, an ability to include the young person or family in any interagency meetings.

An ability to support families in making choices about how they use or engage with the partner agencies involved.

Referring on for parallel work

An ability to draw on knowledge of local referral pathways (i.e. the individuals to approach and the protocols and procedures to be followed)

In relation to any agency to whom children are referred, an ability to draw on knowledge:

of the agency’s reach and responsibilities

of the agency’s culture and practice

of the extent to which the agency shares a common language and definitions to those applied in CAMHS services

An ability to communicate the CAMHS intervention plan, and update other agencies with any changes as the intervention proceeds (including any implications of these changes for the work of other agencies)

An ability to communicate a current understanding of the child/young person’s difficulties, and to ensure that this is updated when additional information emerges.

An ability to maintain a proactive approach to monitoring the activity of other agencies and to challenge them if they do not meet agreed responsibilities

Where appropriate, an ability to act as a conduit for information exchange between agencies

An ability to recognise when effective inter-agency working is compromised and to identify the reasons for this, for example:

institutional/systemic factors (such as power differentials or struggles for dominance of one agency over another)

conflicts of interest

lack of trust between professionals (e.g. where this reflects the ‘legacy’ of previous contacts)

An ability to detect and to manage any problems that arise as a result of differing custom and practice across agencies, particularly where these differences have implications for the management of the case

an ability to identify potential barriers to effective communications, and where possible to develop strategies to overcome them

An ability to identify transitions that have implications for the range of agencies involved (e.g. transition to adult services, moving out of area, change of school) and to plan how these can be managed, to ensure:

continuity of care

the identification of and management of any risks

the identification and engagement of relevant services

An ability to be aware when the child’s needs (in the domains of health, education, physical, emotional, social functioning) are not being met by a CAMHS intervention, and where the involvement of other agencies would be beneficial to the child’s welfare

4

Discharge and monitoring phase

An ability to inform all agencies of the intention to discharge the child from CAMHS

An ability to ensure all partner agencies are aware of current risk levels and have appropriate plans and monitoring in place

An ability to inform partner agencies of the circumstances under which links with CAMHS should be reinstated

An ability to take a proactive stance in relation to monitoring the functioning of the child and their family after discharge has taken place (and to reconnect with them if functioning deteriorates)

An ability to ensure those partner agencies involved have plans for monitoring the wellbeing of the young person

Sources

NHS Quality Improvement Scotland (2010) Draft Standards for Integrated Care Pathways for Child and Adolescent Mental Health Services The Scottish Government (2011) Getting it Right for Every Child

Ability to conduct a Mental State Examination

Competences for the Mental State Examination are not a ‘stand alone’ description of competencies, and should be read as part of the CAMHS competency framework. Effective delivery of mental state examination competencies depends critically on their integration with the knowledge and skills set out in the core competency column (in particular knowledge of mental health problems, and child and adolescent development), the generic therapeutic competency column as well as comprehensive assessment activities set out in the assessment column

Knowledge of the aims of the Mental State Examination (MSE)

An ability to draw on knowledge that the MSE is an ordered summary of the clinician’s observations of the child/young person’s mental experiences and behaviour at the time of interview

An ability to draw on knowledge that the purpose of a MSE is to identify evidence for and against a diagnosis of mental illness, and (if present) to record the current type and severity of symptoms

An ability to draw on knowledge that the MSE should be recorded and presented in a standardised format.

An ability to draw on detailed observations of the child/young person to inform judgements of their mental state, including observations of:

their appearance (e.g. standard and style of clothing, physical condition, etc.)

their behaviour (e.g. tearfulness, restlessness, distractible, socially appropriate, etc)

their form of speech (e.g. quality, rate, volume, rhythm, and use of language, etc)

An ability to draw on knowledge of the child/young person’s developmental stage and hence to tailor questions to their likely level of understanding.

An ability to draw on knowledge that children/young people vary in their ability to introspect and assess their thoughts, perceptions and feelings.

An ability to structure the interview by asking general questions about potential problem areas (such as depressed mood), before asking specific follow-up questions which enquire about potential symptoms.

An ability to respond in an empathic manner when asking about the child/young person’s internal experiences (i.e. their feelings, thoughts, and perceptions).

An ability to ask questions about symptoms which the child/young person may feel uncomfortable about in a frank, straightforward and unembarrassed manner.

An ability to record the child/young person’s description of significant symptoms in their words.

An ability to avoid colluding with any delusional beliefs by making it clear to the child/young person that the clinician regards the beliefs as a symptom of mental illness.

an ability to avoid being drawn into arguments about the truth of a delusion.

