MENTOR PREPARATION FOR NURSING EDUCATION IN NORTHERN IRELAND QUEEN’S UNIVERSITY BELFAST UNIVERSITY OF ULSTER OPEN UNIVERSITY and BELFAST HEALTH AND SOCIAL CARE TRUST NORTHERN HEALTH AND SOCIAL CARE TRUST SOUTHERN HEALTH AND SOCIAL CARE TRUST SOUTH EASTERN HEALTH AND SOCIAL CARE TRUST WESTERN HEALTH AND SOCIAL CARE TRUST Modified October 2009 SECTION 1: INTRODUCTION BACKGROUND The Nursing and Midwifery Council (NMC) has developed a standard to support learning and assessment in practice that has outcomes for mentors, practice teachers and teachers. The NMC published the new Standards to support learning and assessing in practice (NMC Standard 08.06) in August 2006. These are available on the NMC website at http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=2446. The standards identify in detail the new requirements for the training, support and management of mentors, sign-off mentors, practice teachers and teachers of nurses, midwives and specialist community public health nurses from September 2007 onwards. The main purpose of the new standards is to strengthen assessment and learning in practice and to ensure the protection of the public by implementing systems that ensure competency of nursing and midwifery students at the point of registering or recording a qualification with NMC. The new NMC requirements require that pre-registration students and post-registration nursing students commencing after 1st September 2007 must be supported by mentors, sign-off mentors and/or practice teachers who meet the new NMC standards. This requires that Health and Social Care (HSC) Trusts demonstrate that they have the necessary infrastructure in place to meet NMC requirements and service and education programme providers develop mentor, sign-off mentor and practice teacher preparation programmes for approval by NMC. The standard takes the form of a four-stage developmental framework although this document is focusing on that section focusing on mentor preparation to support undergraduate pre-registration nursing programmes (stage 2). The outcomes for the role are identified as different stages within the framework. It is possible to enter or exit from the framework at any stage, and each stage is not dependent on having met the outcomes of a previous stage. The Department of Health, Social Services and Public Safety (DHSSPS) has requested that Northern Ireland Practice and Education Council (NIPEC) project manages the implementation of the NMC standards in Northern Ireland to facilitate HSC Trusts and Higher Education Institutions: To minimise duplication of effort and reduce confusion and misunderstanding To work with service and education programme providers to ensure that programmes developed for mentors, sign-off mentors and practice teachers meet service needs for a regionally developed programme To facilitate the development of adequate numbers of mentors, sign-off mentors and practice teachers to support the programmes commissioned by the DHSSPS. Thus, the development of this programme of preparation was developed in partnership by the three Universities and the service providers within Northern Ireland. The Universities are taking this forward as an amendment to their existing pre-registration nursing and midwifery programmes as identified under Route 1 within the NMC Standards. Route 1 would be suited to programme providers (approved educational institutions and their service partners) who already hold approval for pre-registration nursing/midwifery programmes, programmes leading to an NMC recordable specialist practice qualification …. 2 NMC REQUIREMENTS The NMC has agreed mandatory requirements for each part of the register. These are: Nursing a) Students on NMC approved pre-registration nursing education programmes, leading to registration on the nurses’ part of the register, must be supported and assessed by mentors. From September 2007 a sign-off mentor, who has met additional criteria (paragraph 2.1.3), must make the final assessment of practice and confirm to the NMC that the required proficiencies for entry to the register have been achieved (paragraph 3.2.6). b) Students on NMC approved specialist practice programmes, leading to a recordable qualification on the nurses’ part of the register, must be supported and assessed by mentors. From September 2007 a sign-off mentor, who has met additional criteria (paragraph 2.1.3), must make the final assessment of practice and confirm to the NMC that the required competencies for recording a specialist practice qualification on the register have been achieved (paragraph 3.2.6). From September 2008 support, assessment and sign-off of practice must be by a practice teacher (paragraph 3.3.6). c) Students undertaking NMC approved advanced nursing practice programmes, leading to registration on the sub-part of the nurses’ part of the register, must be supported and assessed by mentors. From September 2007 a sign-off mentor, who has met additional criteria (paragraph 2.1.3), must make the final assessment of practice and confirm to the NMC that the required competencies for entry to the register have been achieved (paragraph 3.2.6). Midwifery d) Students on NMC approved pre-registration midwifery education programmes, leading to registration on the midwives’ part of the register, must be supported and assessed by mentors. All midwifery mentors will have met the additional criteria to be a sign-off mentor (paragraph 2.1.3) as part of their preparation programme. From September 2007 sign-off mentors must make the final assessment of practice and confirm to the NMC that the required proficiencies for entry to the register have been achieved (paragraph 3.2.6). Specialist community public health nursing e) Students on NMC approved specialist community public health nursing programmes, leading to registration on the specialist community public health nurses’ part of the register, must be supported and assessed by practice teachers from September 2007. The practice teacher must make the final assessment of practice and confirm to the NMC that the required proficiencies for entry to the register have been achieved (paragraph 3.3.6). All practice teachers will have met the additional criteria to be a sign-off mentor (paragraph 2.1.3) as part of their preparation. 