Care Cluster 18 to 21

Communication, Relationships and Inter-Personal Skills

    These skills reflect being able to communicate effectively with a variety of people on a range of different matters, in whatever form that communication takes (verbal, non-verbal, spoken, written). This includes skills in understanding what others are communicating, skills in expressing oneself, and skills in establishing effective relationships.

    Progression of this skill is characterised by developments in the complexity of the subject matter, situation/context, purpose, number of people being communicated with, diversity/difference, and potential impact.

All Client-Facing, Clinical Staff


Psychological Awareness
Broad Definition of Skills

Building and maintaining positive working relationships with people. Being able to understand what is being communicated, both verbally and non-verbally, and being able to express oneself appropriately (including in writing).

To have an awareness of, and skills in, communicating effectively & supporting people with dementia and their families. To have an awareness of how to communicate with people with dementia and their families about end of life issues.

    Building trust and respect

  • To have an open and pleasant manner when talking with people.
  • To build and maintain trusting relationships with other people requires an ability to:
    • Communicate with warmth, genuineness, understanding and openness
    • Not to make value judgements about the person you are with.
    • Respond with feeling and to be aware of your own feelings.
    • Demonstrate courtesy and respect when communicating with others (as opposed to acting in ways which are rude, disapproving, impatient, belittling, patronising, dismissive, or consciously hurtful).
    • Communicate acceptance and value to other people irrespective of other people’s behaviour, attitudes, beliefs, status or background.

    An ability to communicate effectively with families and systems that support the person with dementia

  • Understanding of the value of effective communication with families, carers and the system as a whole and how this can improve the person’s care.
  • Developing & maintaining effective working relationships with relatives & carers whilst taking into account their needs.
  • Understanding the work of other agencies and having a knowledge when and how to refer on.
  • Understanding the importance of having a consistent staff group for building relationships with people with dementia and their families.

    Accurate, confidential communication of basic information

  • Provide a basic, brief and accurate verbal or written report of what has happened when you have been working with a person with dementia or their family and to share this with other team members.
  • Understand of the importance of confidentiality and have the ability to retain and pass on information appropriately.

    Understanding verbal and non-verbal communication

  • A basic understanding and awareness of body language and nonverbal communication (one’s own, and other peoples’).
  • An ability to change how you speak to suit the understanding of the person you are with and to take account of factors such as age, capacity, learning ability etc.
  • An ability to understand the impact of the person’s age, culture, ethnicity, gender, socio-economic status and spiritual or religious beliefs on how they communicate.

    Responding to Crises/Challenging situations

  • Listen and respond appropriately in situations where the person is highly distressed (for example, by giving them undivided attention, clarifying understanding of the situation).
  • Communicate sensitively when dealing with high levels of distress
  • Apply basic de-escalation skills
  • Apply basic de-escalation skills with the aim of reducing unhelpful behaviours and managing the person’s feelings.
  • Remain boundaried in a crisis (e.g. resisting natural instincts to physically comfort without considering whether this response is in the person’s long term best interests.

    Basic Listening skills requiring an ability

  • Apply basic listening skills (e.g. to listen and respond encouraging the other person to speak by nodding and smiling where appropriate and asking clarifying questions when necessary).
  • Use humour appropriately to help to establish and maintain relationships.
  • Know when talking or being there quietly is most important.
  • Respond sensitively when receiving highly sensitive or challenging information.
  • Communicate an understanding that people are more than their problems or diagnoses (for example, by recognising and valuing the person’s history and life experience).
  • Recognise and respond to changes in emotional states
  • Understand that the way you speak and behave will affect how comfortable people are when they talk to you.

    Maintaining therapeutic boundaries

  • The ability to understand the need to have a professional working relationship (and that one is not a ‘friend’).
  • An ability to understand that it is important to be consistent and to help the person feel secure by:
    • communicating about appointments in a consistent manner.
    • ensuring that confidentiality is maintained, even when sessions are in the community or in public.
    • being clear about how and when communication is permitted to take place (taking into account guidelines and ethics, e.g. around social media, personal phone numbers etc.).
    • ensuring that as far as possible contact between the professional and the client is limited to pre-arranged appointments.
    • ensuring that any personal disclosure by the individual staff member are necessary, helpful, and in the client’s best interests.
    • avoiding giving, receiving or exchanging gifts.
    • ensuring formal boundaries are maintained once the relationship has been concluded and/or during a break in sessions.

    Communicating Empathy

  • An ability to show empathy i.e.:

    • To see things from the other person’s perspective;
    • To understand their thoughts and feelings and how they might see the world.
    • To have the words to express your understanding and how you feel appropriately
    Adapting communication to meet the needs of people with dementia

  • Find more supportive ways to talk with people who may see or hear less well or for whom English is not their first language.
  • Understand why effective communication is important in dementia care.
  • Recognize the factors that can prevent good communication with people with dementia, for example, an understanding of how problems with thinking and memory may make it more difficult to speak with someone with dementia.
  • Understand how communication needs might change with the different stages of dementia (e.g. mild, moderate & severe).
  • See behaviour as a communication of need and be able to recognise what needs the person might be communicating verbally and non-verbally (e.g. hunger, pain, feelings, boredom).
  • Recognise unmet needs and adjust communication and interactions accordingly.

  • Use a range of verbal and non-verbal communication strategies to help to build a relationship and connect with the person with dementia, such as the use of eye contact, saying their name, tone of voice, body language, re-assurance, simple statements and the acceptable & appropriate use of touch.
  • Take into account rhythm, pace, tone and volume when communicating with people with dementia with language difficulties.
  • Recognise changes in the person with dementia’s body language and expressions and use these as cues to guide responses.
  • Identify and avoid the use of patronising language, e.g. using “you” and “your” rather than “we” and “our”, avoiding unsuitable endearments such as “dear”.

  • Communicate simple instructions and be able to respond to requests despite the person’s physical difficulties and problems with memory and thinking (for example, the use of simple sentences, one step instructions, allowing time for the person to respond).
  • Use effective communication skills when assisting the person with their activities of daily living (for example, using the person’s name, introducing the task, explaining actions, using negotiation if the person is reluctant and respecting the person’s choice to say no and to return when they are less agitated).
  • Use positive language with people with dementia (for example, conveying no in a manner that is acceptable, encouraging, reassuring).
  • Manage repetitive questions by validating their emotions and redirecting the person.
  • Support people with dementia who may be reliving a trauma (for example, by connecting with them, empathising, listening and redirecting when calmer).
  • Understand how “appropriate” life story information can be used to support effective communication.
  • Create and use aids and memory books and aids to assist with communication with people with dementia.s
  • Close interactions appropriately (e.g. smiling, reassuring, thanking, shaking hands).

  • Communicate simple instructions and be able to respond to requests despite the person’s physical difficulties and problems with memory and thinking (for example, the use of simple sentences, one step instructions, allowing time for the person to respond).
  • Use effective communication skills when assisting the person with their activities of daily living (for example, using the person’s name, introducing the task, explaining actions, using negotiation if the person is reluctant and respecting the person’s choice to say no and to return when they are less agitated).
  • Use positive language with people with dementia (for example, conveying no in a manner that is acceptable, encouraging, reassuring).

  • Manage repetitive questions by validating their emotions and redirecting the person.
  • Support people with dementia who may be reliving a trauma (for example, by connecting with them, empathising, listening and redirecting when calmer).
  • Understand how “appropriate” life story information can be used to support effective communication.
  • Create and use aids and memory books and aids to assist with communication with people with dementia.s
  • Close interactions appropriately (e.g. smiling, reassuring, thanking, shaking hands).

Qualified
Mental Health Professionals

(Any graduate-level healthcare professional) Without further accredited training in delivering psychological interventions

Psychologically-Informed Healthcare
Broad Definition of Skills

More advanced communication skills with individuals pertaining to maintaining positive working relationships. Being able to communicate in circumstances that present particular difficulties.

To have well-developed skills in communicating effectively and supporting people with dementia and their families. To have a well-developed understanding of, and skills in working with, families and systems involved in the care of people with dementia, including being able to effectively respond to any challenges. To have a more detailed understanding of how to communicate with people with dementia and their families about end of life issues.

    Maintaining trust and respect in challenging situations

  • Prepare an individual to receive significant news, being mindful of how people might respond to concerns/anxieties regarding a potential diagnosis of dementia, including respecting the right of the individual not to know.
  • Respect, support and promote equality and all aspects of diversity when communicating with people with dementia.
  • Confirm a diagnosis, or discuss other significant news, with sensitivity, following a script and under supervision. For example, finding out what the person already knows or suspects about their diagnosis, exploring what the diagnosis means to the person.
  • Give support to the individual following the experience of receiving a diagnosis of dementia.
  • Demonstrate understanding of the importance of an ability to work consistently in a crisis.

    Communicating collaboratively with families and the care network

  • Communicate collaboratively with the families of people with dementia when planning assessments, treatments and interventions.
  • Provide appropriate guidance, information and advice.
  • Acknowledge and validate the impact that caring for a person with dementia may have on family relationships.
  • Acknowledge and validate the impact of caring for a person with dementia on younger carers.
  • Communicate compassionately and in a timely manner with care partners (e.g. families, other agencies and systems).
  • Work effectively and sensitively with other agencies and systems in the best interests of the person dementia and their family.
  • Understand systemic approaches to working with families and services

    Communicating one’s professional opinion

  • Communicate one’s own professional opinion or view (both formally and informally, in writing and verbally).

    More advanced communication skills

  • More advanced interpersonal communication skills involving an ability to:
    • Communicate accurate listening by, for example, the use of summaries/paraphrases/the reflecting of feelings.
    • Actively monitor the effectiveness of one’s own communication, for example, by monitoring the person’s level of understanding using two-way feedback/clarifying questions.
    • Choose and use closed and open question formats.
    • Ask about and explore the person’s values and beliefs.
    • Negotiate
  • Explain the concept/importance of boundaries (as well as establishing, agreeing, and maintaining these throughout the therapeutic relationship).
    • Articulate and handle differences of opinion sensitively
    • Use self-disclosure in an appropriate manner (to aid intervention/moving the client on).

    Maintaining and understanding communication in challenging situations

  • The ability to maintain communication when receiving highly sensitive or contentious information or in situations where there is high expressed emotion (e.g. by communicating with the person within their frame of reference; by responding to emotion rather than content)
  • An ability to understand that people’s emotional expressions (including aggressive behaviour) are a form of communication
  • The ability to communicate about sensitive subjects, such as sexual functioning or continence
  • The ability to help people find a language with which to articulate and discuss feelings
  • Communicate about sensitive subjects in a straightforward way, such as sexual functioning , personal care or continence.