Ability to enquire into specific symptom areas

An ability to ask about the symptoms characteristic of both uni-polar and bi-polar depression.

an ability to notice and enquire about any discrepancy between the child/young person’s report of mood and objective signs of mood disturbance.

An ability to ask about thoughts of self-harm.

an ability to assess suicidal ideation.

an ability to assess suicidal intent.

an ability to ask about self-injurious behaviour.

An ability to ask about symptoms characteristic of the different anxiety disorders.

an ability to ask about the nature, severity and precipitants of any symptoms as well as their impact on the child/young person’s functioning.

An ability to ask about abnormal perceptions.

an ability to clarify whether any abnormal perceptions are altered perceptions or false perceptions.

an ability to explore evidence for the different forms of hallucination.

An ability to elicit abnormal beliefs.

An ability to interpret the nature of abnormal beliefs in the context of the child/young person’s developmental stage, family, social and cultural context.

an ability to distinguish between primary delusions, secondary delusions, over-valued ideas and culturally sanctioned beliefs.

An ability to assess cognitive functioning.

an ability to assess level of consciousness

an ability to assess the child/young person’s orientation to time, place and person.

an ability to carry out basic memory tests.

an ability to estimate the child/young person’s intellectual level, based on their level of vocabulary and comprehension in the interview, and their educational achievements.

an ability to conduct or refer for formal cognitive assessment if there are indications of a learning disability.

An ability to assess the child/young person’s insight into their difficulties.

an ability to assess attitude towards any illness

an ability to assess attitude towards treatment

Sources: Semple, D. and Smyth, R.(2009) Ovid Online: Oxford Handbook of Psychiatry (Second edition) at www.ovid.com

Ability to undertake a diagnostic assessment

Competences associated with diagnostic assessment are not ‘stand alone’ competencies, and this section should be read as part of the CAMHS competency framework. Effective delivery of competencies associated with diagnostic assessment depends on their integration with the knowledge and skills set out in the core competency column (particularly knowledge of mental health problems and child and family development), the generic therapeutic competency column, as well as being dependent on comprehensive assessment and feedback skills.

Ability to draw on knowledge of diagnostic classification schemes

An ability to draw on knowledge of mental health conditions*

An ability to draw on knowledge that psychiatric diagnoses are usually descriptive rather than explanatory.

An ability to draw on knowledge of categorical and dimensional systems of ordering information.

An ability to draw on knowledge of the principles of a multiaxial framework.

An ability to draw on knowledge of the classification scheme being applied (i.e. the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD))

an ability to draw on knowledge of the nature, pattern, severity, timing and duration of signs and symptoms, and level of impact (social impairment, distress for the child/young person and disruption for others) required to make a diagnosis.

an ability to draw on knowledge of the different diagnostic schemes and how they are based on a hierarchical classification system, with some conditions seen as being more fundamental.

an ability to draw on knowledge of the ways in which different diagnostic classification schemes manage the classification of comorbidity.

An ability to draw on knowledge of the research findings used to validate diagnostic categories which relate to children and young people.

An ability to draw on knowledge of the ways in which diagnosis can be used to guide evidence-based treatment * competences relating to this area are detailed in the relevant section of the competence framework

Ability to carry out a diagnostic assessment

An ability to draw on knowledge of local and national standards and guidelines relating to the assessment of specific mental health and neurodevelopmental conditions experienced by children/young people.

An ability to carry out a comprehensive assessment that combines information from*:

interviews with multiple informants

observations of the child/young person in different settings

measures

information from other agencies

where appropriate a formal mental state examination* and physical examination

An ability to draw on knowledge of structured and semi-structured interviews and observation schedules which may be helpful to the assessment of the condition(s) or the child/young person’s presentation.

with appropriate training, an ability to administer research instruments used to assist in the clinical diagnosis (e.g. the Anxiety Disorders Interview Schedule (ADIS), Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule (ADOS)).

Where appropriate, an ability to administer and interpret structured and semi-structured interviews.

An ability to assess for co-morbid conditions.

An ability to recognise when the child/young person requires additional assessment (e.g. weight measurements to monitor growth or eating problems, medical examinations for endocrine problems, congenital syndromes etc).

An ability to aggregate assessment information in order to decide whether the child/young person meets the diagnostic criteria for a particular condition(s).

an ability to review the evidence for and against a particular diagnosis(es)

an ability to recognise presentations where the child/young person may have elements of several conditions, but does not meet the full diagnostic criteria for any of them.

An ability to incorporate the diagnosis into a formulation of the child/young person and family’s strengths and difficulties. *competences relating to this area are detailed in the relevant section of the competence framework

Ability to feedback diagnostic information

An ability to provide the child/young person and family with information on the diagnosis and how it was reached.