3 SECTION 2: THE UNDERPINNING PRINCIPLES AND THE NMC STANDARD FOR MENTORS The underpinning principles for supporting learning and assessment in practice for any student undertaking an NMC approved programme leading to registration or a qualification that is recordable on the register are that the NMC registrants: A. who make judgements about whether a student has achieved the required standards of proficiency for safe and effective practice must be on the same part or sub-part of the register as that which the student is intending to enter B. must have developed their own knowledge, skills and competency beyond that of registration through Continuing Professional Development (CPD) – either formal or experiential learning – as appropriate to their support role C. hold professional qualifications at an appropriate level to support and assess the students they mentor/teach, i.e. professional qualifications equal to, or at a higher level than, the students they are supporting and assessing D. have been prepared for their role to support and assess learning and met NMC defined outcomes. Also, that such outcomes have been achieved in practice and, where relevant, in academic settings, including abilities to support interprofessional learning E. intending to record their teaching qualification must have completed an NMC approved teacher preparation programme or have been assessed by the NMC, through its accreditation of prior learning route, as having met the equivalent of this. This document is designed to meet the NMC requirements for preparation of mentors in Northern Ireland. NMC mentor standard An NMC mentor is a registrant who, following successful completion of an NMC approved mentor preparation programme - or comparable preparation that has been accredited by a Higher Education Institution (HEI) as meeting the NMC mentor requirements - has achieved the knowledge, skills and competence required to meet the defined outcomes. A mentor is a mandatory requirement for pre-registration nursing and midwifery (sign-off mentor) students. Mentors who are assessing competence must have met the NMC outcomes defined in stage 2 of this standard, or be supervised by a mentor who has met these outcomes. Those who sign-off proficiency must have met the additional criteria to be a sign-off mentor (see paragraph 2.1.3). All midwife mentors must have met the additional criteria to be a sign-off mentor. Once mentors have been entered on the local register (held by placement providers) they are subject to triennial review (see Roles to support learning and assessment in practice on page 9). Mentors are responsible and accountable for: Organising and co-ordinating student learning activities in practice. Supervising students in learning situations and providing them with constructive feedback on their achievements. Setting and monitoring achievement of realistic learning objectives. Assessing total performance – including skills, attitudes and behaviours. Providing evidence as required by programme providers of student achievement or lack of achievement. Liaising with others (eg. mentors, sign-off mentors, practice facilitators, practice teachers, personal tutors, programme leaders) to provide feedback, identify any concerns about the student’s performance and agree action as appropriate. Providing evidence for, or acting as, sign-off mentors with regard to making decisions about achievement of proficiency at the end of a programme. 4 Criteria for supporting learning and assessing in practice – mentors Registrants who intend to take on the role of mentor will be assessing that students have achieved NMC competencies/proficiency. Only mentors who have met the additional criteria to become a sign-off mentor may assess final proficiency.. Mentors must fulfil the following criteria: Be registered in the same part or sub-part of the register as the student they are to assess and for the nurses’ part of the register be in the same field of practice (adult, mental health, learning disability or children’s). Have developed their own knowledge, skills and competence beyond registration i.e. been registered for at least one year. Have successfully completed an NMC approved mentor preparation programme (or a comparable programme which has been accredited by an HEI as meeting the NMC mentor requirements). Have the ability to select, support and assess a range of learning opportunities in their area of practice for students undertaking NMC approved programmes. Be able to support learning in an interprofessional environment – selecting and supporting a range of learning opportunities for students from other professions. Have the ability to contribute to the assessment of other professionals under the supervision of an experienced assessor from that profession. Be able to make judgements about competence/proficiency of NMC students on the same part of the register, and in the same field of practice, and be accountable for such decisions. Be able to support other registrants in meeting CPD needs in accordance with The NMC code of professional conduct: standards for conduct, ethics and performance. Competence and outcomes for a mentor Mentor