A Workforce Competency Framework
for
Newcastle’s Drug and Alcohol Treatment
Providers
1
Contents
Page
Introduction
6
Section A: Psychosocial Interventions
7
A1. Competences to deliver Psychosocial Interventions
8
A1.1
A1.2
A1.3
A1.4
Generic Competences
Basic Competences
Specific (technical) Competences
Metacompetences
A2.
Motivational Interventions
A2.1
A2.2
A2.3
A2.4
A2.5
Generic competences
Basic motivational interviewing competencies
Specific motivational interviewing techniques
Monitoring in motivational interviewing
Metacompetences in motivational interviewing
A3.
Contingency Management
A3.1
A3.2
A3.3
A3.4
Generic competences
Basic contingency management competences
Specific contingency management competences
Metacompetences in contingency management
A4.
Family and social network interventions
9
12
14
A4.1 Treatments/Interventions involving family members
A4.1.1 Working with family members (to engage relation in treatment
A4.1.2 Joint involvement of family members (and their relatives in treatment)
A4.2 Social Behaviour and Network Therapy
A4.3 Competences for Behavioural Couples Therapy (BCT)
A4.3.1 Generic Competences
A4.3.2 Basic BCT competences
A4.3.3 Specific BCT competences
A4.3.4 Metacompetences in BCT
A4.4 Competences for Community Reinforcement Approach (CRA)
A5.
Cognitive and behavioural based relapse prevention
interventions (substance misuse focused)
16
A5.1 Competences for CBT-based guided self help interventions
2
A5.1.1 Generic Competences
A5.1.2 Basic CBT competences
A5.1.3 Metacompetences in CBT
A6.
Evidence Based psychological interventions for co-existing mental
health problems
A6.1
A6.2
A6.3
A6.4
A6.5
Generic competences
Basic CBT competences
Specific behavioural and cognitive therapy
Problem specific competences
Metacompetences in CBT for depression and anxiety
21
A6.5.1 Generic competences
A6.5.2 CBT specific Metacompetences
A7.
Psychodynamic Therapy (substance use focused)
24
A7.1 Outline model for psychoanalytic/psychodynamic therapy competences
A8.
12 Step Work
25
A9.
Counselling – BACP Accredited
26
A9.1 Accreditation for individuals
A9.2 Accreditation for services
A10. Other
Section B
33
Recovery Support Interventions
34
B1.
Defining addiction and recovery
35
B2.
Peer Support Involvement
36
B2.1 Volunteer Peer Meeting and Greeting
B2.2 Informal Support or “Buddying”
B2.3 Volunteer Peer Mentoring
B3.
Facilitated access to mutual aid
38
B3.1 Three essential steps for keyworkers facilitating access to mutual aid
B4.
Family support
39
B4.1 Drug sector partnership
B4.2 Core competencies
B4.3 Additional competencies
B5.
Parenting support
42
3
B5.1 Competences
B5.1.1 Qualities and Experience
B5.1.2 Skills
B5.1.3 Knowledge
B5.2 Parenting support programmes
B6.
Housing Support
44
B7.
Employment Support
45
B8.
Education and Training Support
46
B9.
Supported work projects
47
B10. Recovery Checkups
48
B11. Behavioural based relapse prevention
49
B12. Evidence based mental health focused psychosocial interventions
50
B13. Complementary therapies
51
B13.1 Acupuncture
B13.1.1 Competencies to deliver acupuncture
B13.2 Reiki
B13.2.1 Competencies to deliver reiki
B13.3 Reflexology
B13.3.1 Competencies to deliver reflexology
B13.4 Yoga
B13.4.1 Competencies to deliver yoga
B14. Other
Section C
54
Basis of Pharmacological interventions
55
C1.
C1.1
C1.2
C1.3
C1.4
Prescribing
Non-medical prescribing
Independent prescribing
Supplementary prescribing
The regulators of non-medical prescribers
56
C2.
The Prescribing Competency Framework
58
C2.1
C2.2
C2.3
C2.4
Domain A: The consultation (competencies)
Domain B: Prescribing effectively (competencies)
Domain C: Prescribing in context (competencies)
Competencies for supplementary prescribers
4
C3.
Competencies for doctors
C3.1
Specialist doctors (3)
C3.1.1
Supporting people to recover
C3.1.2
Clinical leadership
C3.2
Intermediate doctors (2)
C3.2.1
Supporting people to recover
C3.2.2
Clinical leadership
C3.3
Generalist doctors (1)
C3.3.1
Supporting people to recover
C3.3.2
Clinical leadership
C3.4
Competencies
C3.5
Training
C3.5.1
C3.5.2
C3.5.3
62
Specialist doctors
Intermediate doctors
Generalist doctors
Appendices
65
Appendix 1: Competences to deliver cognitive and behavioural based
relapse prevention interventions (substance misuse focused)
Appendix 2: Competences needed to relate to people and carry out any
form of psychosocial intervention
Appendix 3: Parenting support programmes in Newcastle
Appendix 4: Entry to education and employment support
Appendix 5: The prescribing competency framework
Domain A: The consultation
Appendix 6: The prescribing competency framework
Domain B: Prescribing effectively
Appendix 7: The prescribing competency framework
Domain C: Prescribing in context
Appendix 8: Competencies for supplementary prescribers
Appendix 9: The three levels of competency for doctors working
with people using drugs and alcohol
5
Introduction
The quality and effectiveness of service provision depends upon the ability of staff to
deliver interventions and their managers to support them. A competent member of
staff consistently applies relevant knowledge and skills to meet the standards of
performance required.
Competent staff benefit organisations and services, or in this case the treatment
system by supporting it to achieve its aim of delivering effective interventions and by
allowing the system to be assured of the quality of its services
A treatment system which has competent staff also provides protection to its service
users as they can be assured that staff are performing to an agreed level and are
consistently demonstrating effective practice
There are also benefits for staff within commissioned services within the treatment
system; working within agreed national occupational standards and locally agreed
standards means that they can clearly understand what the expected levels of
performance are in their own and in other commissioned services within the system.
The recent introduction of Dataset J has specifically defined a number of
interventions relating to the treatment and recovery of users of drugs and alcohol
under the headings pharmacological, psychosocial and recovery support
This paper define the competences required from staff to safely and effectively
deliver these interventions, as defined by Dataset J, using existing standards and
requirements which might include
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NHS Knowledge and Skills Framework
Drug and Alcohol National Occupational Standards
Professional Standards and Codes of Ethics
Supporting People
Skills for Health
NICE guidelines (2012)
Royal College of Psychiatrists
Royal College of General Practitioners
National Treatment Agency for Substance Misuse
Department of Health
Action for Children
6
Section A
Psychosocial Interventions
7
A1: Competences to deliver Psychosocial Interventions
The competences required to effectively deliver psychosocial intervention can,
according to the British Psychological Society (2010)1, be broken down into the
following competences.
A1.1 Generic Competences
The competences needed to relate to people and to carry out any form of
psychological intervention.
A1.2 Basic Competences
Basic intervention specific competences that are used in most sessions.
A1.3 Specific (technical) competences
Specific intervention competences that are employed in most sessions
(usually associated with high intensity interventions).
A1.4 Metacompetences
Competences used by therapists to work across all levels and to adapt the
intervention to the needs of each individual service users. These competences are
abstract as they usually reflect the intentions of the person delivering the intervention
and can be difficult to observe directly but can be inferred from the therapists
actions.
These four categories of competences have been applied throughout this section to
describe the necessary competences for staff to deliver psychosocial interventions
as defined by Dataset J.
Routes to Recovery: Psychosocial Interventions for Drug Misuse – A framework and toolkit for
implementing NICE recommended treatment interventions
1
8
A2.
Motivational Interventions
Dataset J definition: Motivational interventions aim to help service users
resolve ambivalence for change, and increase intrinsic motivation for change
and self-efficacy through a semi-directive style and may involve normative
feedback on problems and progress. They may be focused on substance
specific changes and/or on building recovery capital. Motivational
interventions can be delivered in group or individual format and may involve
the use of mapping tools. Motivational interventions require additional
competences for the worker and delivery within a clinical governance
framework including appropriate supervision. Motivational Interviewing and
Motivational Enhancement Therapy are both forms of motivational
interventions.2
A2.1 Generic competences
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Knowledge of drug misuse and mental health problems
Establishing a positive relationship with the service user
Establishing good relationships with relevant professionals
Gathering background information
Giving service users information about drug misuse
A2.2 Basic motivational interviewing competencies
An ability to:
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2
Adopt an empathetic, non-confrontational, collaborative and non-judgmental
approach
Adopt an evocative tone throughout the intervention which draws out the
service user’s ideas, feeling and wants
Draw out, identify and discuss the service user’s intrinsic motivation for
change
Draw from the service user a distinction between how important it is for the
service user to change and how confident they are they can maintain this
change
Respect the individual autonomy of the service user and responsibility for
change
Communicate to the service user a sense of safety and support
Convey acceptance of the service user and to avoid confrontation or the use
of persuasion
Assist the service user in developing discrepancy between their current
situation and future goals
‘Roll with the resistance’ and avoid direct confrontation of resistance
Support and enhance a service user’s belief in their ability to carry out a
specific activity
Help the service user explore and resolve their ambivalence in favour of
change
Dataset J, November 2012
9