    Communicating complex information clearly and effectively

  • Develop more advanced written communication skills – being able to write for different audiences (client/other professional) and purposes (information/opinion); this might involve:
      • Feedback the outcome of an assessment.
    • Communicate effectively in writing, for example, in a clear, grammatical and succinct way, avoiding the use of jargon.
    • Understand the importance of the legality of the written record (e.g. observable facts…” I noticed that Fred was….”)
    • Explain complex issues (for example risk assessment, care plans) in formal situations (such as ward rounds, meetings with relatives).

    Leading effective discussions in teams and networks

  • Use oral presentation skills to contribute or lead effectively in group settings, for example:
    • In meetings within the team or other services/agencies.
    • In group settings such as psycho educational groups or skills groups.
    • Formal presentations.
  • Adopt a Team approach to delivering care and developing a shared psychological understanding of the person and their needs (& where appropriate, involving the person’s family as core members).
  • Have a basic understanding of team and relationship dynamics.

Qualified (Uni-Model) Psychological Therapists

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Evidence-Based Skills
Broad Definition of Skills

Ability to communicate effectively within the context of a specific therapy relationship. Advanced communication skills. To have specialist skills in communicating effectively and supporting people with dementia and their families. To have a specialist understanding of how to communicate with people with dementia and their families about end of life issues.

    Advanced listening skills

  • Use advanced questioning styles that aid intervention/moving a person on – e.g. Socratic questions, circular questions, solution-focused questions.
  • Notice and respond to subtle behaviour changes (e.g. shifts in mood).

    Maintaining and understanding communication in challenging situations

  • Communicate with distressed individuals (e.g. being able to use psychological techniques to validate the person’s feelings, utilise communication strategies to reduce the levels of distress).

    Communicating a uni-model perspective

  • Summarise and present uni-model psychological ideas/opinions/views (e.g. the nature and purpose of specific models/techniques) in an appropriate and flexible form and style (e.g. verbally/written/diagrammatically; collaboratively/didactically); in different contexts (therapeutic/professional; formal/informal settings).
  • Use single model formulations to assist multi-professional communication and understanding

    Training staff in communication skills

  • Train unqualified and qualified staff in the use of communication skills..

    Communicating effectively with families and the care network

  • Balance competing needs, for example, the needs of carers, those people with dementia and involved services.
  • Liaise and negotiate with families/services/teams and across multiple agencies or with a complex range of health care professionals.
  • Understand the significance of relationships and dynamics when interacting with family members and significant others of people with dementia.
  • Articulate and defend the needs of the person with dementia to others and to ensure that where possible they are met.

    Presentation skills

  • Deliver formal presentations within the area of knowledge, from the perspective of one model.

    Communicate dementia diagnosis and its impact on the person and care network including a specialist ability

  • Prepare an individual to receive a diagnosis of dementia.
  • Skilfully communicate a diagnosis and its impact to an individual and their families (for example, being able to clearly explain the diagnosis and check understanding, get a balance between the different communication needs of people with cognitive difficulties and their family members, be able to moderate the emotional impact of a diagnosis while ensuring clarity, ensuring any mitigating language used has not resulted in misinterpretation of any diagnostic information).
  • Sensitively support the individual during and following the experience of having a diagnosis of dementia (for example, to be able to carry out an emotional exploration of the diagnosis).
  • Have well-developed written communication skills (e.g. adapting written communication to meet the needs of different people, e.g. people with dementia, their families, other professionals, communicating about psychological issues).

    Communication skills to meet specific needs of people with dementia including a specialist ability

  • Communicate with people varying levels of cognitive ability and to be able to adapt communication skills to effectively meet individual needs and experiences.
  • Communication skills with the person with dementia and their family to enable them to understand the psychological processes involved in their approaching death, making adjustments for the lack of verbal communication, pain, psychological and behavioural distress.

    A specialist understanding of how to communicate with people with dementia and their families about end of life issues.

  • Communicate skills with the person with dementia and their family to enable them to understand the psychological processes involved in their approaching death, making adjustments for the lack of verbal communication, pain, psychological and behavioural distress.

Highly Trained Psychological Workers

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Specialist Skills
Broad Definition of Skills

Ability to communicate in complex and difficult situations where a great deal of sensitivity and a high level of understanding are required.

Specialist advanced communication skills. To have highly specialist skills in communicating with people with dementia and their families.

To have highly specialist skills in working with families and systems involved in the care of people with dementia, including an understanding and management of inter-personal dynamics from a multi-model perspective, in terms of dynamics within the team, and between the team and client. To have highly specialist skills in communicating with people with dementia, their families and colleagues about end of life issues.

    Communicating about complex issues and significant challenges

    Individual and Family Level

  • Maintain positive therapeutic relationships whilst communicating about highly complex issues in the context of particularly significant challenges. For example, with those who do not agree that their problems have a psychological element, or hold very fixed beliefs, or whose attachment style makes communication challenging, or where symptoms of complex trauma make communication difficult, or where it is important to take account of other co-existing conditions.
  • Communicate a diagnosis of dementia in situations that are challenging and complex (for example, when the dementia is rare or unusual, when there is significant co-morbidity, or when the person is younger).
  • Communicate effectively with people with dementia or their families who have complex psychological or interpersonal difficulties.

  • Communicate with people with dementia and their families when their situations are more complex (e.g. rarer forms of dementia, young onset dementias)

    • Care Network Level

  • Communicate effectively (for example, a professional opinion or view) regarding highly complex issues, both verbally and in writing, within formal and informal settings, from a multi-modal/integrative psychological framework.
  • Build and maintain trusting relationships in situations where there are significant challenges, for example;
    • On-going difficulties with trust
    • On-going issues of conflict, difference of opinion or avoidance

    Highly specialist skills in multi-model approaches to work with families and systems involved in care of people with dementia

  • Maintain the active and parallel involvement of multiple members of a group e.g. family members, team members, therapy group members, and to communicate with each of them in a way that is congruent with their different developmental stages or roles within the family/group/team/system.
  • Communicate in situations where there are complex dynamics.
  • Encourage reflection on systemic issues/team dynamics.
  • Adopt a team approach to a psychological intervention (or care).
  • Communicate complex verbal information effectively to other staff.

  • Provide specialist consultation and support to ensure effective use of psychological skills within Teams.
  • Adapt communication style to provide integrative/multi-modal support/supervision/consultation/advice/leadership to staff of varying levels of experience/knowledge/skill.
  • Formally present scripted and non-scripted material about a range of highly complex issues from an integrative/multi-modal psychological perspective, whilst using strategies to maximise the learning of others (e.g. encouraging audience participation).

    Communicate with people with dementia and their families in relation to end of life issues, including a highly specialist ability

  • Communicate sensitively with people with dementia and their families as they approach the end of their lives, enabling them where possible to make the best possible choices to ensure ‘a good death’.
  • Make reasonable adjustments for people who are unable to communicate due to the stage of dementia, sensory disability, physical illness, pain, religious or cultural differences.
  • Help people to communicate their wishes by making an opening for a discussion in relation to topics such as wills, power of attorney, advanced directives, funeral services, bequests and other preferences.
  • Communicate knowledge about local resources to the multi-disciplinary team to enable them to support the person to make ‘a good’ death’.

Principal Psychologists



Delivery of
Specialist and Complex Skills
Broad Definition of Skills

Ability to work with the most challenging of interpersonal situations and contexts with confidence. To have advanced psychological skills in communicating with people with dementia.

To have advanced psychological skills in working with families and systems that provide care for people with dementia. To have advanced psychological skills in communicating with people with dementia, their families and colleagues about end of life issues.

    Communicating in complex and profoundly challenging situations

  • Advanced psychological skills in communicating with those who present profound challenges to engagement.

    Exercising leadership and negotiation in complex, challenging situations

  • Lead, negotiate, and contribute to decision making according to a number of competing interests.
  • Negotiate on behalf of the person with dementia and their family to ensure that their psychological needs are heard understood and met.
  • Communicate a professional opinion/view within a multi-modal psychological framework, and maintain it in challenging circumstances.
  • Work with those people or systems where previous communication attempts have broken down through lack of skill, knowledge or experience, for example, families of people with dementia that are difficult to engage.
  • Contribute to the development of services that meet the communication needs of people with dementia.

    Collaborative communication with network services and systems

  • Work in collaboration with other specialist services (e.g. Recovery Teams, Crisis Teams, Care Homes) to effectively meet the needs of people with dementia who have complex presentations or circumstances.
  • Develop strong working relationships with other professionals including other service leads.
  • Respond to/manage communication difficulties caused by, for example, clashes in communication styles, in systemic contexts.

    Advanced ability to communicate with people with dementia, their families and network systems about end of life issues

  • Use of communication skills when working clinically with people with dementia, their families and staff groups where the factors around their end of life are particularly complex and challenging, to ensure they have ‘a good death’.
  • Help to inform families about distressing information and/or to lead ‘day after death’ meetings for families and staff groups.
  • Use communication skills, including group work skills, to support Teams who may have experienced had particularly difficult deaths of the people that they were caring for.
  • Communicate clearly with NHS Trusts/Organisations management about the need to develop and support the development of psychological processes around the care of those people dying with dementia, and their families.

Lead/Head Psychologists



Delivery of Organisational-Level and Competency Initiatives, Service Development, and Clinical Governance
Broad Definition of Skills

An ability to take a position of ultimate responsibility regarding communication about psychological strategy, decisions, and governance. To have highly specialist skills in communicating with people with dementia, their families, colleagues and NHS Trust/Organisation-wide systems about end of life issues.

    Communicating and building influence at a senior organisational/network level involving an expert level

  • Develop strong working relationships with directors, commissioners and policy providers at a local and national level.
  • Explain strategic and organisational decisions to everyone in an organisation or professional group.

    Developing and improving services

  • Develop and implement policies, taking into account the needs of the organisation, high level professional guidance, and the overall research base.
  • Speak with confidence at formal events within and outside the NHS Trust/Organisation.
  • Work at an organisational level to ensure that all staff have an awareness of dementia and understand how to communicate effectively with people with dementia.