competencies are achieved by successful completion of an NMC approved mentor preparation programme that achieves all of the outcomes of stage 2. These outcomes are as follows: Establishing effective working relationships o Develop effective working relationships based on mutual trust and respect. o Demonstrate an understanding of factors that influence how students integrate into practice settings. o Provide ongoing and constructive support to facilitate transition from one learning environment to another. Facilitation of learning o Use knowledge of the student’s stage of learning to select appropriate learning opportunities to meet their individual needs. o Facilitate selection of appropriate learning strategies to integrate learning from practice and academic experiences. o Support students in critically reflecting upon their learning experiences in order to enhance future learning. 5 Assessment and accountability o Foster professional growth, personal development and accountability through support of students in practice. o Demonstrate a breadth of understanding of assessment strategies and the ability to contribute to the total assessment process as part of the teaching team. o Provide constructive feedback to students and assist them in identifying future learning needs and actions. Manage failing students so that they may either enhance their performance and capabilities for safe and effective practice or be able to understand their failure and the implications of this for their future. o Be accountable for confirming that students have met, or not met, the NMC competencies in practice. As a sign-off mentor confirm that students have met, or not met, the NMC standards of proficiency in practice and are capable of safe and effective practice. Evaluation of learning o Contribute to evaluation of student learning and assessment experiences – proposing aspects for change as a result of such evaluation. o Participate in self and peer evaluation to facilitate personal development, and contribute to the development of others. Creating an environment for learning o Support students to identify both learning needs and experiences that are appropriate to their level of learning. o Use a range of learning experiences, involving patients, clients, carers and the professional team, to meet defined learning needs. o Identify aspects of the learning environment which could be enhanced – negotiating with others o to make appropriate changes. o Act as a resource to facilitate personal and professional development of others. Context of practice o Contribute to the development of an environment in which effective practice is fostered, implemented, evaluated and disseminated. o Set and maintain professional boundaries that are sufficiently flexible for providing interprofessional care. o Initiate and respond to practice developments to ensure safe and effective care is achieved and an effective learning environment is maintained. Evidence-based practice o Identify and apply research and evidence-based practice to their area of practice. o Contribute to strategies to increase or review the evidence-base used to support practice. o Support students in applying an evidence base to their own practice. Leadership o Plan a series of learning experiences that will meet students defined learning needs. o Be an advocate for students to support them accessing learning opportunities that meet their individual needs – involving a range of other professionals, patients, clients and carers. o Prioritise work to accommodate support of students within their practice roles. o Provide feedback about the effectiveness of learning and assessment in practice. 6 Mentor preparation programmes Mentor preparation programmes must be: At a minimum academic level of HE (Higher Education) Intermediate level (previously known as level 2) A minimum of 10 days, of which at least 5 days are protected learning time. Include learning in both academic and practice settings. Include relevant work-based learning, e.g. experience in mentoring a student under the supervision of a qualified mentor, and have the opportunity to critically reflect on such an experience. Normally, be completed within three months. Should provide a foundation for undertaking an NMC approved practice teacher programme. Allow AP(E)L to be applied to up to 100% of the programme, and recognise previous preparation of an equivalent nature and standard. It is for placement providers to determine if an individual meets the NMC additional criteria to sign-off a student’s proficiency (paragraph 3.2.6), and therefore they may be placed immediately on the local register with an annotation to identify this. 7 SECTION 3: THE PROGRAMME Admissions (A sample application form is included in Appendix 1) In order to assist the employer in the selection of an appropriate candidate to undertake this course, the employer must select a candidate who: 1. Is a registered first level nurse, midwife and/or specialist community public health nurse. 2. Has been identified through Individual performance review as suitable to function as a mentor before they apply for a training place. 3. Has at least one years’ experience as a practicing nurse or specialist community public health nurse and is deemed competent by their employer to undertake the programme. Part-time workers must have practiced for a sufficient period to be deemed competent by their employer (Hours equivalent to one year full time in practice). 4. Confirm that the applicant is in a role that enables them to function as a mentor. 5. Confirm that the necessary infrastructure will be in place to enable them to undertake the programme through provision of protected time and supervised practice. 