A knowledge of basic principles of stages of change (pre-contemplation;
contemplation; preparation; action and maintenance).
A2.3 Specific motivational interviewing techniques
An ability to:
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Use affirmative statements to acknowledge service user efforts and strength
Use open-ended questions
Avoid the use of ‘traps’ including: question-answer traps; labelling traps;
premature focus traps; talking side traps; blaming traps; and expert traps
A knowledge of the levels of reflection including: repeating; re-phrasing;
paraphrasing; and reflecting feeling
An ability to use reflective listening through:
Forming hypotheses about the meaning of service user statements
Testing hypotheses by reflective statements to the service user
Using different types of reflective statements including simple reflection,
amplified reflection; double-sided reflection
An ability to elicit ‘change talk’ in a collaborative manner through:
Recognising, empathising and reflecting on desire, ability, reasons and need
focused change statements
Recognising and strengthening commitment language
An ability to:
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Build rapport through identifying the service user’s concerns
Centre discussion around the service user’s concerns and needs
Reframe discussion positively
Conclude a session with summaries and open-ended discussion on behaviour
change
Use decisional balance tools to facilitate the exploration of ambivalence
Elicit discrepancy between current behaviour and future goals
Elicit dissonance between beliefs and behaviours
Enhance the service user’s perception of the importance for change and their
confidence they can make this change
Diffuse blame
Invite service users in a non-confrontational manner to consider new
perspectives
Support self-efficacy via affirmation and positive reinforcement
Offer specific information and advice, but only when solicited
Elicit discussion of the benefits and drawbacks of changing problem
behaviour
Develop, in collaboration with the service user, a plan for behaviour change.
A2.4 Monitoring in motivational interviewing
An ability to identify the service user’s readiness for change, both from structured
assessment and open-ended discussion through:
10
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Using informal measures of change such as readiness, importance and
confidence rulers and other basic measures of change
Using key questions to assess readiness to change both to assess and
facilitate readiness to change
An ability to:
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Provide summaries during sessions to demonstrate understanding of the
service user’s problem, structure the intervention and emphasise positive
change focused service user statements
Refer to, and elicit open-ended discussion from, assessment data
Provide positive and constructive feedback and open-ended discussion on
behaviour change during and at the end of sessions
Make use of self-monitoring tools to reflect on and improve performance
Make use of supervision, and the associated assessment and feedback
A2.5 Metacompetences in motivational interviewing
An ability to:
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Adapt motivational interviewing according to the setting in which it is
provided
Pace the rate of the intervention as relevant to service user needs
Set agendas on an ongoing basis in order to clarify session topics and
behaviour change targets
Recognise service user need for motivational interviewing as it arises, and
to deliver it opportunistically
Elicit and be responsive to service user’s feedback
Integrate motivational interviewing into routine assessment systems.
11
A3.
Contingency Management
Dataset J definition: Contingency management (CM) provides a system of
reinforcement or incentives designed to motivate behaviour change and/or
facilitate recovery. CM aims to make target behaviours (such as drug use) less
attractive and alternative behaviours (such as abstinence) more attractive. CM
requires additional competences for the worker and delivery within a clinical
governance framework including appropriate supervision.3
The following competences for contingency management has been derived from
Routes to Recovery: Psychosocial Interventions for Drug Misuse – A framework and
toolkit for implementing NICE recommended treatment interventions, pp. 28-30
A3.1 Generic
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Knowledge of drug misuse and mental health problems
Establishing a positive relationship with the service user
Establishing good relationships with relevant professionals
Gathering background information
Giving service users information about drug misuse
A3.2 Basic contingency management competences
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Knowledge of contingency management principles
Structuring a contingency management programme
Managing the relationship with a service user in a manner consistent with
contingency management principles
A3.3 Specific contingency management competences
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Drug testing for a contingency management programme
Assessment for a contingency management programme
Establishing a contingency management programme
Delivering and monitoring contingency management programme
Managing relationships with external agencies concerning contingency
management
Ending the intervention
A3.4 Metacompetences in contingency management
An ability to:
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3
Judge the level and approach of contingency management intervention
required
Design a contingency management schedule in accordance with behavioural
principles
Dataset J, November 2012
12
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Adapt a contingency management schedule to the characteristics and needs
of individual service users including the nature of their drug misuse
Adapt the contingency management intervention according to the setting in
which it is delivered
Identify barriers to effective intervention and to resolve these within the
boundaries of the agreement with the service user and the overall objectives
of the service setting
Make use of supervision, assessment and feedback on performance as a
contingency management therapist
13
A4.
Family and social network interventions
Dataset J definition: Family and social network interventions engage one or
more of the client’s social network members who agree to support the client’s
treatment and recovery. The interventions use specific psychosocial
techniques which aim to increase family and social network support for
change and decrease family and social support for continuing drug and/or
alcohol use. These interventions may involve the use of mapping tools. They
require additional competences for the worker and delivery within a clinical
governance framework including appropriate supervision. Examples: Social
behaviour network therapy (SBNT), Community Reinforcement Approach
(CRA), Behavioural Couples Therapy (BCT) & formal Family Therapy4
A4.1 Treatments/interventions involving family members
A4.1.1
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Working with family members (to engage relation in treatment)
Family intervention
Community reinforcement and family training
Unilateral family therapy
Cooperative counselling
A41.2
Joint involvement of family members (and their relatives in
treatment)
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Conjoint family group therapy
Behavioural couples therapy
Family therapy
Network therapy
Social behaviour and network therapy
A4.2 Social Behaviour and network therapy
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No competences currently available (Skills Consortium)
A4.3 Competences for Behavioural Couples Therapy (BCT)5
A4.3.1
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Generic competences
Knowledge of drug misuse and mental health problems
Engaging service users
Establishing good relationships with relevant professionals
4
Dataset J, November 2012
Routes to Recovery: Psychosocial Interventions for Drug Misuse – A framework and toolkit for
implementing NICE recommended treatment interventions, pp. 32-34
5
14
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Dealing with the emotional content of sessions
Gathering background information
Giving service users information about drug misuse
A4.3.2
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Knowledge of family approaches to drug misuse and mental health problems
Assessment of couples with drug misuse problems
Knowledge and rationale of BCT
A4.3.3
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Basic BCT competences
Specific BCT competences
Establishing the therapeutic approach in BCT
Monitoring of treatment progress in BCT
Monitoring of drug and alcohol misuse and associated risks in BCT
Ensuring effective delivery of BCT
Relapse prevention
A4.3.4
Metacompetences in BCT
Ability to:
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Adapt sessions responsively in relation to service user feedback
Implement BCT in a manner consonant with its underlying philosophy
Select and skilfully apply the most appropriate BCT intervention techniques
Structure sessions and maintain appropriate pacing
Identify and manage obstacles to treatment participation and goals both in
and out of session
Identify and respond appropriately to non-substance related problems which
may interfere with BCT or present increased risks for the couple, their family
or the wider social network
A4.4 Competences for Community Reinforcement Approach (CRA)
No competences currently available (Skills Consortium) but Dr Robert Myers, the
recognised expert in this field states that a successful CRA therapist must have
sound, fundamental counselling skills. In addition, supportiveness, empathy, and a
genuinely caring attitude are key to establishing the consumer-therapist relationship.
CRA also requires that the therapist be directive, energetic, and engaging. (Bob
Myers)
Attendance at CRA course facilitated by Dr Myers (lead in this field)
15
A5. Cognitive and behavioural based relapse prevention
interventions (substance misuse focused)
Dataset J definition: Cognitive and behavioural based relapse prevention
interventions develop the service users’ abilities to recognise, avoid or cope
with thoughts, feeling and situations that are triggers to substance use. They
include a focus on coping with stress, boredom and relationship issues and
the prevention of relapse through specific skills – e.g. drug refusal, craving
management. They can be delivered in group or individual format and may
involve the use of mapping tools. They require additional competences for the
worker and delivery within a clinical governance framework including
appropriate supervision. Examples: CBT based relapse prevention (which may
include mindfulness and ‘third wave’ CBT), behavioural self control (alcohol)6
The following competences for CBT-based guided self help interventions have been
derived from Routes to Recovery: Psychosocial Interventions for Drug Misuse – A
framework and toolkit for implementing NICE recommended treatment interventions,
pp. 35-36
A5.1 Generic competences
Establishing a positive relationship with the service user
An ability to:
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Develop an empathetic, warm and genuine relationship
Communicate effectively through appropriate use of empathic statements,
reflection, clarification, verbal and non-verbal behaviours.
Establishing good relationships with relevant professionals
An ability to:
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Communicate effectively with professionals about the nature of the service
user’s difficulties, the intervention(s) offered and the resulting outcomes.
Gathering background information
An ability to:
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6
Gain an overview of the service user’s current life situation, any specific
stressors and level social support
Elicit information regarding diagnosis, past history and present life situation
Gather information relating to the impact of emotional distress including work,
home, social and private leisure and close personal relationships.
Dataset J, November 2012
16
Establishing a context for the service and providing rationale for the service
user of the self-help model
An ability to:
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Help the service user understand that the main purpose of the intervention is
to facilitate the use of self-help material(s)
Provide a rationale for guided self-help to service users in an encouraging and
realistic manner
Establish a context for the intervention, through clear explanation of the
practitioner role
Ensure that the service user understands the nature and the timing of
sessions and the schedule of contacts
Convey to the service user the service-user-led, collaborative nature of a selfhelp intervention.
Giving service users specific information relevant to the intervention
An ability to:
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Impart accurate information on the nature, course and frequency of the
presenting problem
Give the service user information about alternative available evidence-based
psychological therapies treatment-choices, as set out in the agreed protocol
for the delivery of guided self-help
Give realistic information regarding outcomes and the prognosis for the
service user’s condition relevant to the self-help interventions.
Assessing the service user’s main problems using a semi-structured interview
An ability to:
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Use open and closed question styles flexibly and responsively
Phrase questions unambiguously
Give the service user regular summaries during the interview
Assess, using agreed protocols; risk to self, others and self neglect
(distinguishing between thoughts, actions and plans) and establish
preventative factors
Gather information on current and past treatment (including relevant medical,
psychological, social and pharmacological interventions)
Gather relevant information on drug and alcohol use
Identify the key problem(s) through appropriate information gathering relating
to the impact of emotional distress including work, home, social and private
leisure and close personal relationships
Elicit information regarding diagnosis, past history and present life situation
Gather information relating to the impact of emotional distress including work,
home, social and private leisure and close personal relationships.
17
Establishing a context for the service and providing rationale for the service
user of the self-help model
An ability to:
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Help the service user understand that the main purpose of the intervention is
to facilitate the use of self-help material(s)
Provide a rationale for guided self-help to service users in an encouraging and
realistic manner
Establish a context for the intervention, through clear explanation of the
practitioner role
Ensure that the service user understands the nature and the timing of
sessions and the schedule of contacts
Gathering information using formal assessment methods
An ability to:
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Administer and interpret formal measures of mental health (e.g. PHQ-9,
CORE-OM, the BDI, problem and goal statements)
Support the service user in the completion of formal measures of mental
health and to support the service user in using these to monitor their progress
Support the service user in use of formal measures of mental health to
determine the content and pace of the intervention.
Decision making regarding the appropriateness of the intervention
An ability to:
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A5.2
Agree on the suitability of the self-help intervention for the service user
Collaboratively negotiate and agree with a service user the next steps in
contact including organisational and therapeutic arrangements
Where necessary in conjunction with a supervisor, identify service users
whose problems lie outside the scope of low-intensity interventions and when
alternative interventions are require
Recognise, where necessary in conjunction with a supervisor, when referral to
another part of the service is appropriate.
Basic CBT competences
Socialising the service user to a CBT model
An ability to:
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Communicate the essential components of a cognitive, and/or behaviourally
based self-help programme
Communicate the options available to a service user within a CBT based selfhelp programme
18
Agreeing the aims of the intervention
An ability to:
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Summarise information gathered from the assessment into a concise problem
summary which is shared and checked with the service user (which includes
information on environmental and/or intrapersonal triggers, physiological,
behavioural and cognitive components of the main problem and the broader
impact of this problem on the service user’s functioning)
Use the problem summary to agree intervention goals with the service user
Negotiate and agree the specific components of a self-help CBT based
intervention.
Facilitating service user self-monitoring
An ability to:
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Support self-monitoring through the use of service-user-completed diaries
(including activity schedules, sleep and thought diaries)
Review diary records with the service user, and to discuss any implications of
these observations with the service user.
Facilitating service user led interventions
An ability to:
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Understand the use of appropriate self-help materials (including written
materials) and self-monitoring materials, and support the service user in the
use of relevant and effective materials
Help the service user problem solve difficulties encountered in the use of
written materials, and self-monitoring materials
Help the service user think through the rationale for performing homework and
related tasks, and to identify and problem solve any anticipated difficulties in
carrying out tasks
Communicate effectively about the delivery, implementation and monitoring of
self-help interventions both in face-to-face contacts and in telephone contacts.
Ending the intervention
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A5.3
An ability to negotiate an appropriate ending to the intervention, including
discussion of relapse prevention.
Metacompetences in CBT
An ability to:
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Maintain a clear distinction between acting as a facilitator of self-help and
taking on the more extensive role of a therapist
19
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With service users who are not making progress or who show low motivation,
to identify when to persist with the intervention and when to re-evaluate its
appropriateness
In the context of indicators of service user progress, maintain fidelity to the
intervention model in the face of service user complexity
Use supervision to identify gaps in knowledge and understanding, and reflect
on and to learn from experience.
Further information relating to these competencies are tabled at Appendix 1 7
7
Appendix 1 - Page 64
20
A6. Evidence –based psychological interventions for co-existing
mental health problems
Dataset J definition: NICE guidelines8 for mental health problems generally
recommend a stepped care approach. Low intensity psychological intervention
for co-existing mental health problems, include guided self-help or brief
interventions for less severe common mental health problems. High intensity
psychological therapies (such as cognitive behavioural therapy) are
recommended for moderate and severe problems. Typically formulation-based
and delivered by clinicians with specialist training and who are registered with
a relevant professional / regulatory body. They can be delivered in group or
individual format. Both low and high intensity interventions require additional
competences for the worker and delivery within a clinical governance
framework including appropriate supervision9
A6.1 Generic competences
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Knowledge and understanding of mental health problems
Knowledge of, and ability to operate within, professional and ethical guidelines
Knowledge of a model of therapy, and the ability to understand and employ
the model in practice
Ability to:
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Engage client
Foster and maintain a good therapeutic alliance, and to grasp the client’s
perspective and ‘world view’
Deal with emotional content of sessions
Manage endings
Undertake generic assessment (relevant history and identifying suitability for
intervention)
Make use of supervision.
A6.2 Basic CBT competences
Knowledge of:
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Basic principles of CBT and rationale for treatment
Common cognitive biases relevant to CBT
The role of safety-seeking behaviours
Ability to:
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Explain and demonstrate rationale for CBT to client
Routes to Recovery: Psychosocial Interventions for Drug Misuse – A framework and toolkit for
implementing NICE recommended treatment interventions, pp. 40-41
8
9
Dataset J, November 2012
21
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Agree goals for the intervention
Ability to structure sessions:
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