    Communicating with people with dementia, their families and the care network regarding end of life issues, including an expert ability to:

  • Communicate clearly at a local, regional and national level in professional and public fora about best practice in meeting the psychological needs of people with dementia and their end of life care.
  • Enable people with dementia, their families and the staff who care for them to articulate their psychological needs and to help to develop and support services which best meet these, locally, regionally and nationally.
  • Ensure that there are systems in place to provide audit, research, publication and dissemination to develop the evidence base in this area.

Assessment and Formulation

    Assessment is the process of gathering relevant information and data in order to help to understand a problem. Psychological formulation is the active process of using this information to inform an intervention plan, according to evidence based principles. Therefore, formulation is normally carried out by an accredited practitioner or a counselling/clinical psychologist. These qualified practitioners would work within teams to share the psychological formulation and its importance in the delivery of care.

    Assessment and formulation are core aspects of psychological work, and are normally on-going processes rather than one-off events. As such, there are different levels of skill appropriate to different purposes and contexts. Increasing skill in this domain reflects greater ability to be able to access and synthesise information from a range of sources.

All service user-facing, clinical staff


Psychological Awareness
Broad Definition of Skills

Pre-diagnosis and Diagnosis

To have a basic awareness of what an assessment for dementia entails.

Working with Stress, Anxiety & Depression in people with dementia and their families

To have a basic awareness of holistic assessment principles, including psychological issues, capacity, and risk. To be aware of how assessment information informs a formulation, and to have an ability to contribute to this process.

Person-centred care and working with psychological and behavioural signs of distress

To have a basic awareness of, and be able to contribute to, a person-centred assessment. To be able to identify potential triggers to distress experienced by people with dementia and contribute towards the assessment and formulation of these.

End of Life Care

To have an awareness of how to contribute towards an assessment of psychological needs for people with dementia who are approaching the end of their life.

    Basic awareness of assessment for dementia signs and symptoms

  • An ability to identify the early signs and symptoms of dementia and to be aware of other conditions which may have or present with similar symptoms (e.g. B12 deficiency, thyroid problems, mood difficulties), under supervision and guidance.
  • Sensitively communicate post diagnostic information, under supervision and guidance.
  • An ability to signpost on for a diagnostic assessment, when appropriate.
  • An understanding of what an assessment for dementia entails and how it might feel to be assessed.
  • A basic awareness of what a multidisciplinary assessment for dementia entails and how to contribute to this.
  • An ability to contribute to the Team’s process of diagnosis, under clinical supervision and guidance, using the knowledge obtained through observation and interaction with the person with dementia and their family.

    Basic understanding of holistic assessment and formulation of stress, anxiety and depression for people with dementia and their families and an ability to contribute to the process

    Assessment

  • A basic ability to contribute to a comprehensive, holistic, person-centred assessment of mental health problems in a person with dementia or their family:
    • To identify the concerns and priorities of people with dementia and their families in relation to their mental health.
    • To observe the person with dementia and gather information that contributes to an assessment and/or formulation of mental health problems in people with dementia (e.g. using ABC charts or record sheets), under guidance and supervision.
    • To recognise signs of depression and anxiety in people with dementia.
    • A basic understanding of the importance of confidentiality.

    Engaging with families, teams and networks

  • A basic ability to work as part of a team, engaging with other professionals who are contributing to the assessment and respecting their points of view.
  • A basic ability to engage with others (such as family members) that are directly involved in the care of the person with dementia and acknowledge their perspectives as part of the assessment.

    Basic understanding of formulation

  • A basic understanding of the function and the importance of formulation to inform intervention.

    Psychosocial factors and risk

  • A basic understanding of commonly–encountered psychosocial factors that frequently feature within psychological formulations (e.g. sexual/physical/emotional abuse; neglect; grief/loss; physical health issues).
  • An ability to respond appropriately if these issues are raised by the client and know where and how to signpost on.
  • A basic understanding of the function and appreciation of the importance of risk assessment and how to contribute to it.
  • A basic understanding of when to act immediately and when to seek help from someone more experienced.

    Contributing to person-centred care

  • An ability to contribute towards a person-centred assessment and formulation:
    • An awareness and knowledge of how to contribute towards a person-centred assessment, including the importance of the person’s life history, preferences, health.
    • An ability to recognise changes in mood and behaviour and to understand what might affect this, including their own interaction with the person with dementia.
    • An ability to recognise the link between the person’s emotions & key thoughts.

    Recognising triggers for psychological and behavioural distress

  • An ability to recognise possible key triggers for psychological and behavioural signs of distress, including the six common areas where needs are not met (i.e. physical health, features of the dementia, personal history, personality features, environment & mental health).
  • An ability to carry out some basic monitoring of behaviours (e.g. to help to establish physical health problems, pain, distress, boredom) using simple record sheets and ABC charts, under guidance and supervision.
  • An ability to link the findings from this monitoring to the person’s care plan.

    Accurate recording of information

  • An ability to accurately report, and legibly record, information gathered in appropriate records and to understand that these have a legal status.

    Working collaboratively

  • An awareness of how work with other staff to develop an agreed explanation for the behavioural and psychological signs of distress and / or unmet need and contribute towards a person centred formulation.

    Basic ability to assess needs and contribute to care plan of person with dementia’s end of life issues

  • To contribute towards the assessment of the person with dementia’s end of life needs and be able to share information with other members of the team in order to develop and an end of life care plan.
  • To be alert to changes in the person’s mood and well-being and to share this with other members of staff.
  • A basic awareness of risk assessment in relation to caring for a someone at the end of their life.
  • A basic awareness of capacity assessments in relation to caring for someone at the end of their life.
  • To share the known and expressed preferences of the person with dementia with the Team to enable them to contribute to the end of life care plan.
  • A basic awareness of factors leading to increased risk and an ability to share concerns with more senior colleagues.

Qualified
Mental Health Professionals

(Any graduate-level healthcare professional) Without further accredited training in delivering psychological interventions

Psychologically-Informed Healthcare
Broad Definition of Skills

Pre-diagnosis and Diagnosis

To have an understanding of the assessment and diagnosis process for people with suspected dementia & be able to contribute to this process.

Working with Stress, Anxiety & Depression in people with dementia and their families

To be able to carry out a basic holistic assessment for people with dementia and their families, incorporating psychological factors alongside biomedical and social factors.An ability to use assessment information to inform the development of basic formulations that can guide interventions or enhance understanding of problems, under guidance & supervision.

Person-centred care and working with psychological and behavioural signs of distress

To be able to conduct a person-centred comprehensive assessment and carry out a presentation targeted assessment.

End of Life

A more detailed ability to carry out an assessment of the person’s psychological needs relating to the end of their life. An ability to relate the knowledge of the individual to a model of loss and bereavement and to contribute to a shared formulation of the person end of life needs.

    To contribute towards multidisciplinary assessment for dementia

  • To have a discussion with the person about the possibilities of a diagnosis of dementia and its implications in straightforward situations, using a script as a guide, after prior clinical supervision.
  • To establish the person’s capacity to consent to an assessment of dementia.
  • To discuss potential barriers to diagnosis and the possible reasons why people may not want to proceed with the formal diagnosis.
  • To respect the person’s wishes about refusing assessment or intervention, to document and share them appropriately.
  • To gather relevant information to contribute to the diagnostic process, using a script as a guide, after prior clinical supervision.
  • To take a history from an individual who may be anxious, nervous or agitated and to know when to signpost on to other services.
  • To assess cognitive difficulties using basic cognitive screens (e.g. ACE3, 6CIT) and to interpret these under guidance and supervision. (see glossary).
  • To monitor for cognitive change over time using basic cognitive screens.
  • To recognise one’s personal limitations within the assessment process, have a knowledge of when to refer on to other services and an ability to share this with the person with dementia and their family.
  • To gather information from a person with dementia and their family in a sensitive way in order to elicit information to detect the progression of dementia and to share this in a care planning process.

    A more detailed ability to accurately collect information that feeds into an assessment and/or formulation

  • via semi-structured clinical interview
  • via observation of the person with dementia’s behaviour and other information sources
  • via structured self-report questionnaires, including the ability to accurately score these and use the data as a source of information, using standard service measures administered under advice and supervision from those with higher levels of skill.

    A more detailed knowledge of and ability to contribute to the process of a comprehensive, holistic, person-centred assessment.

    Person-centred assessment

  • A more detailed ability to assess psychological factors at a general level:
    • Differentiating thoughts, feelings, behaviours, physiological distress and relevant environmental factors.
    • Eliciting relevant problem factors (what, when, where, why, with whom, how).
    • Identifying triggers, maintenance processes, strengths and resources.
    • Eliciting relevant historical information.
    • Asking about sensitive areas (e.g. relating to sexual/physical/emotional abuse; neglect; grief/loss; physical health issues; sexuality, spirituality).
    • Working in a way that acknowledges and values the personal, social, cultural and spiritual strengths and needs of each individual.
    • Recognising the impact of the dementia on the person’s psychological difficulties.

    Understanding simple models of formulation

  • A more detailed ability to use and understand the information gained from psychological assessment and formulation (under guidance and regular clinical supervision).
    • A more detailed understanding of how to use a simple model of formulation e.g. “5 P” formulation (clear description of the Problem; historical Predisposing factors; triggering Precipitating factors; Perpetuating or maintaining factors including avoidance; Protective factors/resources) when thinking about their work with people with dementia.
  • A more detailed ability to recognise depression, anxiety and stress in people with dementia and their families and signpost or refer on as appropriate.

    Risk assessment

  • A more detailed ability to assess areas of risk, and contribute to a wider assessment of risk (e.g. an ability to recognise risk issues identified through client disclosure or a family member’s/other professional’s report, or through awareness gained through understanding current and historical information or observation of client behaviour, including recognising someone’s intention to act).
  • A more detailed ability to recognise the limits of their competence in assessing risk, and the importance of following advice, support, and supervision, being able to refer on in an appropriate and timely manner. (N.B. Issues in relation to risk should ALWAYS be taken to clinical supervision/Team Manager - see Professional Development. Supervision and Training section)
  • A more detailed ability to identify specific risk factors of relevance to people with dementia, their families, carers and the wider community.

    Assessment of capacity

  • A more detailed awareness of what an assessment of capacity is and a general awareness of the legal implications of capacity.

    Motivation and suitability for psychological work

  • A more detailed awareness of motivation and suitability factors in relation to psychological work (e.g. an awareness of the person’s ability to describe their mood and behaviour and to want and be ready to work to change their situation).

