Psychologically INFORMED Care

• Includes: All individuals involved in providing care/practice or a service to the public (e.g., health and social care workers such as nurses, allied health professions and counsellors- many will acquire these knowledge and skills during undergraduate or pre-registration training ) 
• Knowledge of potential psychological needs, relevant resources, and support services 
• Skills in recognising (eliciting) psychological needs and informing people and carers about the range of emotional and support services available 
• Implementation supported by coaching, reflective practice, and informed line management.  

Psychologically SKILLED Care

• Includes: Public and third sector workers with additional competencies in psychological approaches and a role to provide them as part of their routine care/post/role and can be acquired during training in a wide range of roles in for example health and social care
• Knowledge of psychological theories of adjustment and distress, common mental health problems, and specific psychological techniques. 
• Skills in fostering a collaborative relationship, generic therapeutic competencies, counselling skills, delivering psychoeducation, and delivering specific psychological techniques e.g., stress management 
• Implementation supported by coaching, reflective practice, and informed line management. 

ENHANCED Psychological Practice

• Includes: Public and third sector workers with additional competencies in psychological interventions that have proven evidence base, generally as outlined in the Matrix, and a role to provide them within protected time in their post/role  
• Demonstrates competences mapped to the Competency Frameworks guiding the practice of psychological therapies and interventions (e.g., competencies related to: Generic Therapeutic Competences; Assessment, formulation, engagement and planning competences, and Specific Interventions competencies in Roth and Pilling, 2007, 2015). 
• Delivers psychological interventions following problem level formulations or guided by protocols and may sit within a matched or stepped care model 
• Implementation supported by best-practice implementation structures for governance, including clinical supervision of psychological practice delivery, regular outcome monitoring and clear risk management protocols. 

Learn more about - Enhanced Psychological practice: involves the delivery of evidence based psychological interventions that are often briefer and standardised, in the context of governance structures that support the delivery of these interventions in line with the evidence base.  This practice involves competency assessment (often conducted as part of a training programme), regular supervision that identifies ‘stepping up’ requirements and sufficient ongoing practice to support maintenance of competences (i.e., delivering psychological interventions forms a defined part of the working role).  

The range of this type of practice has expanded as the evidence base has grown, often with very good outcomes for people with mild to moderate difficulties, and less costs, both in terms of treatment burden for individuals accessing them (quicker and more accessible) and financial costs for service providers. These psychological interventions can be delivered by a broad range of staff, use a variety of delivery modes (including group and technologically enabled methods) and can occur outwith the traditional clinical setting. To ensure safety and effectiveness, particularly in terms of ‘stepping up’ to more intensive practice types in the circumstance of non-responsiveness or increased risk, this delivery must be embedded in clear governance structures that supports seamless transition to other services or practitioners where needed. 

Increasingly, enhanced practitioners can also be delivering interventions to those with complex difficulties when delivered as part of an overall managed approach to a care or treatment package. 

SPECIALIST Psychological Practice 

• Includes: Public and third sector workers with specific recognised training in psychological theories and therapies and a role to provide them as a substantive remit of their care/post/role.

The delivery of specialist psychological practice can include: 

•  SPECIALIST psychological therapies based on case formulation:  
• The professional has formal (accredited) training and mental health skills to enable them to treat people with significant psychological and mental health difficulties and for some draws on a background of diverse knowledge of psychological theory to manage multi morbidity 
• Knowledge and skills: competent in all sublevels of the Roth and Pilling Competency Framework (2015) with expertise in at least one psychological therapy and for some meta-competencies from a range of Therapy Competency Frameworks. 
• Demonstrates competences for instance through supervision and the use of recognised fidelity tools, generic and therapy specific meta-competences when implementing the psychological therapy (e.g. see Roth and Pilling CBT Framework, 2007, for more information).  
• Implementation supported by best-practice implementation structures for governance, including clinical supervision of psychological therapies, regular outcome monitoring and clear risk management protocols. 

There is a range of practice included in this category. Some specialist practitioners will also provide individually tailored, formulation driven therapies that integrate professional knowledge of multiple models with the individual’s circumstances to improve functioning and reduce the impact of symptoms on individuals with more severe or complex difficulties.

Learn more about - Specialist Psychological Practice:

There is a range of practice included in this category. This can include therapies and interventions for individual mental health conditions, such as CBT for Social Anxiety, access to which have transformed treatments and recovery rates and form the basis for much of the gold standard clinical evidence guiding psychological practice.

Alongside these, and reflecting the complexity and co-morbidity across the population served, there is a requirement for highly skilled practitioners to provide individually tailored, formulation driven therapies that integrate technical skill with autobiographical information to improve functioning and reduce the impact of symptoms on individuals with more severe or complex difficulties. These practitioners may be trained in one therapeutic modality, for instance trained to diploma level* in Cognitive Behavioural therapy (CBT) at a minimum, or may be trained in several therapeutic modalities. Many can integrate models informed by broad psychological science including developmental theory and trauma. Specialist psychological practice can deliver therapies to people with more complex, longer term or entrenched difficulties which might include several areas of functioning or co-morbidity. These highly skilled practitioners have a central role in the supervision, governance and ongoing upskilling of the wider workforce.  

^{*CBT therapists training before 2010 will have equivalent competencies.}

Governance of Types of Psychological Practice

Psychological practice, is by its’ nature, often accessed by people at a challenging point in their lives or when they are vulnerable. It is essential that enhanced and specialist psychological practice is delivered within a structure of supervision that facilitates safe and effective care. It is also important that the wider workforce involved in psychological care (informed/skilled) have access to structures that support the skill development and wellbeing of the person themselves as well as the people they are caring for, recognising the emotional labour of care and therapy. Examples of the governance structures for each type of practice are outlined in the following table. Further information is found in the Supervision and Governance section. 

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