Sharing responsibility for session structure and content
Adhering to an agreed agenda
Planning and reviewing practice assignments (‘homework’)
Using summaries and feedback to structure the session.
Use measures and self monitoring to guide therapy and to monitor outcome
Devise a maintenance cycle and use this to set targets
Problem solving
Ability to end therapy in a planned manner, and to plan for long-term maintenance of
gains after treatment.
A6.3 Specific behavioural and cognitive therapy











Exposure techniques
Applied relaxation and applied tension
Activity monitoring and scheduling
Guided discovery and Socratic questioning:
Using thought records
Identifying and working with safety behaviours
Detecting, examining and helping client reality test automatic thoughts/images
Eliciting key cognitions/images
Identifying and helping client modify assumptions, attitudes and rules
Identifying and helping client modify core beliefs
Employing imagery techniques
Planning and conducting behavioural experiments.
Ability to:


Develop formulation and use this to develop treatment plan/case
conceptualisation
Understand client’s inner world and response to therapy.
A6.4 Problem-specific competences







Specific phobias
Social phobia – Heimberg; Clark
Panic disorder (with or without agoraphobia) – Clark; Barlow
Obsessive compulsive disorder (OCD) – Steketee; Kozac
Generalised anxiety disorder (GAD) – Borkovec; Dugas and Ladouceur;
Zinbarg, Craske and Barlow
Post-traumatic stress disorder (PTSD) – Foa and Rothbaum; Resick; Ehlers
Depression – high-intensity interventions:
o cognitive therapy – Beck
o behavioural activation – Jacobson.
22

A6.5
Depression – low-intensity interventions:
o behavioural activation
o guided CBT self help.
Metacompetences in CBT for depression and anxiety
A6.5.1
Generic Metacompetences:
Capacity to:



Use clinical judgment when implementing treatment models
Adapt interventions in response to client feedback
Use and respond to humour.
A6.5.2
CBT specific Metacompetences:
Capacity to:





Implement CBT in a manner consonant with its underlying philosophy
Formulate and to apply CBT models to the individual client
Select and apply most appropriate BT and CBT method
Structure sessions and maintain appropriate pacing
Manage obstacles to CBT therapy.
23
A7.
Psychodynamic therapy (substance use focused)
Dataset J definition: A type of psychotherapy that draws on psychoanalytic
theory to help people understand the developmental origins of emotional
distress and behaviours such as substance misuse, by exploring unconscious
motives, needs, and defences. Psychodynamic therapy requires additional
competences for the worker and delivery within a clinical governance
framework including appropriate supervision. Therapists should be registered
with an appropriate professional/regulatory body.10
The competencies needed to carry out any form of psychoanalytical /psychodynamic
therapy have been defined by Lemma, Roth and Pilling11. These are tabled at
Appendix 2. 12
10
Dataset J, November 2012
11
‘The competences required to deliver effective Psychoanalytic/ Psychodynamic Therapy’,
Alessandra Lemma, Anthony D. Roth and Stephen Pilling, Research Department of Clinical,
Educational and Health Psychology UCL available online at http://www.ucl.ac.uk/CORE
12
Appendix 2, page 65
24
A8.
12 Step Work
Dataset J definition: A 12-step program or counselling intervention for
recovery from addiction, compulsion, or other behavioural problems.
Interventions are delivered within a clinical governance framework including
appropriate supervision. The aim of a 12-step programme is to facilitate
service users to complete some or all of the 12-steps. (American
Psychological Association)13
Any service provider delivering any element of 12 step work should have knowledge
understanding and application of the relevant steps as well as competencies relating
to psychosocial interventions.
See Section B Recovery Support Interventions – Facilitated access to Mutual
Aid
13
Dataset J, November 2012
25
A9.
Counselling – BACP Accredited
Dataset J definition: A systematic process which gives individuals an
opportunity to explore, discover and clarify ways of living more resourcefully,
with a greater sense of well-being. This requires additional competences for
the worker and delivery within a clinical governance framework including
appropriate supervision14
A9.1 Accreditation for individuals - Process for BACP
Counsellor/Psychotherapist Accreditation – September 201215
COUNSELLOR/PSYCHOTHERAPIST ACCREDITATION SCHEME
STANDARD FOR ACCREDITATION
‘To demonstrate the capacity for independent, competent, ethical practice’
Individuals can apply for accreditation if they provide counselling or
psychotherapy to individual people, couples, groups or families and can
provide satisfactory evidence to meet all Criteria 1 to 9
CRITERIA FOR APPLICATION
Eligibility Criteria 1-5
When individuals apply and throughout the assessment process, they must be:
1.
A member of BACP
2.
Covered by professional indemnity insurance
When individuals submit their application they must be
3.
Practising counselling or psychotherapy
4.
Able to evidence their training and supervised practice:
They must have undertaken training and supervised practice to meet one of the
following criteria:
EITHER:
4.1
14
They have been awarded a qualification from a BACP accredited training
course
Dataset J, November 2012
British Association for Counselling and Psychotherapy (2013) – Applying for accreditation available
at http://www.bacp.co.uk/accreditation/ Accessed: January 2013
15
26
AND
 Have been in practice at least three years when they apply for accreditation
 Have at least 450 hours of supervised practice accumulated within three to six
years (they do not have to be consecutive years)
 Of the 450 hours at least 150 of the hours of supervised practice must be after
the successful completion of your BACP accredited course
 Have been supervised for at least 1½ hours per month throughout the period
of practice submitted
OR:
4.2
They have successfully completed and received an award for
practitioner training that:




Included at least 450 hours of tutor contact hours
Was carried out over at least two years (part-time) or one year (full-time)
Had a supervised placement as an integral part of the training
Covered theory, skills, professional issues and personal development
AND




5.
Have been in practice at least three years when you apply for accreditation
Have at least 450 hours of supervised practice accumulated within three to six
years (they do not have to be consecutive years)
Of the 450 hours at least 150 hours of supervised practice must be after you
have successfully completed your practitioner training
Have been supervised for at least 1½ hours per month throughout the period
of practice submitted.
Supervision
They have an ongoing contract for counselling/psychotherapy supervision for a
minimum of 1½ hours per month for each month in which practice is undertaken.
Reflective Practice Criteria 6-9
6.
Continuing Professional Development (CPD)
6.1 Describe a CPD activity, relevant to your area of practice that they have
undertaken in the 12 months before applying for accreditation
6.2 Provide reason(s) for choosing the activity with reference to your practice
6.3 Show how the activity has influenced their practice
7.
Self-awareness
7.1
7.2
Describe an experience or an activity which has contributed to your
(their)own self-awareness
Provide a reason(s) for choosing the experience or activity
27
7.3
8.
Knowledge and understanding
8.1
8.2
8.3
9.
Show how you (they) use this self-awareness in your(their) practice
Describe a rationale for your client work with reference to the theory /
theories that inform all your(their) practice.
Describe the place of your (their) self-awareness within your (their) way
of working
Describe how issues of difference and equality impact upon the
therapeutic relationship.
Practice & Supervision
In your(their) case material account for:
9.1
9.2
9.3
9.4
9.5
9.6
How your (their) practice is consistent with your(their) described way of
working (in 8.1)
How you(they) use your(their) self-awareness in the therapeutic
relationship
How your(their) practice demonstrates your(their) awareness of issues
of difference and equality and the impact they have on your(their)
counselling / psychotherapy relationships
Use of the BACP Ethical Framework for Good Practice in Counselling
and Psychotherapy and how supervision influences your (their)
practice by:
Describing the awareness you (they) have gained through reflection in
and on supervision
Showing how you (they) apply that awareness in your practice
This is based around a set of criteria and quantitative requirements rather than a set
of competencies. BACP is currently working on devising competencies for talking
therapies but these are still in the early stages of development.
There are a variety of accreditation fees in addition to annual membership fees.
A9.2 Accreditation for services - BACP Service Accreditation Scheme16
The Service Accreditation Scheme (SAS) helps the public, and practitioners, identify
services providing a high standard of counselling/psychotherapy.
The scheme is open to services that meet the eligibility and operational criteria and
agree to be bound by the scheme’s conditions. This includes services that are
members in their own right, or that are part of an organisational member. In the latter
case, the organisational member applies for accreditation and bears ultimate
responsibility for that service.
To achieve accreditation, the service must apply in the prescribed form and
demonstrate that its procedures and practices meet all the criteria.
16
BACP Service Accreditation Scheme available at http://www.bacp.co.uk/accreditation/ Accessed:
January 2013
28
On acceptance, an accredited service:

Will receive a certificate of accreditation

Will have its name listed as a BACP accredited service

May advertise its service as a BACP accredited service (this can be included
on official notepaper)
Accreditation is awarded for a five-year period, during which the service is monitored
by BACP’s quality assurance procedures. At the end of the period the service has to
apply for renewal of its accredited status.
Application fees are charged in accordance with BACP policy.
PART I – CRITERIA FOR ACCREDITATION OF SERVICES
The criteria are divided into two parts:
Part A: Eligibility criteria
Part B: Operational criteria
Part A: Eligibility criteria
These criteria must be met before an application is accepted for assessment under
the operational criteria specified in Part B.
Services making an application for accreditation must:
Criterion 1
Be an organisational member of BACP and subject to its Ethical Framework for
Good Practice in Counselling and Psychotherapy and Professional Conduct
Procedure. If the service is part of an organisational member, it is the organisational
member that will make the application for the accreditation of its
counselling/psychotherapy service.
Criterion 2
Provide a counselling/psychotherapy service.
Criterion 3
Include at least three practitioners who undertake counselling/psychotherapy.
Part B: Operational criteria
Applicants should provide clear, concise and appropriate evidence of meeting all
these criteria.
Criterion 4 – Policy
4.1
Aims and Objectives
A statement of aims and objectives, available to all staff and service users, must set
out clearly:
29





4.2
The purpose of the services provided
The type of counselling/psychotherapy offered
The ethical framework adhered to
The limits of confidentiality
The context and contracting of the work (this includes payment for services,
relationships with the host organisation (if relevant) and times of service
availability).
Publicity
All service publicity material and pre-counselling information should comply with the
Ethical Framework for Good Practice in Counselling and Psychotherapy and be
readily available.
4.3
Staffing
4.3.1 A specified person must hold clinical responsibility for the service. They
should be a member of an appropriate professional body, subject to its
complaints procedure and accredited by or of equivalent standing with it.
4.3.2 A training and development policy should exist for all staff.
4.3.3 A clear selection procedure for counsellors/psychotherapists should exist
4.3.4 Recruitment panels for counsellors/psychotherapists in the service must
include at least one qualified, experienced practitioner familiar with the work of
the service.
4.4
Equal Opportunities
The service should:
4.4.1 Be committed to equality of opportunity for its staff and for users of the service
and comply with all relevant legislation. It must demonstrate a nondiscriminatory approach to staff and users, irrespective of age, colour, creed,
culture, disability, education, ethnicity, gender, information, knowledge,
mobility, money, nationality, race, religion, sexual orientation, social class,
status, etc.
4.4.2 Define its target population and survey users using an equal opportunities
questionnaire or similar procedure.
4.4.3 Recognise its accessibility limitations and publish a strategy for addressing
this.
4.5
Evaluation and feedback
4.5.1 All aspects of the service’s work should be formally evaluated by users and
staff on a regular basis that is at least annually.
4.5.2 Evaluation findings should be reviewed and appropriate changes made.
4.5.3 Annual feedback should be given to users and other stakeholders.
4.5.4 All feedback must maintain users’ anonymity.
Criterion 5 – Management and administration
5.1
Service structure
30
5.1.1 There should be clearly defined and effective management and organisational
structure, which includes a Head of Service who has knowledge and
experience of the counselling field and who has overall responsibility for
management of the service.
5.1.2 There should be clear lines of accountability/reporting.
5.1.3 Formal arrangements for financial accountability should be in place.
5.2
Community liaison
Links with referral resources and specialist services in the community should exist.
5.3
Health and Safety
5.3.1 The service must comply with the current Health and Safety at Work Act and
other relevant legislation.
5.3.2 Practitioners must be given training and best practice guidelines for potential
dangerous and violent situations.
5.3.3 Specific training and guidelines should be provided for those that undertake
home visits.
5.3.4 There should be procedures that help all staff identify and deal with clients at
risk to themselves or others.
5.3.5 Procedures must exist on how to deal with critical incidents such as
dangerous or violent behaviour.
5.3.6 All counsellors/psychotherapists (both voluntary and salaried) should be
covered by Professional Indemnity and Public Liability insurance.
5.4
Administration
5.4.1 All records (whether paper or electronic) should be secure and confidential.
5.4.2 The service should comply with the current Data Protection Act and other
relevant legislation.
5.4.3 Appointment systems, if used, must be private and confidential.
5.4.4 Ownership of, and access to, service user records should be specified.
5.5
Management
5.5.1 All service staff should have the opportunity to meet on a regular basis and to
have access to suitable consultation and feedback.
5.5.2 Part-time, newly qualified practitioners and trainees must be supported by a
permanent member of the counselling/psychotherapy staff, and training in the
service systems and procedures must be given.
5.5.3 Demand on the service should be monitored and managed.
5.5.4 There should be systems to monitor and manage the quality of practitioners
work.
5.5.5 Staff undertaking a variety of roles must make it clear to service users and
colleagues which one they are in at any given time.
5.5.6 Grievance and disciplinary procedures must exist for all staff.
31
5.5.7 Formal links should exist for consultation and referral between counselling/
psychotherapy staff and medical and psychiatric services.
Criterion 6 – Delivery
6.1
Accommodation
Rooms used for counselling/psychotherapy purposes should be private and free
from interruption, furnished appropriately and, when counselling is in process, used
exclusively for that purpose.
6.2
Professional conduct
6.2.1 The service must be run in accordance with BACP’s Ethical Framework for
Good Practice in Counselling and Psychotherapy.
6.2.2 Where counselling/psychotherapy is not appropriate, or the service does not
have the appropriate skills, users must be referred to suitable agencies e.g.
psychiatric services, GP.
6.2.3 Counsellors/psychotherapists should monitor and develop their professional
work through regular supervision/consultation and continuing professional
development (CPD).
6.2.4 All secretarial, administration and reception support staff should work in a
manner that maintains confidentiality. Reception staff must be experienced
and confident in working with those in distress.
6.2.5 An appropriate client/customer complaints procedure should be available.
Organisations need to be a BACP member in order to be eligible to apply for
accredited status and there are a variety of submission fees depending on whether
the organisation is from the not-for-profit or commercial sectors. The fees cover the
cost of assessment both of the initial application and the annual report which needs
to be submitted during the 5 year accreditation term. At the end of 5 years, a new
application needs to be submitted in order to maintain accreditation.
32
A10. Other
Dataset J definition: An intervention based on established psychological
models/ theories, that have an evidence base, and that is undertaken by a
worker with the required competences with adequate supervision and clinical
governance arrangements This category can only be used where an
intervention is not covered by individual, or a combination of, categories
above. It is anticipated that use of this category would be relatively
uncommon.
Competence will be dependent upon the specific intervention being delivered.
33
Section B
Recovery Support Interventions
34
B1
Defining addiction and recovery
Addiction is often referred to as the continued use of a mood altering substance or
behavior despite adverse harmful consequences, or a neurological impairment
leading to such behaviors.
There are many definitions of recovery, and recovery means different things to
different people. Essentially, it is defined by ‘voluntarily maintained lifestyle
characterized by sobriety, personal health and citizenship’ or the ‘process of change
through which individuals improve their health and wellness, live a self-directed life,
and strive to reach their full potential’.17
However, addiction and dependence are referred to as ‘chronic relapsing conditions’
which mean that it can take some people a long time to recover and numerous
attempts at treatment programmes before moving into recovery. Providing services
for people affected by drugs or alcohol includes supporting complex and multiple
needs, and requires a holistic response which is dependent on the individual and
their situation.
17 Source: The Betty Ford Institute Consensus Panel. "What is recovery? A working definition from the Betty
Ford Institute" Journal of Substance Abuse Treatment. 20 September 2007.
35
B2.
Peer Support Involvement
Dataset J definition: A supportive relationship where an individual who has
direct or indirect experience of drug or alcohol problems may be specifically
recruited on a paid or voluntary basis to provide support and guidance to
peers. Peer support can also include less formal supportive arrangements
where shared experience is the basis but generic support is the outcome (e.g.
as a part of a social group). This may include mental health focused peer
support where a service user has co-existing mental health problems. Where
peer support programmes are available, staff should provide information on
access to service users, and support access where service users express an
interest in using this type of support18
The Scottish Drugs Forum suggest that peer support involvement has three main
areas of work 19: volunteer peer meeting and greeting, informal support or buddying
and volunteer peer mentoring
B2.1 Volunteer Peer Meeting and Greeting
This may be done by a volunteer current service user who knows and attends the
service regularly whose role is to meet and welcome potential or new service users
either at the first service visit or initial assessment, and where appropriate, show
them around the service, explain basic health and safety and housekeeping
procedures

Photocopy the checklist and give a copy to the new service user and one for a
service file specific to Service User Involvement

At key work sessions, key worker can ask volunteer involved in Peer Meet
and Greet how many welcome sessions they have done, how they feel, etc.
This should be recorded in the service users file/care plan.
B2.2
Informal Support or “Buddying”
This may be done by a current service user who knows and uses the service
regularly, whose role could either incorporate meet and greet with further
responsibilities, or be a separate role altogether and who would introduce the new
service user to the other service users and staff and agrees an arrangement
whereby the “buddy” makes regular contact with the new service user until the new
service user feels comfortable.
18
Dataset J, November 2012
Scottish Drugs Forum, Service user and peer support available at http://www.sdf.org.uk/userinvolvement/best-practice/ : Accessed: February 2013
19
36
B2.3 Volunteer Peer Mentoring
This may be done by a service user who is in the final stages of their treatment
programme, aftercare or who has left and would like to do some volunteering within
the service. Their role again could incorporate both meet and greet and “buddying”
with further responsibilities or could be a separate role altogether. This role would
be a more formal one than the other two and would assist the development of other
service users through offering support, advice and encouragement so the service
user can draw on the experience of the volunteer peer mentor.
37
B3.
Facilitated access to mutual aid
Dataset J definition: Staff provide a service user with information about selfhelp groups. If a service user has expressed an interest in attending a mutual
aid group, staff facilitate the person’s initial contact with the group, for
example by making arrangements for them to meet a group member, arranging
transport, accompanying him or her to the first session and dealing with any
concerns. These groups may be based on 12-step principles such as
Alcoholics Anonymous, Narcotics Anonymous and Cocaine Anonymous) or
other approaches (such as SMART Recovery)20
B3.1 Three essential steps for key workers facilitating access to mutual aid 21
1. Introduce the topic of mutual aid into sessions with service users and promote
the value of attending meetings
2. Help the service user to contact a current member of a mutual aid group who
can accompany him/her to a meeting
3. Take an active interest in the service user’s attendance at, engagement with
and experience of mutual aid groups.
It requires keyworkers to be knowledgeable about mutual aid and to promote its
value. Services also need to build contacts with local groups.
Familiarity can be improved if staff