    Working with other carers and networks

  • A more detailed ability to engage with other people that are directly involved in the care of the person with dementia and identify their perspectives as part of the assessment.
  • A more detailed ability to feedback the results of assessment and agree an intervention plan with all relevant parties, under clinical supervision and guidance.

    Adhere to sound therapeutic principles in working with the person with dementia and their family members

  • Adapt approaches to work with people with dementia from different cultural and ethnic backgrounds.
  • Ahere to sound therapeutic principles, under supervision, even when not engaging the client in formal therapy

    A more detailed ability to use the principles of person centred care, recognising the perspective of the person with dementia and the importance of their beliefs and values.

  • A more detailed ability to carry out a scripted, evidence-based, bio-psychosocial assessment of behaviour, this may include the use of the Newcastle Model (see glossary) and/or a positive behavioural support model (see glossary), following training and supervision. This would include the six common areas where need is not met:
    • Physical Health (e.g. pain, constipation)
    • Features of dementia (e.g. type and stage)
    • History (e.g. job, lifestyle, significant events, trauma)
    • Personality features (e.g. tendency towards depression, need for reassurance, tendency to withdrawal)
    • Environment (e.g. layout, carers)
    • Mental Health (e.g. psychosis, depression)

    Accurate information and use of standard measures involving a more detailed ability

  • To gather relevant observational information about a person with dementia’s psychological state, including potential early signs of distress and triggers for changes in mood and behaviour, in order to inform an assessment of the person’s behaviour.
  • To assess and review communication skills and styles of interaction between the person with dementia, family and other carers.
  • To assess when a person’s feelings and perception of a situation may affect their behaviour, including their experience of pain or their reaction to the behaviour of others.
  • To assess and review the meaningful social contacts and daily occupations of the person with dementia.
  • To carry out a formal assessment of behaviour (including an assessment of behaviours that put the person with dementia or others at risk).
  • To carry out an appropriate assessment of need using methods such as ABC charts, functional analysis assessment tools (see glossary), behavioural frequency monitoring, following training and supervision.
  • To accurately report, and legibly record, information gathered in appropriate records and to understand that these have a legal status.

    Contributing to psychological formulation

  • A more detailed ability to contribute to the process of psychological formulation, using the six features of unmet need (Physical health, Features of Dementia, History, Personality Features, Environment, Mental Health) and the development of a person-centred, co-produced care plan under supervision.
  • An ability to recognise and contribute to the formulation of the person with dementia’s strengths, in addition to their needs.
  • A more detailed ability to contribute to making recommendations about proposed interventions.

    Ability to develop simple formulation under guidance

  • To develop a simple formulation, based on knowledge of loss and bereavement for a person with dementia’s end of life needs, under supervision and guidance.

    More detailed ability to assess person with dementia’s end of life psychological needs

  • To carry out an assessment of the person with dementia’s end of life psychological needs.
  • To enable the person with dementia, where possible, to make simple choices about their care based on their past preferences and family recommendations.

    Assessing risk and distress at the end of life

  • A more detailed ability to be alert to situations of increased physical risk or psychological distress e.g. due to deterioration in condition, changing environmental circumstances, family visits etc. and to share this with other staff.

Qualified (Uni-Model) Psychological Therapists

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Evidence-Based Skills

Specialist Clinical Staff

This might include Assistant clinical or counselling psychologists clinical psychologists in training on older adult placements, IAPT workers who are age champions, BABCP therapists whose registration for a specific psychological therapy includes an interest in and skills for adapting this to working with older people, nursing staff with experience of working in older age services and e.g. a Diploma In Dementia care or a specific therapy, Occupational/physio or speech and language therapists who have the skills and competencies to provide specific therapeutic inputs for people with dementia.
Broad Definition of Skills

Pre-Diagnosis and Diagnosing

To be able to carry out comprehensive assessments that inform a psychological intervention plan. To be able to use assessment information to formulate from a psychological perspective that integrates theory with practice.

Working with Stress, Anxiety & Depression in people with dementia and their families

To be able to carry out comprehensive uni-model assessments that inform a psychological treatment plan. To be able to use assessment information to formulate from a specific therapeutic perspective that integrates theory with practice.

Person-centred care and working with psychological and behavioural signs of distress

To be able to carry out and individualised assessment and biopsychosocial formulation.

End of Life

A specialist ability to carry out an assessment and formulation of the person’s end of life of their psychological needs and to integrate this into the person’s assessment and formulation.

    Conduct pre-diagnosis counselling regarding dementia including a specialist ability

  • Carry out a pre-diagnostic counselling session according to scripted guidance.
  • Recognise the potential psychological barriers to diagnosis and the possible reasons why people may not want to proceed with the formal diagnosis.
  • Accept a person’s wishes about refusing assessment or intervention, to document and share this appropriately.

    Comprehensively assess dementia including use of standardised measures

  • Undertake a comprehensive scripted assessment for common presentations of Alzheimer’s Disease, vascular dementia or mixed dementia (e.g. Alzheimer’s Disease & Vascular dementia).
  • Administer, accurately score and interpret basic cognitive assessment and pre-diagnostic measures, under supervision (e.g. Mini ACE, ACE-3, MOCA).

    Promote equality of access to assessment and meet specific needs of diverse groups

  • Tailor the assessment process to the specific needs of people from diverse groups (e.g. those with intellectual disabilities, and those who may be Bi-sexual, Lesbian, Gay and Trans-gender).
  • Recognise the importance of equal access to dementia assessment and diagnosis for people from diverse communities and to be able to provide effective clinical care to people from particular ethnic groups (i.e. cultural competence).

    Identify and manage differences in opinion

  • Recognise differences in opinion about the diagnostic process and to understand how to manage these
  • Recognise that possible errors may be made in diagnosis and the impact of these on the person and their family.

    Identify need for onward referral of complex cases

  • An ability to recognise when to refer on complex or less clear cut cases (e.g. people with high pre-morbid functioning, mild cognitive impairment, mood difficulties and more complex dementia presentations), after discussion in clinical supervision.

    Supporting the person and family regarding the impact of a dementia diagnosis

  • Manage communications sensitively about the diagnosis of dementia and its related implications in professional and family settings under clinical supervision and guidance.
  • Support the person and their family to manage the impact of a diagnosis including working through the ‘normal’ reaction to a changed future.
  • Recognise changes in role in the family, including continuity/discontinuity in relationships, brought about by changes in the person with dementia’s physical or mental state.
  • Acknowledge and work with feelings of shame, encouraging the person with dementia and their family to treat each other with care and compassion.
  • Recognise the ‘burden’ and possible embarrassment that caring for a person with dementia may put on the family and other carers.
  • Respond to the emotional, existential and spiritual experiences of people facing, or having been given a diagnosis of dementia.

  • Understand and acknowledge the complex impact of a diagnosis for younger people with dementia and their families.

    Sharing information and establishing a formulation-based intervention under supervision

  • Share the information gained in the assessment process to establish a straightforward formulation to inform intervention, under clinical supervision.

    Working to agreed service standards

  • Work within the service standards agreed through the Memory Services National Accreditation Programme.

    Conduct a detailed assessment

  • Carry out a thorough assessment of psychological factors to inform a therapeutic intervention from a specific theoretical perspective.
  • Adapt the assessment process to meet the needs of the person with dementia.

    Awareness of other options and referral pathways

  • Be aware of other appropriate options and to refer on.

    Use assessment to develop a standard formulation

  • Integrate assessment information with theoretical knowledge to develop a formulation that is drawn from standard formulation models for specific disorders.

    Assess motivation and suitability for psychological work

  • Assess motivation and suitability for psychological work (including timeliness, appropriateness and safety) with reference to a specific psychological model.

    Adapt formulation to meet specific needs of person with dementia

  • Have a developed competence to adapt the formulation meet the needs of the person with dementia (for example, representing it in a pictorial form rather than verbal, repeating the information in several modalities).

    Contribute to multidisciplinary formulation from specific model perspective

  • Contribute to the process of multidisciplinary formulation with a particular contribution from a specific model.

    Assessment of risk

  • Assess and formulate risk issues from the perspective of the psychological model being used (which may involve consultation, supervision, or advice from a more skilled psychological practitioner who is able to draw on multiple models and theories).

    Use measures of assessment, formulation and outcomes

  • Select, administer, accurately score and interpret relevant measures that contribute to the assessment and formulation, including the monitoring of outcomes.

    Share outcome of assessment and its implications with family

  • Share the outcome of the assessment of psychological difficulties with the person with dementia and their family and communicate an awareness of the potential consequences.

    Conduct psychological assessment and formulation using a person centred care model

  • Observe and record the behaviours of people with dementia.
  • Conduct individualised psychological assessments of people exhibiting behavioural and psychological signs of distress, under clinical supervision.
  • Assess the person with dementia’s functioning within different/multiple systems.
  • Conduct individualised psychological formulations in relation to behavioural and psychological signs of distress, under clinical supervision.
  • Develop a psychological formulation, under clinical supervision, which could be presented in a number of formats (e.g. audiotape, pictorial, diagrammatic, written).

    Assess and formulate therapeutic interventions at the end of life for people with dementia their families and care teams

  • Use assessment and formulation skills to inform specific therapy based intervention to enable the psychological needs of the person with dementia and their family to be met at the end of their life; this may include therapeutic interventions to improve the environment, mood, behaviour and well-being or to reduce pain and discomfort.
  • Have a specialist awareness of the formal stages in both capacity and risk assessment in relation to end of life care
  • Contribute to these assessments as part of a team process.

    Ability to use structured and standardised assessments

  • Use structured protocols to assess needs and determine interventions (e.g. TREA model -Treatment routes for exploring agitation (Cohen Mansfield, 2000, Dementia Care Mapping (Bradford Dementia Group).

    Biopsychosocial formulation

  • Systematically review relevant information from other colleagues (e.g. including medical review, mental well-being, life history, physical environment, social and occupational environment) as a method to identify potential determinants of behaviour (ref Alternatives to antipsychotics BPS Briefing Paper (2013) Brechin, D., Murphy, G., James, I.A., and Codner, J.)

Highly Trained Psychological Workers

who are able to draw on multiple models and theories (e.g. clinical or counselling psychologists with relevant neuropsychological experience.)

Delivery of
Specialist Skills
This professional group will have received a 3-year post-doctoral training in clinical or counselling psychology in addition to probable experience and training at earlier levels of the model. This training will enable them to assess, formulate, select, plan and evaluate appropriate psychological interventions for people with dementia and to supervise the work of others at levels 1-3.
Broad Definition of Skills

Pre-Diagnosis and Diagnosing

To be able to carry out a more detailed assessment of dementia, including the use of neuropsychological assessments, as part of the diagnostic process for people who have more complex presentations.