6. Confirm that the necessary infrastructure will be in place to enable them to satisfy the NMC Standards for Mentorship after completion of the programme. 7. Has an appointed designated practice supervisor who is a qualified Mentor for a minimum of two years. Structure of the Programme Basic Programme The programme is designed as a blended course of elearning and face-to-face activities. The elearning is primarily based on materials developed for the Making Practice Based Learning Work project funded by the Department of Employment and Learning (NI) and the Higher Education Funding Council (England). However, other relevant NMC, University and other documentation will also be used. The 10 days equivalent of the programme will be divided as follows: 2 days face to face 3 days elearning 5 days mentoring practice 5 days of protected learning time will be provided through: 2 days face to face learning 2 days elearning 1 day practice The 10 days of required learning will be verified by the designated practice supervisor, all course participants are required to maintain an activity log. Sign-Off Mentor Following completion of the programme, those proceeding to become sign-off mentors (including all midwives) will be supervised on at least three occasions for signing off proficiency at the end of a final placement by an existing sign-off mentor or practice teacher. In addition, to be confirmed as a sign-off mentor they will demonstrate: Clinical currency and capability in the field of practice in which the student is being assessed. The NMC requirements to remain on the local register. A working knowledge of current programme requirements, practice assessment strategies and relevant changes in education and practice for the student they are assessing. 8 An understanding of the NMC registration requirements and the contribution they make to meeting these requirements. An in-depth understanding of their accountability to the NMC for the decision they make to pass or fail a student when assessing proficiency requirements at the end of a programme. Methods of Learning A variety of teaching methods and learning environments are used to provide course participants with the best opportunities to study, to develop skills and expertise, produce evidence, and prepare for final assessment. The various methods of teaching include those listed below: Elearning: will provide the theoretical knowledge that the course participant needs to undertake the role of mentor It will be supplemented by Learning in the Workplace – A Toolkit for Placement Tutors, Supervisors, Mentors and Facilitators. This will be available within every Trust. Face-to-face Contact: will provide opportunities for course participants to explore the context of the role will provide an overview of the relevant curricula will enable discussion and analysis of situations and issues which will/may arise in practice Practice Based: The programme includes 5 days of practice learning across the 12 weeks of the programme, based in the course participant’s workplace within a setting that will enable them to demonstrate achievement of the required competencies. The practice learning element of the programme is a fundamental part of the course, which will build on the foundation of the learning achieved through face-to-face and e-learning activities. The practice learning element will be co-ordinated by a designated practice supervisor who will also be responsible for assessing the course participant’s competence. Course participants may also be supervised by other clinical staff in agreement with the designated practice supervisor. The designated practice supervisor will be required to observe and assess course participants during the programme to enable feedback to be provided on on-going progress. The practice based experience: will provide the opportunity to observe, review and apply the knowledge and skills needed for successful mentorship will provide the opportunity to reflect upon and evaluate their own performance as a mentor In order to achieve the required period of practice learning (5 days equivalence) each course participant will be required to demonstrate that the totality of their activities meet this compulsory element of the programme. It is recognised that each course participant will develop at their own pace and meet requirements within a workplace setting; this element of the programme has been designed to accommodate this. Course participants will be required to maintain a portfolio to evidence this. Within the portfolio documentation, course participants are given clear guidance on what learning is required and the resources available for each of the eight domains specified by the NMC. During the practice learning element of the programme it is expected that course participants will be allocated one student to mentor during the 12 weeks of the programme who requires supervision, teaching and assessing for a period of no less than 4 weeks. It is also expected that course participants will be given opportunities to observe experienced mentors in action and participate in activities related to management of pre and/or post–registration programmes for nurses. Assessment Strategy 9 The assessment strategy is practice based and requires that course participants demonstrate that they have integrated theory and practice through teaching, supervising and assessing students in the practice setting. Assessment of Programme Outcomes Assessment of programme outcomes includes formative and summative assessment processes. The programme uses a portfolio approach for collection of evidence to ensure that programme outcomes are met. Regular feedback sessions with their designated practice supervisor will help