20
Read the information or watch the videos on the websites of each of the 12step and SMART Recovery mutual aid groups
Become familiar with the key texts i.e. Alcoholics Anonymous’ The Big Book
(Cocaine Anonymous also use this) and Narcotics Anonymous’ Basic Text
Take a short course, such as SMART Recovery’s one-hour online introduction
Talk to members of the mutual aid groups. All operate a public information
service whose purpose is to talk to professionals about their work – their
speakers are often members with substantial experience
Learn from colleagues and clients. Many drug and alcohol services have staff
and service users who attend mutual aid groups and who may be willing to
share their knowledge and experience
Attend an open meeting, where professionals are welcome. All the fellowships
run these and all they ask is that you identify yourself as a professional before
the meeting starts.
Dataset J, November 2012
21
Helping clients to access and engage with mutual aid – Turning evidence into practice available at:
http://www.nta.nhs.uk/r-Evidence%20and%20Guidance.aspx : Accessed: January 2013
38
B4.
Family Support
Dataset J definition: Worker has assessed the family support needs of the
individual/family as part of a comprehensive assessment, or ongoing review of
their treatment package. Agreed actions can include: arranging family support
for the family in their own right or family support that includes the individual in
treatment22
This work closely links to family and support network interventions (under
Psychological interventions) and can be divided into three broad categories23



Interventions that work with family members to promote the entry and
engagement of drug and or alcohol users into treatment
The joint involvement of family members and the relatives using drugs and/or
alcohol in the treatment of the user
Interventions aimed to respond to the needs of family members affected by
drug and alcohol problems in their own right
The 5 Step family intervention in primary care model24 support/intervention model
should be used when working with families and focuses on staff being able to do
carry out the following:





Listen non-judgementally
Provide information
Discuss ways of responding
Explore sources of support
Arrange further help if needed
B4.1 Drug Sector Partnership
Four national charities, Adfam, DrugScope, eATA and the Alliance – have formed
the Drug Sector Partnership 25 to support community and voluntary sector
organisations working in the drug and alcohol sector.
The partnership suggest that there are core and additional competencies of a family
practitioner working with families affected by drug or alcohol use.
22
Dataset J, November 2012
23
Copello, Vellemand and Templeton, 2005
24
Copello et al (2007) 'The 5-Step family intervention in primary care: I. Strengths and limitations
according to family members', Drugs: education, prevention and policy, 14:1, 29 - 47
25
www.drugsectorpartnership.org.uk/
39
B4.2 Core competencies
SCDCPC311:
SFHSS03:
SCDLDSS6:
ASTH416:
Promote effective communication and information sharing
Promote, monitor and maintain health, safety and security in the
workplace
Reflect on, develop and maintain your practice
Develop practice which promotes choice, well-being and
protection of all individuals
B4.3 Additional competencies
CCSCC17:
SFHAB5:
SFHAD1:
SFHMH13:
SFHMH6:
Contribute to safeguarding children, young people and
vulnerable adults
Assess and act upon immediate risk of danger to substance
users
Raise awareness about substances, their use and effects
Work with families, carers and individuals during times of crisis
Assess the needs of carers and families of individuals with
mental health needs
These National Occupational Standards (NOS) have been taken from the 2009
Health and Social Care suite and Adfam and the Federation of Drug and Alcohol
Professionals (FDAP) have jointly developed a competence-based certification for
practitioners supporting families affected by drugs and alcohol.
The new FDAP/Adfam Drug & Alcohol Family Worker Professional Certification is
specifically designed for practitioners working with families affected by substance
misuse, after consultation with the sector, and the development of a unique role
profile. It will provide practitioners with a package of benefits, including:
This certification is offered at the registration level. Practitioners will, as a minimum,
require their employers to attest to their competence in each of the national
occupational standards outlined in the Role Profile. Practitioners will be required to
develop a portfolio of proof of competence which may be asked for by FDAP as part
of random sampling and which will allow them to demonstrate continued professional
development in order to re-accredit at the end of the 3 years.
Recertification
Certification is valid for three years. To be eligible for re-certification, a practitioner
must provide up to date evidence of their on-going competence in the units
concerned.
40
Professional standards
As well as demonstrating their competence, to be certified as a Drug & Alcohol
Family practitioners must also adhere to FDAP's Code of Practice26.
26
Available at: http://www.fdap.org.uk/code_of_practice.php Accessed: April 2012
41
B5.
Parenting support
Dataset J definition: Worker has assessed the family support needs of the
individual as part of a comprehensive assessment, or ongoing review of their
treatment package. Agreed actions can include a referral to an in-house
parenting support worker where available, or to a local service which delivers
parenting support27
B5.1 Competences to deliver parenting support 28
The person should have the ability to:


Carry out a comprehensive substance misuse assessment - DANOS AF3
Contribute to protecting children, young people from danger, harm and abuse
(HSC325)
B5.1.2
Qualities and experience
The person should be:





Child focused
Warm, respectful and sensitive
Action focused
Engage and build trust
Support and challenge
5.1.3
Skills
The person should have the following skills:








Empowering and enabling families
Communication skills
Planning skills
Decision making and problem solving skills
Providing a flexible and non-prescriptive approach to delivery
Engaging and working with other services
Self awareness and self reflection
Ability to interact positively with children and young people
5.1.4
Knowledge
The person must have:


Technical and professional expertise
Awareness of equality and diversity issues
27
Dataset J, November 2012
‘Skills framework for developing effective relationships with vulnerable parents to improve outcomes
for children and young people (2011) available at: www.actionforchildren.org.uk/
28
42


Understanding family context
Knowledge of support available
B5.2 Parenting Support Programmes
There is a variety of parenting support programmes in Newcastle29 which are
coordinated by Parent Early Intervention Programme (PEIP). Staff in commissioned
services should have knowledge of and be able to appropriately signpost or refer
clients to30 these programmes.
29
http://www.newcastle.gov.uk/education-and-learning/parental-support/parenting-supportprogrammes-newcastle
30 Appendix 3, page 74
43
B6.
Housing Support
Dataset J definition: The worker has assessed the housing needs of the
individual as part of the comprehensive assessment, or on-going recovery
care planning process, and has agreed goals that include specific housing
support actions by the treatment service, and/or active referral to a housing
agency for specialist housing support. Housing support covers a range of
activities that either allows the individual to maintain their accommodation or
to address an urgent housing need31
Staff in commissioned services should, as part of a client’s initial (comprehensive)
assessment and ongoing review32:







Assess housing related need at entry to treatment and review regularly
Optimise treatment to improve someones stability and ability to satisfy a
landlord of their ability to maintain a tenancy
Provide advice, information and advocacy to ensure people in treatment are
being paid appropriate benefits
Provide training and support (or access to them) in the skills needed to
maintain a household and tenancy including financial and debt management
to ensure rent is paid
Work with people to improve chances of employment
Provide (often in partnership with others) second stage or other supported
accommodation
Work with other agencies to ensure people have the foundations for stability somewhere to live, an income, be free from excessive debt.
In addition, staff in commissioned drug treatment services should




31
32
33
Understand the ‘Gateway’33, its operating policies and procedures and how it
relates to their service/service users
Have knowledge of the housing related services available within the city and
what those services provide
Have knowledge and understanding of the Drug Management Protocol
Be able to effectively signpost or refer service users to appropriate agencies
Dataset J, November 2012
Medications in Recovery – Re-orientating drug dependence treatment, Strang 2012 p.23
http://www.newcastle.gov.uk/housing/housing-advice/newcastle-gateway#whatisgateway
44
B7.
Employment Support
Dataset J definition: The worker has assessed the employment needs of the
individual as part of the comprehensive assessment, or on-going recovery
care planning process, and agreed goals that include specific specialised
employment support actions by the treatment service, and/or active referral to
an agency for specialist employment support. Where the individual is already a
claimant with Jobcentre Plus or the Work Programme, the referral can include
a three way meeting with the relevant advisor to discuss
education/employment/training (ETE) needs. The referral can also be made
directly to an ETE provider34
Staff in commissioned treatment services should be able to recognise the typical
barriers to employment experienced by the client group and how these may be
overcome by35





Recognising, appropriately referring and supporting individuals with substance
misuse problems into JobCentre Plus using the joint working protocol 36
Understanding the vital role that employment plays in the clients recovery
journey
Understanding the vital role that JCP and the Work Programme play in
supporting treatment and recovery (and vice versa)
Knowledge and understanding of the local champions and contacts are
across the agencies and their respective roles
Knowledge and understanding of the operational protocols and client
pathways for shared clients
Staff in commissioned treatment services should have an awareness of the support
available to clients under this heading37and be able to signpost and/or refer clients
as appropriate
34
Dataset J, November 2012
Employment and Recovery, A good practice guide – (NTA, 2012)
36 Joint working protocol between Jobcentre Plus and Treatment Providers ( NTA, 2010)
37 Appendix 4, page 68
35
45
B8.
Education and training support
The worker has assessed the education and training related needs of the individual
as part of the comprehensive assessment, or ongoing recovery care planning
process and agreed goals that include specific specialised education & training
support actions by the treatment service, and/or active referral to an agency for
specialist education & training support. Where the individual is already a claimant
with Jobcentre Plus or the Work Programme, the referral can include a 3 way
meeting with the relevant advisor to discuss ETE needs. The referral can also be
made directly to an ETE provider
This is part of the ongoing welfare reforms38 and links to employment support
Staff in commissioned services should be aware of the support available under this
heading39 and be able to signpost and/or refer clients as appropriate
Staff in commissioned treatment services should be able to recognise the typical
barriers to education and training support experienced by the client group and how
these may be overcome by




Recognising, appropriately referring and supporting individuals with substance
misuse problems into education and training support
Understanding the vital role that education, training and support plays in the
clients recovery journey
Understanding the vital role that education and training support providers play
in supporting treatment and recovery (and vice versa)
Knowledge and understanding of local education and training support
provision and contacts within that provision
Staff in commissioned treatment services should have an awareness of the support
available to clients under this heading40and be able to signpost and/or refer clients
as appropriate
38
http://www.dwp.gov.uk/policy/welfare-reform/get-britain-working/
39
Appendix 4, page 68
Appendix 4, page 68
40
46
B9. Supported work projects
Dataset J definition: The worker has assessed the employment related needs
of the individual as part of the comprehensive assessment, or ongoing
recovery care planning process and agreed goals that include the referral to
one of the following: a service providing appropriate paid employment
positions where the employee receives significant on-going support to attend
and perform duties; or an appropriate volunteer placement, including active
referral to an agency which provides specialist support to find volunteer
placements.
Staff in commissioned services should be aware of those services providing
appropriate paid employment positions where the employee receives significant ongoing support to attend and perform duties and where to refer clients to in order to
find a volunteer placement and be able to signpost and/or refer clients as
appropriate
Staff in commissioned treatment services should be able to recognise the typical
barriers to education and training support experienced by the client group and how
these may be overcome by