Working with Stress, Anxiety & Depression in people with dementia and their families

Ability to assess a person’s psychological needs and functioning in a comprehensive and high individualised way. To be able to use this information to derive idiosyncratic formulations and decide which, if any, psychological approaches are most relevant.

Person-centred care and working with psychological and behavioural signs of distress

A highly developed specialist psychological assessment and formulation skills, using a knowledge of psychological theories and therapeutic models that may explain the psychological and behavioural signs of distress for the person with dementia, their family and others caring for them.

End of Life

A highly specialist ability to carry out an assessment and formulation of the person’s psychological needs at the end of their life, and to share this with the person with dementia, their family and the team who will be providing the person’s care.

    Multi-model, integrative and individualised assessment

  • Lead on pre-diagnostic work where there are more complex diagnostic issues or where family dynamics are more complex.
  • Administer, score and interpret a detailed, service standard, neuropsychological assessment as part of the diagnostic process for people who have more complex presentations.
  • Report critically on the outcome of tests.
  • Utilise knowledge about appropriate use of tests including knowledge of the reliability and validity of the neuropsychological assessments and of those situations when the norms would not be applicable.
  • Select from a range of other neuropsychological tests when service standard assessments are not appropriate (e.g. when assessing a person with learning disabilities or when the person is younger or may have a rarer form of dementia, or there are questions about their ability to drive).

  • Carry out an enhanced psychological assessment taking into account e.g. health issues, pre-existing mood disorders, trauma, abuse, alcohol and drug use.
  • Administer other forms of psychometric assessment (e.g. measures of depression & anxiety).
  • Determine when testing is not appropriate, or where findings cannot be interpreted.
  • Respect a person’s wish to not be assessed and to be able to share that with the referrer/Team.
  • Know when and where to refer on for more specialist assessment.

    Leading and advising on assessment processes and psychometrics

  • Share and explain the assessment process to others.
  • Develop one’s skills and the skills of others in the administration of new psychometric assessments in standardised and supervised settings.

    Communicating complex assessment and formulations to individuals, families and teams

  • Clearly and sensitively communicate information about a diagnosis of dementia and its implications in situations where there is more complexity.
  • Recognise and to work with changes in role in the family, including continuity/discontinuity in relationships, brought about by changes in the person with dementia’s physical or mental state.
  • Plan formulation based interventions and post diagnostic support integrating information from a variety of sources

    Offering specialist advice and consultation on complex clinical issues

  • Offer specialist advice and consultation when people present with non-standard signs and symptoms or rare forms of dementia and complex neurological conditions.
  • Share and develop formulations following assessment and diagnosis.

    Assessing motivation and suitability for psychological work

  • Assess motivation and suitability for psychological work (including timeliness, appropriateness, preparedness for therapy and safety) from a multi-model perspective, including prioritising and determining who should deliver what and when and in what context.

    Contributing and sharing multi-model formulation to multi-disciplinary teams

  • Contribute from multiple psychological models to the process of MDT formulation.
  • Ensure that the psychological formulation is appropriately shared, understood, and used.

    Highly specialist ability to select and use specific measures in assessment and formulation

  • Select, administer and interpret relevant measures which contribute to assessment and formulation, including those measures that require specific training or skills (e.g. specialist personality assessment; formal functional analysis).

    Multi-model approaches to risk assessment and management

  • Apply a multi-model psychological understanding to the area of risk assessment and management, including being able to guide the work of others and contributing to team-level risk management plans.

    Provide support, consultation and supervision to teams and networks involving a highly specialist ability

  • Offer specialist support, consultation and supervision to multi-agency teams in relation to the assessment of dementia and facilitate the Team’s knowledge and skills development in the formulation process.
  • Develop systemic formulations and modify and reformulate in light of on-going changes.

    A highly developed specialist knowledge of the process of a comprehensive, holistic, person-centred assessment and formulation

  • Assess psychological functioning in a sophisticated, comprehensive, and individual way, drawing on and integrating perspectives from more than one theoretical position.
  • Utilise a wide range of sources of information and observation and modify formulations in light of this information (e.g. knowledge of co morbidity, current level of cognitive functioning, systemic factors, complex family dynamics).
  • Use theoretically grounded and evidence informed, highly individualised and tailored formulations (for example, integrating the specific impact of the person’s dementia with their mental health problems and other psycho-social factors).
  • Share formulations with the person with dementia, their family, Teams or other professionals using appropriate language and modes of presentation.
  • Assess psychological functioning in a sophisticated, comprehensive and individual way, drawing on and integrating perspectives from more than one theoretical position.

  • Utilise a wide range of sources of information and observation and continually modify formulations in the light of this information (e.g. knowledge of co-morbidity, current level of cognitive functioning, complex family dynamics).
  • Use theoretically grounded and evidence informed, highly individualised and tailored formulations (for example, integrating the specific impact of the person’s dementia with their mental health problems and other psycho-social factors).
  • Share formulations with people with dementia, their families, teams or other professionals using appropriate language and pitched at the appropriate level.s
  • Work effectively whilst holding alternative/competing explanations in mind.
  • Be able to incorporate factors recognising the impact of dementia into individualised formulations of psychological difficulties for both people with dementia and their family members.

    Lead comprehensive biopsychosocial assessments and formulations in complex and challenging situations including a highly specialist ability

  • Conduct psychological, cognitive and neuropsychological assessments to determine the strengths and deficits of the person with dementia.
  • Assess complex presentations of behaviour and distinguish between behaviours related to dementia, physical health or mental health conditions.
  • Assess, through the use of behaviour observation, functional analysis and cognitive assessments, how cognitive impairments might have an impact on someone’s behaviour and recognise how strengths and retained abilities might be used to reduce challenging behaviour.
  • Assess complex situations, including those where there are multiple and/or longstanding psychosocial difficulties and understand the impact of these for the person with dementia.
  • Use advanced formulation skills integrating complex facts or situations requiring analysis & interpretation.

  • Share formulations with other team members enabling effective team management and care planning.
  • Think and reformulate at Team level when psychological therapy is not working and advise when to step up, step down interventions.

    • Conduct assessment, formulation and interventions regarding person with dementia’s end of life care

  • Conduct specialised person-centred psychological assessments of the person with dementia’s end of life care needs.

    Training and supervision

  • Provide teaching, training and supervision to other staff working with end of life care needs.

    Risk assessment

  • Carry out relevant capacity and risk assessments in relation to the end of life care for people with dementia.

Principal Psychologists



Delivery of
Specialist and Complex Skills
Broad Definition of Skills

Pre-Diagnosis and Diagnosing

A highly detailed understanding and advanced ability to carry out a holistic bio-psychosocial assessment for people with a possible dementia, including cases where there are greater levels of complexity and more contentious issues.

Working with Stress, Anxiety & Depression in people with dementia and their families

Ability to assess and formulate in situations where there is considerable complexity or difficulty.

Person-centred care and working with psychological and behavioural signs of distress

Advanced skills in psychological assessment and formulation, using psychological theories and therapeutic models, of psychological and behavioural signs of distress and skills in ensuring the delivery of standardised assessments and formulations of BPSD across the service.

End of Life

An advanced ability to provide a detailed assessment and formulation to the person, family, team and service about the person with dementias complex end of life care needs in relation to the relevant current literature and national best practice.

    Promoting quality standards in care systems

  • Ensure that the service is working to implement national standards and best practice (e.g. Memory Services National Accreditation Programme).

    Advanced knowledge of the governance, selection, administration and interpretation of psychometric assessment processes

  • Select from a range of psychometric tests, including the selection of specialist neuropsychological tests, and the ability to administer these when working with people with dementia.
  • Administer, or oversee the administration, of tests that require specialist training.
  • Interpret and report critically on the outcome of tests.
  • Determine when testing is not appropriate, or where findings cannot be interpreted.
  • Plan and lead on the development of appropriate batteries of assessment according to the best current evidence base and to ensure that tests are used, scored and interpreted according to the manufacturer’s standards.
  • Review and evaluate the use of the assessments in relation to their reliability and validity for the given population and to ensure all those using the assessments and the results of these understand the importance of this.

    Advanced knowledge of the governance, selection, administration and interpretation of psychometric assessment processes

  • Enable the person with dementia, their family, the team and the service to assess and formulate complex end of life care needs.
  • Conduct capacity and risk assessments for people with dementia with complex end of life needs.

    Assessment of Serious Untoward Incidents: an advanced ability to:

  • Conduct assessments of Serious Untoward Incidents in relation to the end of life care of people with dementia, across the NHS Trust /Organisation and the region.

    Advanced ability to assess challenging and complex issues

  • Ensure that standards of service delivery are met in relation to pre-diagnosis, diagnosis and formulation.
  • Work with people with greater levels of complexity and ‘hold’ more contentious or issue based cases (e.g. where families unhappy with the service or where families are awaiting more specialist input from regional/national centres).

    Sharing formulations to plan complex multi-agency interventions in systems of care

  • Develop and share formulation in complex cases with the person, family, team and other agencies.
  • Share formulations across more complex systems (e.g. where are person’s needs will be met by both physical and mental health services, or where family members have a variety of health issues for which they need to access a range of services).
  • Integrate assessment and formulation to plan multi-level or multi-agency interventions for person centred post diagnostic and support.

  • Lead on the development of new care pathways for people with dementia and their families for both simple and complex presentations.

    An advanced knowledge of holistic, person-centred assessment and formulation and its application at a service level

  • Assess and formulate in complex situations that require analysis, interpretation, and expert judgment, especially where there may be a range of opinions.
  • Synthesise information from a wide range of sources and contexts and to use this information to develop flexible formulations for a variety of different functions and purposes (e.g. to guide the client, to help the team respond consistently and appropriately, to help plan coordinated interventions etc.).
  • Lead on the development and use of complex psychological formulation within the service; supporting colleagues at all levels to understand and embed formulation into their practice.
  • Assess and formulate difficulties that arise within the multi-disciplinary team or between agencies (e.g. where there are differences of opinion or conflicting accounts.

  • Take a lead role in planning for complex situations where risk has been assessed as a significant issue and multi-disciplinary or multi-agency coordination is required.
  • Offer second-opinion assessments or reassessments where difficulties have been encountered e.g. for Mental Health Act Tribunals, Advocacy or multiagency complex reviews and investigations both within and outside of NHS Trust/Organisation settings.