An ability to provide the child/young person and family with developmentally appropriate information on the condition and intervention options.

Ability to record diagnostic information.

An ability to record the diagnosis in relevant systems (notes, letters, electronic systems etc)

An ability to record the assessment information leading to the diagnosis.

An ability to record the information that was shared with the family, and other agencies

Ability to review the diagnosis

An ability regularly to review the diagnosis in order to take account of the child/young person’s development and response to intervention.

References: American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th edition. American Psychiatric Association, Washington D.C. Goodman, R., & Scott, S. (2005). Child Psychiatry. Second Edition. Blackwell, Oxford. Lord, C., Rutter, M. & LeCouteur, A. (1994). Autism Diagnostic Interview-revised: a revised version of a diagnostic interview for care-givers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659-685. Rutter, M., & Taylor, E. (2002). Clinical Assessment and Diagnostic Formulation. pp 18-31 in Child and Adolescent Psychiatry: Fourth Edition (eds M.Rutter, & E. Taylor). Blackwell Science, Oxford. Silverman, W.K & Nelles, W.B. (1988). The Anxiety Disorders Interview Schedule for Children. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 772-778. Taylor, E., & Rutter, M. (2002). Classification: Conceptual Issues and Substantive Findings. pp 3- 17 in Child and Adolescent Psychiatry: Fourth Edition (eds M.Rutter, & E. Taylor),). Blackwell Science, Oxford. World Health Organisation (1996) Multiaxial classification of child and adolescent psychiatric disorders: The ICD-10 classification of mental and behavioural disorders in children and adolescents. World Health Organization, Geneva.

1

Behavioural Observation Knowledge

An ability to draw on knowledge of the primary processes involved in shaping behaviour and learning including:

learning theory principles (e.g. reinforcement (positive and negative), contingency, stimulus control, punishment)

social learning theory principles (e.g. imitation/modelling, environmental influence, vicarious learning, predictive function and self efficacy)

Planning the observation

An ability to identify when behavioural observations can make a contribution to the process of assessment and formulation (usually when behavioural issues are relevant to, or are the focus of, the intervention)

An ability to identify a specific focus for observation (for example a particular behaviour, interaction or event)

An ability to draw on knowledge of the main strategies used in behavioural observations in order to select the most appropriate method

An ability to draw on information from the assessment to establish when, where and for how long observations should take place (e.g. drawing on information about the settings or circumstances are most likely to elicit particular behaviours, or the frequency of a specific behaviour)

An ability to reflect on one’s own perceptual or attitudinal biases and maintain an objective, open minded stance

An ability to draw on knowledge of the ways in which subjective judgments can introduce bias (e.g. where the meaning of a behaviour is ambiguous, or where previous observations of the child in other contexts influence the observer’s judgments)

An ability to obtain consent from the child and/or their carer(s) to carry out the observation

An ability to gain consent from individuals or services who may provide the location for the observation

Gathering data

An ability to draw on knowledge of the main strategies used for naturalistic behavioural observation (including their strengths and weaknesses)

An ability to engage family members, teachers and other observers in the process of collecting and maintaining diary records

An ability to explain the rationale for, and procedures used in, behavioural observation (i.e. the need to gather accurate information about a behaviour in order to plan the intervention)

An ability to make use of diary records (a chronological record of behaviour made after the behaviour occurs, or a way of tracking the child’s development over time)

An ability to draw on knowledge of the potential limitations of diary records (e.g. consistency and accuracy of recording, observer bias, the risk that unstructured recording will result in extraneous detail)

An ability to make use of a “running record” (a sequential record maintained over a given time, made while the behaviour is occurring and which identifies the circumstances surrounding particular events or activities)

2

An ability to draw on knowledge of the potential limitations of this strategy (e.g. time, quantity of unstructured and undifferentiated data produced and failure to capture relevant detail)

An ability to make use of time sampling (recording the frequency with which behaviours occur within a given period of time)

An ability to make use of event sampling (recording the frequency of behaviours that occur when a particular event or activity takes place)

an ability to draw on knowledge of the potential limitations of this strategy (e.g. the application to covert behaviours, their inefficacy for behaviours that only occur infrequently)

Across all approaches to observation, an ability accurately to record:

the frequency of target behaviours

the content of target behaviours

environmental factors that may be temporally related to target behaviours

Ability to monitor the child’s environment using an “ABC” chart:

An ability to draw on knowledge of the use an ‘ABC’ chart to monitor the child’s environment and to identify:

Antecedents: setting conditions and specific triggers for the challenging behaviour