Recognising, appropriately referring and supporting individuals with substance
misuse problems into supported work projects
Understanding the vital role that supported work and volunteering plays in the
clients recovery journey
Understanding the supported work projects and agencies supporting
volunteer placements play in supporting treatment and recovery (and vice
versa)
Knowledge and understanding of local supported work projects and agencies
providing specialist support to find volunteer placements and the contacts
within that provision
Staff in commissioned treatment services should have an awareness of the support
available to clients under this heading4142and be able to signpost and/or refer clients
as appropriate.
41
42
Appendix 4, page 68
http://www.volunteercentrenewcastle.org.uk/index.php
47
B10. Recovery Check Ups
Dataset J definitions: Following successful completion of formal substance
misuse treatment there is an agreement for periodic contact between a service
provider and the former participant in the structured treatment phase of
support. The periodic contact is initiated by the service, and comprises a
structured check-up on recovery progress and maintenance, checks for signs
of lapses, sign posting to any appropriate further recovery services, and in the
case of relapse (or marked risk of relapse) facilitates a prompt return to
treatment services43
Recovery management check-ups should be provided as follows44


Regular phone calls to (or other contact with) people who have left structured
treatment.
At least once a quarter when someone has first left treatment and then no
less than once a year for up to five years. (The duration and intensity of
checkups
for a particular individual will be based on their problem severity and recovery
capital).
AND should include the following



43
44
Assessment of how the person’s recovery is progressing
Provision of feedback and support
Provision of rapid access back into structured treatment, if needed (rapid reentry option)
Dataset J, November 2012
Medications in Recovery, Re-orientating drug dependence treatment: Strang (2012)
48
B11. Behavioural based relapse prevention
Dataset J definition: Evidence based psychosocial interventions [as described
in Section 4. Psychosocial] that support on-going relapse prevention and
recovery, delivered following successful completion of the formal phase of
structured substance misuse treatment. These are interventions with a
specific substance misuse focus and delivered within substance misuse
services45
Actions should be in accordance with those detailed under psychosocial
interventions
45
Dataset J, November 2012
49
B12. Evidence based mental health focused psychosocial
interventions
Dataset J definition: Evidence-based psychosocial interventions for common
mental health problems [as described in Section 4. Psychosocial] that support
continued recovery by focusing on improving psychological well-being that
might otherwise increase the likelihood of relapse to substance use. These are
delivered following successful completion of the formal phase of structured
substance misuse treatment and may be delivered by services outside the
substance misuse treatment system following an identification of need for
further psychological treatment and a referral by substance misuse services 46.
As detailed under psychosocial interventions
46
Dataset J, November 2012
50
B13. Complementary therapies as defined by Dataset J
Complementary therapies aimed at promoting and maintaining change to substance
use, for example through the use of therapies such as acupuncture and reflexology
that are provided in the context of substance misuse specific recovery support 47
.
B13.1 Acupuncture
Staff in commissioned drug treatment services delivering this intervention should be
members of the British Acupuncture Council (BAcC)
BAcC members have completed a first-degree-level training or equivalent in
traditional acupuncture including substantial elements of western anatomy,
physiology and pathology ; will record all relevant details of clients health condition
and their medical history before treatment commences; uses only pre-sterilised
single-use needles which are safely disposed of after treatment; carries out
treatment in accordance with exemplary professional standards developed by the
British Acupuncture Council and detailed in the BAcC Codes of Safe Practice and of
Professional Conduct; uses a treatment room and equipment (all) that conforms to
standards laid out in the BAcC Code of Safe Practice and (in nearly all cases) has
also been approved by local authority environmental health officers; has full medical
malpractice and public/product liability insurance cover.
B13.1.1
47
48
Competences for acupuncture (cross references with NHS Key
skills framework) as defined by Skills for Health48, the sector skills
council for health
CH Ac1
Evaluate and process requests for acupuncture
CH Ac3
Assess the client for acupuncture
CH Ac4
Agree action with the client (Acupuncture)
CH Ac5
Formulate the acupuncture treatment plan
CH Ac6
Provide the acupuncture treatment
CH Ac7
Advise the client on acupuncture related self care
strategies
CH Ac8
Evaluate the effectiveness of the acupuncture treatment
and self care
CH Ac9
Review the acupuncture and evaluate the care
Dataset J, November 2012
www.skillsforhealth.org.uk/
51
B13.2 Reiki
Staff in commissioned drug treatment services, practising this therapy should be
members of one of the regulatory bodies of this discipline. There are currently two
Regulatory Bodies soliciting membership by practitioners of Reiki and other
complementary therapies in the UK, the Complementary and Natural Healthcare
Council and the UK Reiki Federation49 .Registrants will have to be insured and sign
up to a CPD Policy (continuing professional development), disciplinary procedures
and code of professional conduct and ethics.
B13.2.1
Competences for Reiki as defined by Skills for Health50, the sector
skills council for health
CNH1
Explore and establish the clients needs for
complementary and natural healthcare
CNH2
Develop and agree plans for complementary and natural
healthcare with clients
CNH12
Provide Reiki to clients
B13.3 Reflexology
Staff in commissioned drug treatment services practising this therapy should be
working to the nationally agreed standard and ensure that their practice reflects up to
date information and policies
B13.3.1
Competences for Reflexology as defined by Skills for Health51 ,
the sector skills council for health
CNH11
Provide Reflexology to clients
Users of this standard will need to ensure that practice reflects up to date information
and policies.
There is currently no legal regulation of reflexology in the UK.
49
http://www.reikifed.co.uk/reiki-regulation/regulatory-bodies
www.skillsforhealth.org.uk/
51 www.skillsforhealth.org.uk/
50
52
B13.4 Yoga
Staff in commissioned drug treatment services or staff commissioned to deliver this
intervention should be registered with the Yoga Alliance UK52 whose aim is to
maintain a register of teachers, trainers and schools and to set standards for yoga in
the UK.
B13.4.1
Competences for Yoga as defined by Skills for Health53 , the
sector skills council for health
CNH 14
Deliver Yoga Therapy to clients
Users of this standard will need to ensure that practice reflects up to date information
and policies.
52
http://www.yogaalliance.co.uk
53
www.skillsforhealth.org.uk/
53
B14. Other
Dataset J definition: A recognised recovery activity or support intended to
promote and maintain a service user’s recovery capital, that is not captured by
an individual, or combination of, categories above
Competence will be dependent upon the specific intervention being delivered.
54
Section C
Pharmacological intervention
55
C1.
Prescribing
Doctors, dentists and a defined range of other healthcare professionals (referred to
collectively as non-medical prescribers) are able to prescribe.
C1.1 Non medical prescribing
Prescribing by specially trained nursed, optometrists, pharmacists, physiotherapists,
podiatrists and radiographers, working within their clinical competence as either
independent and/or supplementary prescribers
C1.2 Independent prescribing
Independent prescribing is prescribing by a practitioner, who is responsible and
accountable for the assessment of patients with undiagnosed or diagnosed
conditions and for decisions about the clinical management required, including
prescribing. In practice, there are TWO distinct forms of non-medical independent
prescriber.
i) An independent prescriber may currently be a specially trained nurse, pharmacist
or optometrist who can prescribe any licensed medicine within their clinical
competence. Nurse and pharmacist independent prescribers can also prescribe
unlicensed medicines and controlled drugs.
ii) A community practitioner nurse prescriber (CPNP), for example district nurse,
health visitor or school nurse, can independently prescribe from a limited formulary
called the Nurse Prescribers’ Formulary for Community Practitioners, which can be
found in the British National Formulary (BNF).
C1.3 Supplementary prescribing
Supplementary prescribing is a voluntary partnership between a doctor or dentist
and a supplementary prescriber to prescribe within an agreed patient-specific clinical
management plan (CMP) with the patient’s agreement.
Nurses, optometrists, pharmacists, physiotherapists, podiatrists and radiographers
may currently train as supplementary prescribers and once qualified may prescribe
any medicine within their clinical competence, according to the CMP.
C1.4 The regulators of non-medical prescribers
Professional regulators are required to set standards of education, training, conduct
and performance and approve education programmes that prepare healthcare
professionals to prescribe. They record the qualification of prescriber on their
register. The regulators are:
 Nursing and Midwifery Council (for nurses and midwives)
 General Pharmaceutical Council (for pharmacists)
 General Optical Council (for optometrists)
 Health Professions Council (for physiotherapists, podiatrists and
radiographers)
56
All prescribing should be in line with the ‘single competency framework for all
prescribers’ 54which underpins a prescribers personal responsibility for prescribing. It
can also be used by any prescriber at any point in their career as well as by others to
inform standards, develop education and inform guidance and advice.
The single competency framework has three domains, each containing three
dimensions of competency (nine in total).
54
NHS National Prescribing Centre (May 2012)
57
C2.
The Prescribing Competency Framework
The prescribing competency framework (below) has three domains, each containing
three dimensions of competency (nine in total). Within the nine competency
dimensions are statements describing the activities or outcomes prescribers should
be able to demonstrate.
C2.1 Domain A: The consultation
C2.1.1
Competency 1: Knowledge
Has up-to-date clinical, pharmacological and pharmaceutical knowledge relevant to
own area of practice
C2.1.2
Competency 2: Options
Makes or reviews a diagnosis, generates management options for the patient and
follows up management
58
C2.1.3
Competency 3: Shared decision making (with parents, caregivers or advocates where appropriate)
Establishes a relationship based on trust and mutual respect. Recognises patients
as partners in the consultation
The statements underpinning each competency are tabled at Appendix 5 55
C2.2 Domain B: Prescribing Effectively
C2.2.1
Competency 4: Safe
Is aware of own limitations. Does not compromise patient safety
C2.2.2
Competency 5: Professional
Ensures prescribing practice is consistent with scope of practice, organisational,
professional and regulatory standards, guidance and codes of conduct
C2.2.3
Competency 6: Always improving
Actively participates in the review and development of prescribing practice to
optimise patient outcomes
The statements underpinning each competency are tabled at Appendix 6 56
C2.3 Domain C: Prescribing in context
C2.3.1
Competency 7: The healthcare system
Understands and works within local and national policies, processes and systems
that impact on prescribing practice. Sees how own prescribing impacts on the wider
healthcare community
C2.3.2
Competency 8: Information
Knows how to access relevant information. Can use and apply information in
practice
C2.3.3
Competency 9: Self and others
Works in partnership with colleagues for the benefit of patients. Is self aware and
confident in own ability as a prescriber.
The statements underpinning each competency are tabled at Appendix 7 57
C2.4 Competencies for supplementary prescribers
55
Appendix 5, page 72
Appendix 6, page 74
57 Appendix 7, page 75
56
59
Supplementary prescribers require the same common competencies as independent
prescribers to ensure safe and effective prescribing within the scope of their practice.
The competencies for supplementary prescribers are the same as those of
independent prescribers however there are several modifications and additions that
reflect the unique nature of a supplementary prescribing relationship.
The modifications to the competency framework are tabled at Appendix 858
58
Appendix 8, page 76
60
C3.
Competencies for doctors
The Royal College of Psychiatrists and Royal College of General Practitioners have
published guide CR173 for commissioners, providers and clinicians 59 which defines
three levels of competency for doctors working with drug and alcohol users and the
training those at each level need to undertake. They define the three levels as
specialist doctor, intermediate doctor and generalist doctor
C3.1 Specialist doctors(3)
C3.1.1
Supporting people to recover
Specialist doctors will be able to work with people with the most severe and complex
needs. Working with them and with other doctors and professionals, they will be able
to lead on planning and delivering support and medical treatment towards their
recovery.
Examples of particular roles include:








C3.1.2
providing expert advice to other doctors on diagnosis, assessment and
recovery care planning, for example on complex drug interactions,
comorbid drug-related physical and mental health issues, and integration of
psychosocial and medical treatment;
accepting referrals of people with the most severe or complex needs;
expert oversight of provision of psychosocial support, based on
comprehensive knowledge of research evidence;
leading introduction of innovative interventions to improve outcomes and
quality of provision;
complex prescribing, for example injectable opioid substitution treatments
(which also requires a license for some treatments);
providing liaison drug and alcohol services in acute medical and psychiatric
settings and expert advice to courts;
providing expert advice to accountable officers and responsible officers.
Clinical leadership
The clinical leadership of specialist drug and alcohol services, including inpatient
facilities, is a key role for specialist doctors. They take responsibility for leading on all
aspects of clinical governance and quality assurance in line with the requirements of
the designated monitoring bodies, including clinical effectiveness and patient safety
across services in their area. They act as advisors on commissioning and
implementation of policy through their input into local structures. They also champion
and lead research and innovation to develop new clinical guidance and service
protocols, both at local and
national level. They will be able to provide supervision, appraisal and training
‘Delivering quality care for drug and alcohol users: the roles and competencies for doctors’
(September, 2012)
59
61
to doctors at all levels of competency.
C3.2 Intermediate doctors (2)
C3.2.1
Supporting people to recover
Intermediate-level doctors will be able to make a full assessment of strengths, risk,
harm and urgency for people with more severe or complex needs, and to work with
them to formulate, initiate and monitor medical care in support of their recovery
goals. This includes both the delivery of psychosocial interventions and prescribing
most pharmacological treatments, as well as advising on harm reduction. They will
be able to work with people to help them address any mental health problems or
other physical health issues, drawing on support and supervision from specialists as
appropriate.
They will be aware of local protocols on provision of care to people with
a mental illness using drugs and alcohol, and will be able to ensure
appropriate, coordinated care is provided by relevant services.
C3.2.2
Clinical leadership
Intermediate-level doctors will have the specialist expertise to be able to lead on
aspects of clinical governance in drug and alcohol services, including clinical audit.
They will be able to work in partnership with other agencies to ensure that there is a
full range of recovery options available locally, including both abstinence-oriented
and harm reduction interventions. They will be able to provide supervision and
training to generalists, trainees and other healthcare professionals working in the
field. They will be able to make a substantial contribution to service management, a
substantial contribution to service management, including by advocating for service
users and promoting their involvement.
C3.3 Generalist doctors
C3.3.1
Supporting people to recover
All doctors supporting drug and alcohol users should be able to identify people
whose use of drugs or alcohol may pose a risk to their own, or others’, health and
well-being, including that of children, through safeguarding issues; make an
assessment of their needs and risks; and correctly diagnose substance use
disorders.
They should be able to provide the person and their family/carers with advice and
information to support and motivate them in pursuing recovery, referring them to
more specialist services if necessary, as well as helping them manage their general
mental and physical health in liaison with other professionals. They will be able to
prescribe
medication, including opioid substitution therapy, only in uncomplicated cases.
62
Psychiatrists working at generalist level will also be able to implement mental health
legislation, and to lead on supporting their own patients who are using drugs or
alcohol and also have a mental illness, referring to more specialist help when
needed.
C3.3.2
Clinical leadership
Generalists will not usually be in a position to lead drug and alcohol services,
although all doctors are expected to participate actively in clinical governance
activities – for example, GPs participating in an annual audit of uptake of
vaccinations for blood-borne viruses.
C3.4 Competences
There are three levels of competency for doctors working with people using drugs
and alcohol at Generalist, Intermediate and Specialist levels60. These are tabled at
Appendix 9 61
C3.5 Training
C3.5.1
Specialist doctors
All doctors working at specialist level should either: be listed on the GMC’s Specialist
Register as a psychiatrist with an endorsement in substance misuse psychiatry, with
the supervision and CPD requirements this entails;
or
 have training, experience and supervision equivalent to this, as certified by
the GMC through an appropriate Certificate of Eligibility for Specialist
Registration (CESR; for details of CESR for psychiatrists
or
 be listed on the GMC’s GP Register and have the following additional training
and experience: all the RCGP certificates listed earlier, or equivalent CPD
approved by the RCGP SMAH unit; and if possible, a Masters degree or
Diploma in addictions;
and
 experience, evidenced in a logbook/portfolio, of front-line specialist work at a
senior level and for a substantial length of time, including managing complex
cases, working autonomously where necessary and in line with up-to-date
best practice;
and
 experience in: medicines management; strategic leadership and management
of other clinical staff; supervision, mentorship and appraisal of others; clinical
leadership and professional standards; integrated and multi-agency working;
local policy and guideline development, audit, risk and incident review
and
‘Delivering quality care for drug and alcohol users: the roles and competencies of doctors’, pp. 2224 available at www.rcpsych.ac.uk
60
61
Appendix 9, page 77
63

appropriate ongoing CPD relevant to this field.
C3.5.2
Intermediate doctors
All doctors working at intermediate level should either: be listed as a GP on the
GMC’s GP Register, and





have completed the RCGP certificates in Harm Reduction, Health Recovery
and Well Being, the Management of Drug Misuse, both Parts 1 and 2; and the
RCGP Certificate in the Management of Alcohol Problems in Primary Care;
and
undertake a specialist peer-led appraisal at least every 2 years to supplement
their annual appraisal as a GP;
and
undertake relevant annual CPD;
or
be listed on the GMC’s Specialist Register as a psychiatrist (but not
necessarily with an endorsement in substance misuse), with the CPD and
supervision requirements this entails;
and
have extensive experience of working with people using substances under the
supervision of a consultant addictions psychiatrist.
C3.5.3.
Generalist doctors
The various medical Royal Colleges and Faculties require different competencies of
doctors training in their respective specialties. Colleges also provide various CPD
opportunities – for example, the RCGP encourages all GPs to complete its
certificates in harm reduction, alcohol management and drug use (Part 1).
A project sponsored by the Academy of Medical Royal Colleges has identified a set
of basic, core competencies for all doctors in supporting people using drugs and
alcohol at generalist level, and these are now being embedded into the postgraduate
curricula of the medical Royal Colleges62
This will help ensure that every opportunity is taken to provide people with
information and motivation to pursue recovery, and reduce the risks of medical
complications which can arise from a lack of recognition of patients’ drug and alcohol
use.
62
Academy of Medical Royal Colleges & Royal College of Psychiatrists, 2012.
64
Appendices
65
Appendix 1: Competences to deliver cognitive and behavioural based relapse prevention interventions (substance misuse
focused)
66
Appendix 2: Competences needed to relate to people and to carry out any form of psychological intervention
67
Appendix 3: Parenting support programmes in Newcastle
Strengthening Families
This programme is available via Byker Sands family centre and sees parents/carers
working both separately and together focusing on;

building nurturing skills,

placing boundaries,

reinforcing messages that all behaviour has consequences,

developing positive relationships,

enabling communication,

supporting young people in developing skills to enable them to cope with
stress and peer pressure
Incredible Years School Age
Incredible Years is available via Byker Sands family centre and supports the
development of positive and nurturing parenting through;

play

praise

effective limit setting

use of ignoring and time out strategies
The Parent Factor in ADHD
The Parent Factor programme is for parents / carers who have a school aged child
who has been diagnosed with Attention Deficit Hyperactive Disorder. It focuses on
the specific parenting skills and knowledge that are required within this context. The
programme has four main aims:

To increase parents knowledge of ADHD and its treatment

To give parents insight into how it feels to be a child with ADHD

To give parents advice on how to promote a more positive relationship with
their child