    • Advanced knowledge and skills in assessment, formulation and planning interventions for challenging and complex psychological issues relating to the person with dementia and care systems

  • Provide biopsychosocial assessment for more complex presentations of dementia.
  • Interpret information from complex neuropsychological assessments to inform person centred formulation, care planning and intervention so as to reduce and minimise psychological and behavioural signs of distress.
  • Share knowledge, in situations that are more complex, with the person with dementia, their family and members of the team/service in order to create a formulation and stepped series of interventions to reduce behaviours perceived as challenging and to maintain independence and well-being.
  • Facilitate a shared understanding at a service level of why people might experience BPSD and the interventions which might be planned to alleviate this for the person and the organisation.
  • “Contain” the behaviour that is perceived as challenging for the individual, the family, the team or the service in order to ensure best practice and a reduction in distress over time.

Lead/Head Psychologists



Delivery of organisational-level and competency initiatives, service development, and clinical governance
Broad Definition of Skills

Pre-Diagnosis and Diagnosing

An expert understanding of a holistic bio-psychosocial assessment process for people with a possible dementia including the equitable delivery of neuro-psychological assessments across an organisation, and delivery of diagnostic care pathways based on best practice.

Working with Stress, Anxiety & Depression in people with dementia and their families

Ability to take an organisational overview and systems-level approach to assessment and formulation, taking responsibility for designing and implementing effective assessment processes.

Person-centred care and working with psychological and behavioural signs of distress

An ability to ensure the delivery of organisation-wide standardised assessments and formulations of behavioural and psychological symptoms of distress.

End of Life

An expert ability to provide a detailed assessment and formulation to the person, family, team and service about the person with dementia’s highly complex end of life care needs in relation to the relevant current literature and national best practice for example where there is a strong incidence of behaviours which challenge, limited communication skills, complex family dynamics, high perceived unmet need.

    Selection and administration of formal psychometric assessments at the individual and care system level

  • Demonstrate and share expert skills in pre-diagnostic counselling and assessment of dementia.
  • Demonstrate an expert knowledge of a range of neuro-psychological tests and an expert ability to select appropriate tests, including specialist neuropsychological tests.
  • Administer or oversee the administration, of tests that require specialist training.
  • Interpret or report critically on the outcome of tests.
  • Determine when testing is not appropriate, or where findings cannot be interpreted.
  • Oversee the equitable and transparent delivery of neuro-psychological assessments across the organisation/Trust.
  • Provide governance regarding the appropriate use of neuro-psychological assessments across the organisation/Trust.

    Promote evidence-based best practice at organisational and network level

  • Ensure standardised evidence based best practice across the organisation/Trust in pre-diagnostic and diagnostic pathways and to develop these in line with national and professional guidance.
  • Work with a range of people/agencies (e.g. GPs, commissioners, voluntary agencies, adult social care, public health, library support services) to plan and develop care pathways for best practice in pre-diagnosis, assessment, formulation and post diagnostic support.
  • Integrate best practice initiatives in dementia care into NHS Trust/Organisation and local care pathways e.g. MSNAP, DAA, Books on Prescription, contributing to their development where possible

    Assess and formulate specialist and complex needs at the individual and organisation/systems level

  • Offer or arrange specialist assessments in situations where there are no clear commissioning guidelines.
  • Contribute a psychological understanding in complex risk situations where there is risk to the person, community and organisation (e.g. exceptional or complex cases, ethical dilemmas around risk, DOLS).
  • Work at an organisational level to ensure that the psychological needs of people with dementia and their families are met in a timely way, ensuring best practice and appropriately skilled staff.
  • Demonstrate the ability to formulate a system/service/organisation, and/or understand the dynamics of whole services.
  • Draw on organisational and managerial theory in addition to psychological theory.
  • Demonstrate and explain the impact of formulation and reformulation in terms of systems and service delivery across the NHS Trust, Agency or Organisation.

    Promote evidence-based, person-centred assessment and formulation regarding psychological and behavioural symptoms of distress at care systems level

  • Ensure a standardised understanding of assessment and formulation of psychological and behavioural signs of distress across the organisation.
  • Promote, develop and maintain a person centred care pathways across the organisation.
  • Achieve new evidence based service developments in the field of dementia care (e.g. through the development of GP checklists, carer monitoring, more standardised pathways with LSA commissioners of nursing homes, clearer expectations of what psychological care care-homes are expected to deliver).

    Work with the person with dementia, family and care systems to assess evidence based and devise person-centre interventions and risk assessments regarding challenging end of life needs

  • Work with the person with dementia, their family, staff and the NHS Trust/Organisation to devise and provide person -centred interventions to best meet the person’s end of life needs.
  • Use psychological skills and knowledge to enable further development of the national and international evidence base in psychological approaches to end of life care.
  • Conduct capacity and risk assessments at a local, regional and national level for those people with dementia who have complex and challenging end of life needs.

Intervention

    Intervention can take many forms, but should always be underpinned by a level of assessment and formulation. However, it is possible that the person who assessed and formulated may not be the person delivering the actual intervention, which allows for flexibility in skill mix within teams. Intervention is commonly with individuals, although may be in a couple or group context. Intervention may not always be in the context of a formal therapeutic relationship, but may take place in more informal ways, especially at lower levels

    . A person may receive intervention at one point from more than one professional at once. (E.g. Someone might have a Level 1 worker signpost them to local services or supporting a Books on Prescription input, whilst undergoing a further neuropsychological assessment at level 4 and receiving CBT for health anxiety at level 3, according to a formulated care plan).

    For each level except level 1, there is an implicit assumption that the professional will be expected and able to advise, guide, and supervise the work of those in lower levels.

All Clinical Staff Who Deal With People


Psychological Awareness
Broad Definition of Skills

Post Diagnostic Interventions and Living Well with Dementia

To have a basic awareness of post-diagnostic support & psychological interventions aimed to help people live well with dementia.

Working with Stress, Anxiety & Depression in people with dementia and their families

Delivering specific psychosocial interventions under instruction/guidance, or supporting clients with self-help, based around social inclusion.

Person-centred care and working with psychological and behavioural signs of distress

To have a basic skill in delivering person centred care. To have basic skills in intervening and working with behavioural and psychological symptoms of dementia and be able to carry out low intensity interventions and support the work of qualified staff (management of contextual issues).

End of Life

An ability to offer basic psychological support to people with dementia who are at the end stages of their life. An ability to offer basic psychological support to the families of people with dementia who are at the end stages of their life.

    Support and deliver psychologically informed care plans under supervision for people with dementia and their families

  • Follow a psychologically informed care plan and be able to provide support and guidance to people who have just been given a diagnosis of dementia in order to help them to understand the condition, its impact on them and where to get further reliable information.
  • Sensitively communicate post diagnostic information, under supervision and guidance.
  • Use appropriate psycho-educational/self-help material with people with dementia and their families, under supervision and guidance.
  • Signpost people with dementia and their families to appropriate services in the local community.
  • Promote routine & structure in order to enhance the quality of life of the person with dementia.

  • Provide a range of meaningful activities to help people to live well with their dementia (e.g. singing, quizzes, art, poetry, reminiscence on IPods, painting, singing, gardening, exercise)
  • Support individuals to engage in meaningful activities that would be normal for them and their cohort.
  • Assist in the joint delivery of some interventions for people with dementia that will help them to live well with their condition (e.g. attending and supporting cognitive stimulation groups or life story work, under supervision and guidance).
  • Encourage people with dementia and their families to support each other.
  • Recognise ‘normal’ reactions to loss and grief and to support people with dementia and their families in accepting the impact of the diagnosis.
  • Recognise vulnerability, inability and inappropriate reactions which might be a result of their dementia and to refer on to other professionals.

    Delivery of specific standardised psychological interventions

  • Be aware of the role of therapeutic work and which interventions can appropriately be carried out at this level.
  • Support and deliver delegated psychological interventions that are specified by colleagues with higher levels of psychological knowledge, under supervision and guidance e.g. :
    • problem solving
    • activity scheduling
    • basic psycho-education
    • supporting clients through the use of worksheets and guided self-help tools
  • Support group-based psycho-educational or basic skills-based interventions in devised and run by with a more skilled colleague.

    Contributing to team intervention

  • Contribute to a team approach to delivering psychological interventions (e.g. being able to focus on one part of an intervention in the context of a bigger picture that might involve other approaches and people)
    Identifying risk and contributing to crisis plans

  • Identify relevant information to contribute to a crisis plan.
  • Recognise the signs of distress, including suicidal thoughts and intentions, and to provide an appropriate response to support a person at risk of suicide to remain safe.
  • Pass this risk information on to a qualified member of staff immediately.
  • Use basic suicide intervention skills.

    Provide information

  • Provide information and support for families as pre-directed in supervision.
  • Signpost people with dementia and their families to relevant local organisations.

    Delivery of practical supportive interventions related to social inclusion

  • Deliver practical and supportive interventions based around social inclusion:
    • Help people maintain positive relationships and family contact, engage with peer support and active community involvement.
    • Enable involvement from family members.
    • Promote creative, cultural and recreational activities that are meaningful to the individual to enable the best possible quality of life and fulfilment.
    • Reduce social isolation by enhancing social networks and sources of social support.
  • Form and run activity groups based on increasing social inclusion, under supervision.
  • Bring people from a wide range of social and cultural backgrounds together in a group for supportive social activities, under supervision.

    Work in a person-centred way with the person with dementia where there are psychological and behavioural signs of distress, under guidance, supervision and support.

    Including a basic ability to:

  • Support the person to engage in meaningful activities and social interaction programmes.
  • Signpost people with dementia and their families to relevant local organisations.
  • Identify and respond positively and appropriately to behavioural and psychological signs of distress, such as those that pose a risk to the person with dementia or others.
  • Recognise possible early warning signs and triggers for behavioural and psychological signs of distress and work to minimise these.
  • Recognise significant changes in behaviour and report these to more experienced staff, especially when there is an increased level of psychological distress.
  • Decide on the nature and level of response to behaviours, including immediate response, further assessment.

    Recognise and manage feelings

  • Recognise and validate the person with dementia’s underlying feelings.
  • Recognise how and when language or communication difficulties contribute to increasing distress.
  • Re-assure and offer an appropriate response when someone is agitated, withdrawn or distressed.
  • Monitor distress in a systematic way, including identifying early warning signs for those with more advanced dementia.
  • Meet or manage the person’s unmet needs where possible.
  • Understand ways of working that reduce distress and agitation in the individual through following a person centred care plan.