Behaviour: a record of target behaviour and any variations in severity and frequency in different settings and contexts

Consequences: what happens after the challenging behaviour, identifying, possible reinforcers (both positive and negative)

An ability to draw up an ABC chart which includes:

a clear operational definition of the behaviours to be observed

any guidance which may be required in order to obtain reliable recordings (e.g. criteria for defining when one incident ends and another begins)

An ability to select the contexts and situations to be monitored, guided by knowledge of the contexts and individuals associated with a greater likelihood of challenging behaviour

An ability to engage other individuals in completing the chart, where required, offering appropriate training and checking inter-rater reliability

Ability to minimise ‘reactance’

An ability to reduce the risk that the process of observation produces significant changes to behaviour:

where the observer is in close proximity to the subject, an ability to maintain an unobtrusive stance and minimise interaction with them

an ability for the observer to locate themselves in a position that minimises their visibility and their impact on the behaviour being observed (e.g by sitting at the back of a classroom)

an ability to discretely redirect children if approached (e.g. to the teacher)

Ability to maintain an accurate record

An ability to include a concise summary of the subject, context and purpose of the observation:

An ability to record the scene at the commencement of recording

An ability to record information in the order it occurred

An ability to structure the recording by time (for example break the description into 30 second segments by recording the passing of each 30 seconds in the margin)

3

An ability to record observations accurately, including:

the exact words spoken, where possible

descriptions of specific behaviours

non-verbal as well as verbal communication

emotional content of behaviour/communication

An ability to identify clearly any inferences or judgements within the description by (for example) using brackets in a transcript

Ability to draw inferences from the observation

An ability to ensure that conclusions about behaviour are based on adequate evidence

An ability to recognise where inferences about the causes of, or relationship between behaviours, are being made and to record this accordingly

An ability to draw on knowledge of cultural differences in the meaning of behaviour and communication when attempting to understand the function of those behaviours

An ability to draw on knowledge of developmental and learning theories to help understand:

how the activities of individuals who are interacting with the target child impact on that child’s behaviour

how the activities of the target child impact on their environment

An ability to include an account of the child’s perspective when interpreting their behaviours or circumstances (e.g. their capacity to understand the impact of their behaviour)

Ability to assess and manage risk

An ability to assess any risk posed to the child or others during the observation and formulate a plan of action with the aim of maintain the child’s safety (e.g. if required, intervening and removing an individual or individuals, recruiting assistance from others present)

Sources Pellegrini, A.D. (2004) Observing children in their natural worlds: a methodological primer. Mahwah, N.J.: Lawrence Erlbaum Associates

1

Ability to undertake structured cognitive, functional, and developmental assessments

Reference/ Source ?

An ability to draw on knowledge of a range of neurodevelopmental disorders and the ways in which these present across the developmental range, including features in the domains of:

cognition

behaviour, and the behavioural “phenotypes” associated with neurodevelopmental presentations

emotion

social functioning

An ability to draw on knowledge of current literature relevant to cognitive testing and underlying cognitive models, and its relevance for test design and interpretation.

Pre-assessment (post referral)

If required, an ability to contact referrers in order to clarify the aims and expected outcome of the assessment process

An ability to gather data from all relevant sources, including parents, school social services, GP, in order to:

contribute information to the overall assessment

guide the selection of assessment procedures which are likely to be appropriate/ relevant

identify any factors which may impact on the administration of testing (such as physical or sensory impairments)

An ability to identify any inconsistencies across respondents and consider their likely relevance in relation to the assessment process

An ability to locate and interpret previously-conducted structured and/or medical assessments in order to inform the current assessment process, specifically to:

inform the selection of testing procedures used in the current assessment

provide a baseline measure/measure of comparison

compile a developmental profile

The ability to undertake structured cognitive, functional, and developmental assessments focuses on the use of standardised tests of cognition, language and functioning. It does not focus on other components/types of developmental assessment, for example, taking a developmental history, obtaining information from other agencies, or conducting observations, which are described under the comprehensive assessment section.

2

Ability to select tests relevant to the referral issues

An ability to generate hypotheses that might account for the impairment (or presentation) based on information gleaned pre-assessment

to draw on knowledge of psychometric theory to select appropriate testing strategy

an ability to adjust the hypothesis, where necessary, based on the outcome of the hypothesis testing strategy

An ability to draw on knowledge of assessment procedures to select those relevant to the assessment question

An ability to draw on knowledge of the populations on which tests have been standardised, and any implications this will have for individual clients in relation to their:

age

gender

socio-economic status

country of origin

ethnicity

level of functioning

Test administration

The ability for the tester to administer only those assessment procedures for which they are appropriately qualified.