To educate parents on strategies for effective behaviour management
Triple P
Triple P is a parenting and family support strategy that aims to prevent severe
behavioural, emotional and developmental problems in children by enhancing the
68
knowledge, skills and confidence of parents. This programme incorporates sessions
on causes of children’s behaviour problems, strategies for encouraging children’s
development and strategies for managing misbehaviour. Active skills training
methods used in the sessions include modelling, rehearsal, self-evaluation, and
homework tasks. Several generalisation enhancement strategies are incorporated
into the program to promote the transfer of parenting skills across settings, siblings
and time.
69
Appendix 4: Entry to Education and Employment support
The Work Programme
Up to two years of tailored in and out of work support designed to help people into
paid employment. Delivered by private companies, charities and the public sector.
Providers have the freedom to include the services they feel will be most effective –
this can include training, mentoring, work placements, supported job search etc. This
is for people aged 18 and above who have been unemployed for 9-12 months or
more, and most people on Employment Support Allowance (ESA) / Incapacity
Benefit (IB). People facing serious disadvantage in the job market, including
homeless people, people with histories of substance use and mild to moderate
mental health problems can opt to join at the discretion of their Jobcentre Plus
adviser after 3 months.
Joining is mandatory for people on Job Seekers Allowance (JSA), and for people on
ESA other than in the Support Group. Once on the Programme, continued
participation is always mandatory and the provider can require customers to carry
out mandatory tasks and activities and referral is by Jobcentre Plus only.
The Youth Contract 18-24
This is a series of incentives and improved offers, rather than a stand-alone
programme. Employers have a wage incentive of £2,275 for each person recruited
from the Work Programme and staying in the job for at least 6 months. It also
includes additional apprenticeship places, incentive payments for small and medium
enterprises (SMEs) recruiting apprentices, additional Sector Based Work Academy
and Work Experience places. This is for unemployed people aged 18-24 and
referral is through a JobCentre Plus adviser
Supported work projects
The worker has assessed the employment related needs of the individual as part of
the comprehensive assessment, or ongoing recovery care planning process and
agreed goals that include the referral to one of the following: a service providing
appropriate paid employment positions where the employee receives significant ongoing support to attend and perform duties; or an appropriate volunteer placement,
including active referral to an agency which provides specialist support to find
volunteer placements.
Links to employment support/education and training support63
Staff in commissioned services should be aware of the following and be able to
signpost and refer clients as appropriate using the joint working protocol64
Day One Prison Release
63
http://www.dwp.gov.uk/policy/welfare-reform/get-britain-working/
64
Joint working protocol between Jobcentre Plus and Treatment Providers ( NTA, 2010)
70
Immediate access to the Work Programme, rather than at 3, 9 or 12 months.
People released from a custodial sentence who make a claim for JSA will be
mandated to the Work Programme immediately. Jobcentre Plus staff will be
processing any claims prior to release. People who do not claim JSA before leaving
prison but who do so within 13 weeks of leaving will also be mandated to the Work
Programme.
It is mandatory and the referral route is through Jobcentre Plus advisers, either in
prison or following release..
New Enterprise Allowance
Support for unemployed people to become self-employed. Consists of business
advice and support, an interest-bearing loan of up to £1000 and a tapered allowance
of £1274 over 6 months to help the transition to self-sufficiency. This is for people
who have been claiming JSA for 6 months or longer. People who are on, or who are
required to be on the Work Programme are ineligible.
It is voluntary and the referral route is through JobCentre Plus advisers
Work Choice
6-9 months of pre-employment support, plus longer-term in-work support. The
Programme is designed to support people with disabilities into paid employment.
Delivered by private companies, and the voluntary and public sectors, includes
elements such as vocational training, CV building, job brokerage. This is for
Disabled people with complex employment support needs for whom other DWP
provision is not suitable and those who are in work but under threat of losing their job
as a result of their disability.
It is not mandatory and the referral route is through JobCentre Plus Disability
Employment Advisers, voluntary sector organisations with Statutory Referral
Organisation status, Work Programme providers.
Voluntary Work Experience
Up to 8 weeks unpaid work experience, expenses are met. Placement can be with
private, voluntary or public sector organisations. Administered by Jobcentre Plus.
This is for people aged 16 – 24 who have been unemployed for between 3 and 9
months. It is voluntary to join, continued participation is now voluntary as well,
although a sanction may be applied if someone is asked to leave for gross
misconduct. The referral route is through Jobcentre Plus advisers
Mandatory Work Activity
Up to 4 weeks of unpaid work, designed to instil the habits and routines of working
life. The activity is being delivered by organisations from the private, voluntary and
public sectors, and the work has to be of benefit to the community. This is for people
on JSA, any age, at the discretion of Jobcentre Plus adviser. It is mandatory and
‘customers’ who fail to complete a placement without good cause will lose their
Jobseeker’s Allowance for a minimum of 3 months. The referral route is through
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Jobcentre Plus advisers
Sector Based Work Academy
Mix of pre-employment training and a work placement of up to 6 weeks, followed by
a guaranteed interview. Whilst the interview is guaranteed, there is no requirement to
have a job vacancy. Any external training is fully funded through the Skills Funding
Agency and delivered by Further Education colleges and training providers. The
training is QCF accredited. This is for people aged 18 or over claiming JSA or in the
Employment Support Allowance/Work Related Activity Group (ESA WRAG group). It
is voluntary to join, but there is a risk of sanction if the ‘customer’ leaves. The referral
route is through Jobcentre Plus advisers.
Work Trial
Work Trial is a trial in an actual job vacancy that gives an opportunity for an
employer to see how someone gets on in a post, and allows a jobseeker to show an
employer that they are the right person to fill it. Benefits and expenses will be paid
for the duration of the trial, which will generally not be longer than 15 working days.
You may be able to arrange your own Work Trial with an employer, subject to your
Jobcentre Plus adviser agreeing. Generally, this is for people on JSA for more than 6
months, but anyone interested is encouraged to discuss with their Jobcentre Plus
adviser who will tell them if they are eligible or not. It is not mandatory and the
referral route is through Jobcentre Plus advisers
Employment on Trial
A prior agreement with Jobcentre Plus that a customer leaving a new job of more
than 16hrs per week between 4 and 12 weeks after starting will remain eligible for
JSA, reducing the risk for people prepared to try out a new job but concerned about
how it will work out. Generally, this is for people who have been unemployed for
more than 13 weeks, but anyone interested is encouraged to talk to their Jobcentre
Plus adviser who will tell them if they are eligible or not. It is not mandatory and the
referral route is by prior agreement with Jobcentre Plus adviser
Work together
Jobcentre Plus aims, where appropriate, to encourage and support people into
volunteering opportunities when doing so will help the individual to improve their
skills, CV, confidence, gain references and so on. Anyone can be a volunteer, but
anyone interested should speak to their Jobcentre Plus adviser who can provide
advice and support as well as making sure that they are still available for work and
that their welfare benefits are not at risk. It is not mandatory.
Community Action Programme (currently under pilot)
Up to 30 hours of unpaid work per week for up to 26 weeks. The work would
normally be for community benefit and is likely to be with a local authority, charity or
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social enterprise. Concurrent with the placement there will be provider-led job search
and potential additional support of up to 10 hours per week. This is for the very longterm unemployed; typically people who have been through the Work Programme
without finding employment and have thus been unemployed for a minimum of 2
years. It is mandatory and the referral route is through JobCentre Plus
Newcastle Futures65
Newcastle Futures are able to support Newcastle residents of working age, not in
employment (or those in employment of 15 hours or less). Refugees must have
leave to remain or indefinite leave to remain and migrants must be in receipt of a
benefit. We are not able to help customers who do not have access to public funds.
All residents must be unemployed AND match one of the below criteria AND live
within the Newcastle City Council boundaries:
Criteria





Newcastle residents of a specific postcode area*
Lone Parent (with dependant child/children aged 16 years or under)
Workless Families (supporting dependant child/children aged 16 years or
under)
Aged 16 to 24
Sickness Benefit (Incapacity and ESA) Claimant
* To find out if your client lives in an area which is covered by the services or for
information about outreach venues across the city of Newcastle, contact:
Lesley Widdowson
Newcastle Futures
1 Cathedral Square
Cloth Market
Newcastle
NE1 1EE
T: 0800 587 0478 (Freephone)
E: info@newcastlefutures.co.uk
65
http://www.newcastlefutures.co.uk/
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Appendix 5: The prescribing competency framework
Domain A:
The consultation
74
75
Appendix 6: The prescribing competency framework
Domain B: Prescribing Effectively
76
Appendix 7: The prescribing competency framework
Domain C: Prescribing in context
77
Appendix 8: Competencies for supplementary prescribers
78
Appendix 9: The three levels of competency for doctors working with people using drugs and alcohol
1:
2:
3:
Generalist
Intermediate
Specialist
1
2
3
Provide information and advice on harms and risks to people using drugs and alcohol, their families and carers
X
X
x
Work to reduce stigma faced by people who use drugs or alcohol
X
X
X
Provide advice on medical interventions and treatment to people using drugs and alcohol in support of their
recovery needs and goals, and to reduce harm as appropriate
X
X
Develop educational materials on drug and alcohol use to support prevention and recovery
X
X
X
X
X
X
Supporting people to recover
Advice and Information
Identification and diagnosis
Correctly identify people using drugs and alcohol and diagnose substance use disorders
Provide support and advice to generalist doctors on identification of substance use disorders and appropriate
referral pathways
Provide support and advice to intermediate and generalist doctors on appropriate identification and diagnostic
tools and strategies
X
X
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Assessment and Recovery Care Planning
1
2
3
Carry out basic assessment of drug and alcohol use, associated strengths, harms, risks, urgency, and need for
referral to more specialist services
X
X
X
Carry out risk assessment of suicide and harm to others, and assessment of psychiatric comorbidity, and need
for further medical treatment and/or onward referral
X
X
X
Carry out comprehensive assessment of drug and alcohol use, associated strengths, harms, risks, urgency, and
need for referral to more specialist service
X
X
Work with people with less severe or complex needs to devise and initiate recovery care plan in collaboration
with other professionals as appropriate
X
X
Carry out comprehensive assessment of people with more severe or complex needs using drugs or alcohol,
including strengths, risks, comorbidities, and need for interventions
X
Advise intermediate and generalist doctors on assessment and recovery care planning
X
Work with people with the most severe or complex needs to devise and initiate a recovery care plan, drawing on
the full range of treatment models and settings, in collaboration with other professionals as appropriate
X
Providing support, care and medical treatment
Support people using or recovering from drugs or alcohol use in caring for their general mental and physical
health and well-being
X
X
X
Liaise with relevant professionals (including social care, criminal justice, housing, medical, psychiatric,
employment professionals) Provide appropriate management of assisted withdrawal where facilities allow
X
X
X
80
Providing support, care and medical treatment
1
2
3
Provide appropriate management of assisted withdrawal where facilities allow
X
X
X
Implement relevant mental health legislation for drug and alcohol users and lead on supporting people with more
complex psychiatric comorbidity (psychiatrists only)
X
X
X
Provide appropriate support and interventions for families and carers of people using or recovering from drugs or
alcohol use
X
X
X
Prescribe appropriately for people using or recovering from drugs or alcohol, including opioid substitute
prescribing and provision of medications to prevent relapse
X
X
X
Address health needs and comorbidities of drug or alcohol users with more severe or complex needs, in
collaboration with other professionals
X
X
Arrange or provide appropriate psychosocial interventions for people using or recovering from drugs or alcohol
X
X
Carry out, with the person receiving support, regular review of recovery care plans
X
X
Lead on provision of support and medical treatment for people with the most severe and complex needs
X
Appropriately prescribe injectable opioid substitution treatments (if licensed) and other complex prescribing (e.g.
innovative or off-label uses of medicines)
X
Provide liaison drug and alcohol services in acute medical and psychiatric settings
X
Provide expert, specialised support for vulnerable groups of drug and alcohol users, such as young people,
homeless people and pregnant women
X
X
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Providing support, care and medical treatment
1
2
Provide specialist interventions for new emerging drugs of misuse
3
X
Clinical Leadership
Clinical Governance and innovation
Be aware of research and clinical guidelines on drugs and alcohol relevant to clinical role
X
X
X
Participate in research and clinical governance activities, including clinical audit
X
X
X
X
X
Lead on aspects of clinical governance, including clinical audit
Provide leadership on all aspects of clinical governance, and take responsibility for ensuring they comply with
various national standards
X
Lead on development of local clinical guidelines and protocols and contribute to national initiatives
X
Lead research and innovation in treating substance use disorders and supporting drug and alcohol users, to
improve services and care
X
Supervision, appraisal and training
Provide general training in treating substance use disorders and supporting people using drug and alcohol to
generalist doctors and other staff
X
X
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Supervision, appraisal and training
1
2
3
Provide training for medical undergraduates and postgraduates in treating substance use disorders and
supporting people using drug and alcohol
X
X
Provide training and supervision for medical trainees and staff in other disciplines66 in treating substance use
disorders and supporting people using drugs and alcohol
X
X
Supervision, support, training and advice to keyworkers on delivery of psychosocial interventions
X
Provide support, advice, supervision, mentoring and appraisal to intermediate and generalist doctors in treating
substance use disorders and supporting people using drugs and alcohol
X
Provide supervision for non-medical prescribers
X
X
Advise responsible officers on competency issues arising for doctors working with people using drugs and
alcohol in the context of revalidation
X
Advise accountable officers on appropriate uses of relevant controlled drugs
X
Carry out specialist assessment of fitness to practise for the General Medical Council and other professional
organisations, and expert assessment of people using drugs and alcohol in childcare or criminal proceedings
X
66
Postgraduate medical training is subject to specific requirements relating to trainers, for example psychiatry trainees must be supervised by an
appropriately qualified trainer in psychiatry
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Service Development
1
2
3
Support service provision and development locally
X
X
X
Contribute to service management locally
X
X
Champion service user involvement and provide advocacy for service users
X
X
Manage specialist in-patient services for people using drugs or alcohol
X
Provide expert clinical advice on drug and alcohol use to commissioners and providers regarding appropriate
service provision and development in line with research and national guidance
X
Provide expert clinical advice and advocacy on drug and alcohol matters to policy makers nationally
X
Support medical workforce development locally and nationally
X
84