    Use de-escalation techniques

  • Carry out de-escalation techniques and make the person safe, when necessary, according to a person centred care plan.
  • Support the person to regulate their anxiety and settle following de-escalation.

    Provide information

  • Provide information and support for families as pre-directed in supervision.
  • Signpost people with dementia and their families to relevant local organisations.

    Offer basic psychological support to people with dementia who are at the end stage of life involving a basic ability and knowledge

  • Work with the team to help someone have ‘a good death’.
  • Provide practical and psychological care to enhance the person with dementia’s well-being as they reach the end stages of their life.
  • Provide practical and psychological care to enhance care and well-being of the family of person with dementia’s as they reach the end stages of their life.
  • Be aware of one’s own reactions to family losses and to not be overwhelmed by other peoples’ sadness.

Qualified
Mental Health Professionals

(Any graduate-level healthcare professional) Without further accredited training in delivering psychological interventions

Psychologically-Informed Healthcare
Broad Definition of Skills

Post Diagnostic Interventions and Living Well with Dementia

To have a more detailed understanding of the psychological components & delivery of post-diagnostic interventions & psychological interventions aimed at helping people live well with dementia.

Working with Stress, Anxiety & Depression in people with dementia and their families

Delivering psychologically-informed & supervised protocol-based interventions.

Person-centred care and working with psychological and behavioural signs of distress

To have a more detailed understanding of ways of intervening with the behavioural and psychological signs of distress in people with dementia and be able to carry out high intensity interventions (protocol-led interventions).

End of Life

A more detailed psychologically informed ability to offer simple psychological intervention techniques to people with dementia and who are at the end stages of their life.

    Offer psychological interventions under supervision for the person with dementia and their families

  • Address the beliefs and fears about dementia and discuss the psychological and emotional impact of the diagnosis with the individual and their family.
  • Work with the person with dementia and their family to build and maintain resilience, under psychological guidance and supervision.
  • Deliver post-diagnostic interventions to people with dementia and their families (e.g. psycho-educational groups, 1:1 intervention, sign-posting), under psychological guidance and supervision.
  • Provide Cognitive Stimulation Therapy and other psycho-social interventions, under supervision and guidance.
  • Use Life Story work, including an ability to elicit an appropriate level of information (e.g. being able to avoid emotionally difficult information).
  • Enhance psychological well-being (e.g. through use of compensatory-behavioural strategies and activities to help people maintain their routines and live well with dementia).
  • Use basic problem solving skills to compensate for a person’s changing abilities.
  • Use simple, validated measures to monitor change.
  • Educate and help to develop strategies to ensure that the person’s life history & individual preferences are taken into account.
  • Work with family carers, where appropriate, to assist in developing appropriate activities and support for the person with dementia.
  • Suggest and use appropriate electronic aids to maintain skills within an agreed intervention programme or care plan.

    Lead psycho-educational or skills groups

  • Co-facilitate or lead on manualised group psycho educational or skills-based interventions that are within their area of knowledge/specialism.
  • Engage people with dementia in group work and contribute to managing group processes that arise.

    Deliver specific psychological and psychosocial interventions using standard formulations

  • Use brief or generic therapeutic approaches (e.g. brief solution focused approaches, Cognitive Behavioural Approaches (e.g. problem-solving and behavioural activation), and psychosocial interventions.
  • Plan and deliver specific interventions for specific problem areas, under guidance and supervision, or using standard formulations.
  • Use standard packages and written protocols for individuals or groups:
  • Provide technical interventions rather than formal psychotherapy (as formulation is not required in order to deliver the intervention).
  • Provide psycho-education and develop problem solving skills, demonstrating the ability to adapt and integrate information rather than simply presenting pre-written information as in level 1.

    Work effectively with the care network

  • Display an awareness of the input of other agencies and their interventions with the people with on one’s caseload and able to share appropriately planned therapeutic work to ensure an integrated care plan.

    Goal development, intervention and session planning

  • Develop and agree goals with the person with dementia or their family member, (recognising that goals need to be of a kind that can be put into practice, adhering to SMART principles (Specific, Measurable, Agreed, Realistic, and Timed).
    • Promote change through tasks between sessions where possible.
    • Help the person with dementia engage with the intervention by identifying and helping them to overcome possible obstacles, under guidance and clinical supervision.
    • Manage between-session contacts with the person with dementia, under guidance and clinical supervision.
    • Manage planned therapeutic endings, under guidance and clinical supervision.
    • Match the structure and pace of the work to the needs of the person with dementia.
    • Maintain adherence to tasks without unnecessary switching.

    • Engage with session planning and management, working to timescales within and across appointments, and an ability to adapt to the person with dementia’s need.
    • Maintain the pace of a therapeutic conversation, including the ability to interrupt are direct the conversation where necessary.
    • Use appropriate measures to monitor change and keeping simple records.
    • Adapt the intervention to meet the needs of people with dementia (e.g. use of written prompts, pacing, involving the family in the intervention)
    • Provide basic information in order to allow consideration of the range of different approaches that might be helpful (including those not able to be offered by the professional themselves).
    • Understand and respond to emotional content of sessions, including the management of strong emotions such as anger and related aggressive or distressed behaviour.
    • Ability to be flexible in the management of the person’s dementia and other co-existing issues.

    Adhere to sound therapeutic principles in working with the person with dementia and their family members

  • Adapt approaches to work with people with dementia from different cultural and ethnic backgrounds.
  • Ahere to sound therapeutic principles, under supervision, even when not engaging the client in formal therapy

    Work effectively with risk and crisis issues displaying a more detailed ability

  • Work positively and in partnership with people who are at risk of, or who do self-harm, using a problem solving approach and develop jointly agreed goals under clinical supervision including to:
    • Promote safety as well as positive risk taking behaviours.
    • Empower the person to decide the level of risk they are prepared to take with their health and safety, if they have the cognitive capacity to do so.
    • Promote the minimisation of harm in the context of self-harm and substance misuse and be able to refer on appropriately.
    • Respond to and manage crises working with the person with dementia (and others) to develop a crisis plan, identifying recurrent patterns and strategies that could be implemented to help deal with any emerging crises.
    • Specify the role the person with dementia, family and friends and services will play in the plan.
    • Review these plans (and identify any ways in which they need to be revised) under clinical supervision.

    Deliver specific psychological and psychosocial interventions using standard formulations

  • Use brief or generic therapeutic approaches (e.g. brief solution focused approaches, Cognitive Behavioural Approaches (e.g. problem-solving and behavioural activation), and psychosocial interventions.
  • Plan and deliver specific interventions for specific problem areas, under guidance and supervision, or using standard formulations.
  • Use standard packages and written protocols for individuals or groups
  • Provide technical interventions rather than formal psychotherapy (as formulation is not required in order to deliver the intervention).
  • Provide psycho-education and develop problem solving skills, demonstrating the ability to adapt and integrate information rather than simply presenting pre-written information as in level 1.

    To implement simple interventions as part of a care plan for people with dementia at the end of their lives

  • Use simple intervention techniques as part of an agreed care plan to enable the person with dementia to meet their psychological needs for safety, comfort and wellbeing as they approach the end of their life.
  • Use simple intervention techniques as part of an agreed care plan to enable the family of the person with dementia to meet their psychological needs for wellbeing.
  • Respond to changes in mood in a structured way to reduce anxiety, distress, agitation etc.

    Manage endings

  • Manage endings and service transitions positively, (both planned endings and premature or unplanned endings where the person with dementia terminates contact with the service earlier than planned)
    • Be outcome-focused, collaborative, review, monitor and seek feedback.
    • Communicate about this clearly, providing written communication about care planning, reviews and endings.

    Manage feelings

  • Work with acceptance and help the person with dementia to understand and manage change, loss and grief.
  • Understand of the use and application of validation therapy.
  • Adapt approaches to meet the needs of family care-givers with anxiety, depression or stress.

    Assess and implement person-centred care in working with people with dementia and the care system in relation to psychological and behavioural signs of distress

  • Implement a person-centred approach (e.g. in the use of advanced planning for end of life care and life story work).
  • Describe the bio-psychosocial influences on the behaviour of the person with dementia and to use this to work with evidence-based management strategies according to a care plan.
  • Enable the person with dementia to use compensatory strategies to balance their difficulties.
  • Recognise any behavioural and emotional changes that are associated with the person’s dementia and to be able to provide appropriate support, comfort or reassurance when they are distressed.
  • Conduct interventions on the basis of the assessment, formulation and care plan.
  • Implement strategies for working with people with dementia that reduce distress, under supervision.
  • Develop communication and interaction skills with families.
  • Recognise the interactions of the person with dementia and their family with each other and when they cause distress.
  • Establish the life history of the person with dementia.
  • Engage the person with dementia in a meaningful activity and social interaction programme.
  • Change the physical environment to reduce psychological distress.
  • Perform on-going monitoring of behaviour and refer on to more experienced staff, if no improvement occurs.
  • Use de-escalation techniques under supervision
  • Deliver dementia awareness training.

Qualified (Uni-Model) Psychological Therapists

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Evidence-Based Skills
Broad Definition of Skills

Living well with dementia (including improving & maintaining cognitive function)

To have a specialist knowledge of the psychological components and delivery of post-diagnostic interventions and psychological interventions aimed at helping people to live well with dementia.

Working with Stress, Anxiety & Depression in people with dementia and their families

Delivering evidence based or recommended psychological therapy in a more formalised or structured way.

Person-centred care and working with psychological and behavioural signs of distress

To have specialist skills in intervening with the psychological and behavioural symptoms of distress using Individualised formulation-led interventions.

End of Life

To be able to offer specific therapy based interventions to people with dementia who are at the end stages of their life and their family.

    Lead psycho-educational and basic therapeutic groups using a specialist ability

  • Lead psycho educational, skills-based, or basic therapeutic groups for people with dementia focussing on the need to:
    • Plan the group structure, content and recruitment of appropriate members.
    • Work with a co-facilitator.
    • Manage the group process, and group dynamics.
    • Highlight the importance of preparation and evaluation.
    • Develop appropriate feedback.

    Clinical Supervision

  • Understand the value of regular clinical supervision, including preparation and record keeping, using sessions to:
    • Identify the needs of the person with dementia.
    • Select the most appropriate intervention within the skills available.
    • Reflect on and attend to interpersonal process issues.
    • Identify and respond to obstacles which prevent the successful outcome of the intervention.
    • Adapt interventions to meet the needs of the person with dementia.