An ability to recognise that all aspects of the initial encounter may provide important data for the assessment (including, for example, the initial meeting in the waiting room, or the ways in which those present interact with each other)

An ability to provide a testing environment which promotes optimal performance from the child/young person (e.g. using age appropriate language and being friendly rather than distant/clinical, or minimising potential distractions in the room)

Where appropriate, an ability to encourage parents to allow the child/young person to come into the testing environment by themselves (to reduce the chances that they will be distracted), and to recognise where this separation impacts on test performance

where parents remain in the testing situation, an ability to explain the importance of allowing the child to complete the testing independently

An ability to monitor the child or young person’s behaviour and interactions throughout the assessment, including:

their level of motivation/engagement with the assessment process

their activity levels

their level of concentration or distractibility

their social/communication skills

their specific areas of difficulty/competence

their reaction to failure/success

their persistence

any reassurance seeking

their receptivity to encouragement/reinforcement

An ability to document these observations systematically and to identify whether they are consistent with reports from other sources

An ability to draw on knowledge of child development to gauge when behaviour is within “normal” limits (e.g. knowing how the ability to concentrate varies with age)

An ability to draw on knowledge of common reactions to assessment (such as anxiety) and to take into account their impact on the child’s functioning

3

An ability to engage the child/young person throughout the testing process, alternating periods of rest, “fun activity” and testing to maintain motivation and concentration

An ability to draw on knowledge of the ways in which the assessment process may impact on functioning in (neuro)developmental disorders (e.g. the structured non-distracting testing environment may improve the functioning of children with Autistic Spectrum Disorder)

An ability to adhere to standardised testing structure and protocol, as described in the relevant manual:

implementing any variations in “rules” in line with the procedures specified in the manual (e.g., the criteria for discontinuing a test, or for prompting the child)

applying the criteria for scoring to the responses made by the child in order that results remain relevant to norms and standardisation

recording responses accurately

following scoring procedures

An ability to establish whether additional non clinic-based assessment is required (e.g. behavioural observation in the school or home)

An ability to draw on knowledge of test-retest reliability to ensure that tests are not re-employed too soon (i.e. potentially invalidating any results)

An ability to identify where a child being assessed differs from the samples on which standardisation is based , and to interpret and report their results in relation to this limitation

Where it is not possible to follow the standardised testing procedure (e.g. because the child is uncooperative, or has profound/specific difficulties), an ability to adapt testing (and to record the adaptations that have been made):

an ability to recognise that while adapting tests has practical value (in terms of identifying the child’s strengths and weaknesses) the resulting scores will not be psychometrically sound

An ability to select and/or adapt tests in order to match them to the needs of children with sensory difficulties or physical limitations

Ability to interpret test results

An ability to integrate data from testing with behavioural observations and information from other assessment sources to produce a coherent account of the child’s functioning.

An ability to interpret results in terms of:

the child’s level of functioning (across the domains assessed)

their relationship to functioning in the standardised sample for the test

the pattern or profile of results, across the domains tested

the significance of individual test results in the context of their overall functioning

An ability to apply the findings to:

describe/explain the child’s functioning

describe/explain the ways in which their current environment may be impacting on the child/young person’s functioning

describe how the interaction of the two may result in particular behaviours, strategies or patterns of impairment (e.g. apparent underperformance)

4

Ability to use the assessment to identify an intervention plan

An ability to adopt a strength based approach to the development of intervention strategies

An ability to use findings from assessment to suggest strategies which:

are aimed at enhancing the child/young person’s skill and abilities

alter the child’s environment, with the aim of enhancing/maximising their functioning

An ability to communicate intervention strategies to those delivering them, using language and concepts which are clear and adapted to the context

An ability to support individuals who are carrying out interventions based on the assessment outcome, ensuring that they understand and can carry-through the intervention plan.

Ability to report on the assessment

Ability to report the results of the assessment in writing using clear, concise and appropriate language, including:

the reasons for testing

sources of information

materials used (including what each test measures)

testing procedure (including relevant behavioural information)

any adaptations

An ability to communicate findings verbally to parents/carers, and where appropriate children/young people, including discussion of:

their experience of the testing process

the meaning of the findings for the child and for the family

any areas that the child and family need clarifying

their expectations for the distribution and use of the report

Source: Charman, T., Hood, J., & Howlin, P. (2008) Psychological Assessment in the Clinical Context. pp 299-316 in M. Rutter., & E. Taylor (Eds.) Child and Adolescent Psychiatry (Fifth Edition). Oxford: Blackwell.