course participants to build their portfolios and will be offered in a relationship that enhances self-assessment, self-confidence and self-esteem. The designated practice supervisor will meet with course participants, as a minimum, at the commencement of the practice learning and mid-way to provide them with a formative assessment of progress. Each course participant will develop a portfolio of activities, which will provide evidence of critical analysis and on-going reflection of practice, including accounts of direct observation of teaching, supervising and assessing pre-registration students. The portfolio will include the following: Reflective accounts of practice learning Records of teaching, supervising and assessing activities directly observed and assessed by their designated practice supervisor or other approved clinical staff Records of other related activities Summative assessment will take place on completion of the programme. The course participant’s designated practice supervisor is required to assess the portfolio of evidence and discuss this with them to identify that the student has or has not achieved the required outcomes. Successful completion of the programme requires that designated practice supervisors have identified that course participants meet all the required outcomes of the programme, and the form in Section 3 of the portfolio documentation requires to be completed and signed by each course participant and their designated practice supervisor. Failure in Assessment In cases where course participants cannot demonstrate that they meet the required outcomes, the designated practice supervisor will, in collaboration with the course participant, devise an action plan to facilitate the course participant in achieving the required outcomes. The course participant must demonstrate achievement of the required outcomes within a period that does not normally exceed 4 weeks from the initial programme completion date. Entry on local register of mentors On successful completion of the programme the designated practice supervisor will sign a certificate of completion, which will be forwarded to the nominated member of HSC staff for entry of the mentor’s details on the local register of mentors normally held by the healthcare organisation. To maintain this entry all mentors require to have an annual update, arranged between the education and service provider to ensure that they are kept up to date with curriculum changes and related activities. In addition, to retain their entry on the local register, all mentors are required to have a triennial review carried out by their line manager or professional lead to ensure currency of mentor competencies. Entry on the local register will lapse for mentors who cannot demonstrate that they continue to meet current NMC standards. Information held on the local register of mentors will be transferred each week to the Higher Education Institution. This will enable HEIs to verify mentor status. 10 Sign-Off Mentor Annotation on the Local Register of Mentors and Practice Teachers Placement providers are responsible for ensuring that a registrant designated as a sign off mentor and entered on the local register as such has met the criteria specified by the NMC. All mentors are subject to annual appraisal, which will include appraisal of mentor competency. In addition all mentors will undertake triennial review of their mentor role to ensure that they meet NMC triennial review requirements. Through these processes line managers or professional leads will identify mentors for annotation on the local register as a sign-off mentor and will confirm that due regard is met in relation to the students the mentor will be supervising and assessing to ensure clinical currency and capability in the field of practice in which the student is being assessed. This will be confirmed through: discussion with the mentor verification of supporting evidence line manager or professional lead observation of competence. Following confirmation of due regard, an experienced sigh off mentor or practice teacher will be identified who will supervise and assess the mentor in relation to the NMC criteria identified below. The designated sign-off mentor or practice teacher will confirm that the mentor demonstrates the following: An understanding of the NMC registration requirements and the contribution the sign-off mentor makes to meeting these requirements. An in-depth understanding of their accountability to the NMC for their decision as a sign-off mentor to pass or fail a student when assessing proficiency requirements at the end of a programme. In addition the mentor will be supervised by their designated sign-off mentor or practice teacher on at least three occasions for signing off proficiency at the end of a final placement and demonstrate competence in the role. When all of the above has been confirmed, the designated sign-off mentor or practice teacher will confirm to the line manager or professional lead that the mentor has met NMC requirements as a sign-off mentor. The line manager or professional lead will make arrangements for the mentor to be annotated on the local register as a sign-off mentor. 