Describing ethical competences - caveats

• turning ethical principles into competences is a challenge:

• nonetheless competences have been described for some areas of practice

• principles are abstract and require interpretation• interpretation involves relating the principle to a

specific context • hard to specify a competence that covers all potential

contexts/ eventualities

Describing ethical competences in competence frameworks

• all modality frameworks include some reference to ethical conduct – ability to work within legal and professional guidelines– practice in relation to difference

• CAMHS framework includes much more detailed consideration

• describe – the knowledge clinicians need to draw on– the usual pattern of practice

Universal & selective

prevention programmes

Generic Therapeutic Competences

Core competences for work with children/ young people

Knowledge of development in children/young people and of family development and transitions

Knowledge of legal frameworks relating to working with children/young people

Meta competences

Meta-competences for child and adolescent work

Multi Systemic Therapy

Parent training (based on social learning theory)

Systemic family therapy for anorexia

Health promotion across settings

Problem solving and social skills training (Dinosaur school)

Functional Family therapy

CBT for OCD

CBT for depression

CBT for PTSD or other trauma related problems

IPT-A for depression

Psychodynamic therapy for depression

Self-help for a range of problems

Ability to engage and work with families, parents & carers

Knowledge and understanding of mental health problems in children/young people and adults

Knowledge of, and ability to operate within, professional and ethical guidelines

Knowledge of models of intervention, and their employment in practice

Ability to foster and maintain a good therapeutic alliance and grasp the perspective & ‘world view’ of members of the system

Ability to deal with the emotional content of sessions

Ability to manage endings and service transitions

Ability to undertake a single session assessment of service appropriateness

Ability to make use of supervision

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

Specific Interventions

Emotional health promotion in schools

CBT for anxiety disorders

Assessment & formulation

Ability to undertake structured behavioural observations

Ability to undertake structured cognitive, functional and developmental assessments

Interventions for challenging behaviour

Ability to assess the child’s functioning within multiple systems

Substance abuse

Ability to work with groups of children or and/or parents/carers

Ability to undertake a diagnostic assessment

Risk assessment and management

Ability to make use of measures (including monitoring of outcomes)

Ability to formulate

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

Knowledge of psychopharmacology in child and adolescent work

Ability to work with difference (cultural competence)

Disruptive behaviour disorders (ADHD, Oppositional Defiant, early onset Conduct Disorder)

Depressive conditions

Conduct disorder

Anxiety and trauma

Anorexia

Autistic spectrum disorders

Interventions for psychosis

Ability to undertake a comprehensive assessment

Ability to work within and across agencies

Knowledge of, and ability to work with, issues of confidentiality, consent and capacity

Ability to recognise and respond to concerns about child protection

Ability to communicate with children/young people of differing ages, developmental level and background.

Ability to conduct a mental state

Specialist mental health assessments

Orange shaded boxes = additional competences that should be demonstrated by all caseholding members

of a CAMHS team

Interventions for Social Communication (Howlin et al.)

Systemic approaches

Motivational interviewing

Contingency management

Systemic therapy for depression

Behavioural interventions for sleeping problems

Engagement & communication

Professional/legal issues

Assessment & planning

Blue shaded boxes = competences that should be demonstrated by all members of a CAMHS team

Unshaded boxes = additional competences that will be demonstrated by some, but not all, members of a

CAMHS team

Problem Solving

Assessment of Alcohol & Substance Misuse

Behavioural interventions for enuresis

Behavioural interventions for encopresis

Behavioural interventions for feeding problems

Ehlers & Clark

Cohen

Education & Skills programme (Breterton et al.)

Individual therapy (Kendall)

Group therapy (Barrett)

Professional/legal issues

Knowledge of legal frameworks relating to working with children/young people

Knowledge of, and ability to operate within, professional and ethical guidelines

Knowledge of, and ability to work with, issues of confidentiality, consent and capacity

Ability to work with difference

Knowledge of legal issues relevant to working with children and young people

• draws attention to legislation in the areas of:

• capacity and informed consent• parental rights and responsibilities• participation• child protection• mental health • education• data protection• equality

Knowledge of, and ability to operate within, professional and ethical guidelines

• covers practice in the areas of:

Knowledge of, and ability to work with, issues of confidentiality, consent and capacity

• covers practice in the areas of:• knowledge of policies and legislation • knowledge of legal definitions of consent to an intervention• knowledge of capacity• knowledge of parental rights and responsibilities• ability to gain informed consent to an intervention from

children, young people and their carers• ability to draw on knowledge of confidentiality and

information sharing• ability to inform children, young people and their families

about issues of confidentiality and information sharing• ability to assess the child/young person’s capacity to

consent to information sharing• ability to share information appropriately and securely

Ability to work with difference (cultural competence)

• covers practice in the areas of:

• basic stance• knowledge of the significance for practice of specific beliefs,

practices and lifestyles • knowledge of social and cultural factors which impact on access• ability to communicate respect and valuing of children and

families • ability to gain an understanding of the experience of specific

beliefs, practices and lifestyles• ability to adapt communication • ability to employ and interpret standardised

assessments/measures • ability to adapt interventions• ability to demonstrate awareness of the effects of clinician’s own

background • ability to identify and to challenge inequality

Limitations

• competence cannot be applied by rote; requires metacompetence - ability to:

• nonetheless, competence descriptions could have a role in:

• recognise when ethical considerations apply• identify and implement ethical actions that are

contextually appropriate

• specifying a curriculum• reminding us of areas of relevant knowledge • reminding us of relevant procedures