11 Quality Assurance Processes Mentor Programme Review Review Groups will be set up at Regional and HSC Trust level to keep the quality of programme delivery under review. HSC Trust Mentor Programme Review Group Each Health and Social Care Trust will establish a group to keep mentor programme delivery within the Trust under review. The group is required to keep formal minutes of meetings. Membership The review group will meet twice a year and comprises The Education Lead for the Trust (chair of the review group) Nominated Trust representatives involved in programme delivery (agreed by the Trust) Nominated representatives from relevant education providers (agreed by the education providers) Terms of Reference 1. To review a sample of student portfolios to ensure consistency in application of standards, sample size to be agreed by review group members 2. To report to the Regional Review Group and make recommendations to enhance the quality of programme provision Regional Mentor Programme Review Group A regional review group will be established to keep mentor programmes across the HSC Trusts, independent sector and education providers under review. The group will receive reports from the HSC Trust Mentor Programme Review Groups and make recommendations to enhance programme delivery. The group is required to keep formal minutes of meetings. Membership The review group will meet annually and comprises: All Education Leads from HSC Trusts (one will chair the review group) Nominated representatives from Queen’s University, Belfast, the University of Ulster and the Open University. Nominated representatives from the independent sector Terms of Reference 1. To consider the quality of programme delivery in relation to programme objectives, content and outcomes. 2. To consider mentor and student evaluation of the programme. 3. To make recommendations regarding enhancements to programme delivery. 4. To prepare and submit a summary report to the HEI’s for inclusion in the annual report to NMC 12 TABLE 1. STRUCTURE OF THE PROGRAMME Week Content Type of Learning NMC Standards to Support Learning and Assessment in Practice Pre-reading and portfolio for reference NMC Standards for Pre-Registration Education All relevant NMC Standards and Circulars (Course participant to register for NMC circulars and access documentation) (designated practice supervisor identified) 1 role of mentor – accountability and responsibility and protection of the public Face-to-Face (1 day) (HEI led) structure of mentorship programme, methods of learning, introduction to elearning clarification of NMC Standards and the NI context introduction to teaching, learning and assessment in practice Retrieve curriculum documentation for clinical area Commence portfolio - learning contracts 2 Assessment of learning needs, the learning environment, Elearning/Practicebased 3 Planning for learning Elearning/Practicebased 4 Teaching students under supervision Elearning/Practicebased 5 Supervising students in practice and giving feedback Elearning/Practicebased 6 Principles of assessment Elearning Introduction to assessment strategies and schedules for NI courses Face-to-Face (½ day) (HEI led) Case studies on assessment – Failure to Fail 7 Clinical Assessment in practice Elearning/Practicebased 8 Being a mentor in practice Practice-based 9 Being a mentor in practice Practice-based 10 Being a mentor in practice - Assessment of mentoring skills Practice-based 11 Finalising portfolios 12 Reflection, evaluation, review of accountability and responsibility 13 Face-to-Face (½ day)(Trust led) ROLES AND RESPONSIBILITIES The course participant and the designated practice supervisor will establish a learning contract which will ensure successful completion of this NMC approved mentor preparation programme. Course Participant The course participant has to take responsibility for their learning, specifically: 1. Completion of elearning materials and associated activities 2. Attendance and contribution to face-to-face sessions 3. Completion of portfolio with submission of evidence for achievement of learning outcomes 4. Maintain the Time-Log of activities performed 5. Arranging, in consultation with the designated practice supervisor, appropriate experience with pre-registration students 6. Arrange times to discuss progress with their designated practice supervisor. Designated Practice Supervisor 1. Plan a learning schedule, which will provide the opportunity for the course participant to meet their learning objectives and gain competency in mentoring. 2. Facilitate learning by encouraging critical thinking and reflection. 3. Provide dedicated time and opportunities for the course participant to observe how the mentor/sign-off mentor fulfils their role with pre-registration students. 4. Facilitate course participants in undertaking supervised practice with pre-registration students and provide appropriate feed-back. 5. Facilitate the integration of theory with practice in the clinical area. 6. Be able to make judgments about competence / proficiency of NMC students on the same part of the register and in the same field of practice, and be accountable for such decisions. 7. Assess and verify that, by the end of the course, the course participant has completed the required 10 days of study and has met the outcomes.. 8. Complete and forward a copy of the Certificate of Completion to nominated individual within the HSC Trust for entry on the Local Register of Mentors. 14 Manager The manger’s responsibilities include: 1. Selection of appropriate people to undertake the course 2. Selection of appropriate people to act as designated practice supervisors 3. Ensuring that appropriate resources are made available for the course participant and designated practice supervisor to fulfil their roles, including provision of protected time for learning. 15 APPENDIX 1. APPLICATION FORM Name Date of entry to NMC Register PIN Part of Register Sub-Part of Register (Adult/Mental Health/Learning Disability/Children) Current Area of Practice Trust Place of work / Service group Confirmation of support from line manager: Signature of Line Manager Designated Practice Supervisor: Signature of agreed Designated Practice Supervisor Date of Application Date Commencing Course: 16