    Provide psychological and psychosocial post-diagnostic interventions for people with dementia and their families

  • Provide support and guidance to people with dementia to assist them to understand the condition and its impact on them as an individual.
  • Provide support and guidance to family carers, where appropriate, to enable them to understand the condition, its impact on the individual and themselves.
  • Understand the concerns of people related to the implications of receiving a diagnosis of dementia, particularly related to stigma, the impact on independence, finances, driving and family dynamics.
  • Offer psycho-education about psychological adjustment to a diagnosis of dementia and an understanding of basic models of loss and bereavement.
  • Provide post-diagnostic interventions, including individualised interventions when the person’s circumstances may be less usual (e.g. where English is not their first language, where the person has learning disabilities), under supervision and guidance.

  • Offer evidence-based psycho-social interventions to the person with dementia (e.g. Cognitive Stimulation training, Counselling, Life Story work).
  • Use problem solving skills to compensate for a person’s changing abilities.
  • Work with the person with dementia and their family to build and maintain resilience, under psychological guidance and supervision.
  • Deliver interventions to support the families and carers of people with dementia and to support in the person with dementia being able to live well with their condition.
  • Use validated measures to monitor change in the person’s cognitive abilities and signpost to services when appropriate.
  • Educate and help to develop strategies to ensure that the person’s life history & individual preferences are taken into account

    Deliver uni-model psychological therapy

  • Deliver formalised uni- model psychological therapy (e.g. CBT, Systemic) in a structured way making appropriate adaptations for people with sensory loss or those with cognitive changes due to early stage dementia.
  • Deliver a single model, formulation-driven psychological therapy, (rather than relying on standard/generic formulation).
    • Deliver psychological interventions as an appropriately trained and supervised psychotherapist, with demonstrated skill through a formal accreditation process and an ability to make adaptations suitable for people living with dementia and their families.
    • Deliver recommended model-specific interventions based on NICE and other professional therapeutic guidelines (e.g. EMDR, CBT, DBT, CAT etc.) with appropriate age related adaptations.

    Use of assessment and formulation skills for offer specific therapy based interventions to people with dementia who are at the end stages of their life

  • Use assessment and formulation skills to inform specific therapy based interventions to enable the psychological needs of the person with dementia and their family to be met at the end of their life; this may include therapeutic interventions to improve the environment, mood, behaviour and well-being and to manage pain.
  • Share psychological models of the process of loss, bereavement and acceptance with the person with dementia and their family so that they may understand the stages and tasks of grief.
  • Use the knowledge about what factors contribute to ‘a good death’ in order to work with the person, their family and the team to be able to achieve this.

    Provide more advanced therapeutic skills to people with dementia

  • Help the person with dementia engage in therapy, making adaptations as appropriate, as informed by the current literature.
  • Identify when resistance to therapy is a part of the person with dementia’s difficulties including when the person with dementia is responding to an accurate perception of differences of opinion between themselves and the therapist.
  • Engage the person with dementia in a discussion about the range of different approaches that might be helpful (rather than simply presenting information).
  • Make simple, in session, person-centred adaptations within the model or formulation.
  • Engage in empathic confrontation.
  • Recognise when therapy has reached the limits of its usefulness.
  • Promote change between sessions by developing effective tasks in collaboration with them and their current needs and level of understanding (e.g. involving family members as co-therapists)

  • Be responsive and flexible in what is happening in the moment.
  • Recognise and respond to subtle changes in the behaviour and mood of the person with dementia.
  • Understand and respond to emotional content of sessions, reflecting on the meaning of the individual’s emotional expression/behaviour, and during interventions to elicit emotions that facilitate change.
  • Manage strong emotions such as excessive anger and related aggressive behaviour, and also the avoidance of strong affect during the assessment and the intervention process, where necessary.
  • Work with high levels of distress, allowing appropriate venting of emotions, de-escalating emotional reactions, containing emotions, without unnecessary use of personal disclosure or unnecessary boundary violations.
  • Support people with dementia through practice, role play, rehearsal.
  • Provide psycho education, drawing on specific theories and more advanced psychological knowledge.
  • Use and share wider psychological knowledge and theories with the person with dementia to help to highlight aspects of their condition.
  • Enable adjustment to develop in the context of life review work.

    Develop an awareness of and a specialist ability to use the best evidence based models for managing behavioural and psychological signs of distress in people with dementia (e.g. The Newcastle model)

  • Plan and carry out a systematic person centred intervention which reduces psychological and behavioural signs of distress using knowledge gained in training and supervision.
  • Tailor an intervention to the person with dementia’s presentation, assessment, diagnosis and formulation.
  • Integrate the basic tenets of person centred care for people with dementia into their preferred therapeutic model through which interventions will be delivered.
  • Use the methods of the Newcastle Model to manage behaviours that challenge (e.g. boredom, agitation, aggression, vocalisation).
  • Work using a systematic protocol and evidence-based interventions under clinical supervision.
  • Use decision trees to determine interventions under supervision (e.g. TREA model).

  • Use interventions that improve quality of life and mood (e.g. behavioural management and advice, Dementia Care Mapping, reminiscence therapy, cognitive stimulation techniques, aromatherapy, exercise, singing, gardening etc.).
  • Use specialist communication skills to carry out Care Home liaison work
  • Work with staff in Care Home settings and training them to understand and contribute to the care plan and implement the agreed strategies, using methods based on the current literature.

    Further guidance and supervision: having a specialist awareness of the need to:

  • Seek further immediate guidance when an atypical reaction occurs (e.g. when someone seems to react over emotionally with anger or tears ; is detached from a highly emotional issue or when the situation becomes more complex than originally anticipated in supervision).
  • Use Trust protocols for alerting more senior colleagues and managers to issues causing concern.

Highly Trained Psychological Workers

Who are able to draw on multiple models and theories (e.g. clinical or counselling psychologists).

Delivery of
Specialist Skills
Broad Definition of Skills

Post Diagnostic Interventions and Living Well with Dementia

To have a highly specialist knowledge of the psychological components and delivery of post-diagnostic interventions and psychological interventions aimed at helping people to live well with dementia.

Working with Stress, Anxiety & Depression in people with dementia and their families

Delivering specialist or complex therapy that draws on more than one psychological model, and is underpinned by a good understanding of theory and evidence.

Person-centred care and working with psychological and behavioural signs of distress

To have highly specialist skills in intervening with the psychological and behavioural symptoms of distress using Individualised formulation-led interventions, including the development and delivery of bespoke training packages.

End of Life

A highly developed specialist ability to develop person-centred psychological interventions for people with dementia and their end of life care .

    Provide advice, consultation and supervision,

  • Provide advice, consultation, and supervision in this specialist area
  • Train other staff in the use of psychological approaches for people with dementia and their families.
  • Lead on the design and running of complex group interventions.

    To have a highly specialist knowledge of the psychological components and delivery of post-diagnostic interventions and psychological interventions aimed at helping people to live well with dementia and to support their families

  • Offer a psychotherapeutic intervention to enable people to emotionally and practically adjust and come to terms with a diagnosis of dementia.
  • Use and share re-formulations for the person with dementia, the family or other professionals, as new information comes to light, to re-plan appropriate post diagnostic interventions.
  • Plan, lead, coordinate, oversee and evaluate post diagnostic groups whilst working with other professionals/other agencies and providing supervision and support.
  • Utilise advanced skills to provide individualised and group post diagnostic interventions e.g. for those with less usual presentations of dementia, (e.g. YOD, complex issues with families and children, work with young carers etc.).

  • Acknowledge and work therapeutically with feelings of shame, encouraging the person with dementia and their family to treat each other with care and compassion.
  • Recognise the ‘burden’ and possible embarrassment that caring for a person with dementia may put on the family and other carers, providing formal therapeutic input for carers on an individual basis where appropriate.
  • Provide a psychological oversight of the course of dementia and planned interventions for the person with dementia, their family and other professionals to enable the person to live well with their condition.
  • Develop and deliver psychosocial interventions in more complex situations (e.g. Life Story work) or to combine multimodal approaches to intervention, (e.g. CBT/CAT/systemic therapy) following a specialist formulation of post diagnostic needs and intervention.
  • Work with systems at a later stage of diagnosis, providing a formulation for family, team or care home to plan appropriate post diagnostic interventions.
  • Provide a psychological structure for complex case discussion.

    Delivering specialist or complex therapy that draws on more than one psychological model, underpinned by a good understanding of theory and evidence.

    As a clinical/counselling psychologist

  • Select from a number of psychotherapeutic models and interventions to choose the most appropriate therapeutic intervention for the presenting problem as defined by the process of assessment and formulation.
  • Integrate the knowledge gained from neuropsychological assessment about cognitive strengths and weaknesses into the therapeutic model and to be able to share this with the person with dementia, their family and the wider team or intervening agencies.
  • Deliver or to supervise the delivery of this intervention by an appropriately trained member of staff, making frequent and regular adaptations to take account of changing needs and circumstances and sharing these adaptations with the multidisciplinary team.

  • Adapt the known therapeutic models to the needs of people with dementia and their families taking into account the systems with which they are engaged and the nature of their cognitive impairment.
  • Have an awareness of the importance of the interplay between physical health, cognitive ability and mood in the person with dementia’s response to psychological therapy and having the skills required to adapt the therapy to focus on the most significant area at any one time.
  • Provide therapeutic interventions in a range of settings including wards, day hospitals, care homes, community locations.
  • Bring together a number of professionals providing psychological interventions with the person with dementia and their family and coordinate this according to an agreed care plan to ensure clear communication and accountability at all stages of the intervention.
  • Draw upon psychological models to help the person with dementia, their family and other professionals involved to understand the possible purpose of psychological and behavioural symptoms of distress as a part of therapy and how to intervene to manage these in the least restrictive way.
  • Devise person centred therapeutic interventions which maximise the life skills and independence of the person with dementia for as long and as safely as possible.

  • Plan and devise group work according to therapeutic principles and specific therapeutic models and to ensuring the safe delivery of this group work in conjunction with co-therapists and carry out regular audit and evaluation.
  • Provide more individualised approaches for carers/young carers, including protocol and non-protocol carers groups and those with carers as co-therapists, and young carers.
  • Teach, train, supervise and support other staff and carers working with people with dementia in local services.
  • Provide psychological case management to colleagues such as speech and language therapists, social workers etc. who are providing psychological interventions.
  • Work with family of the person with dementia where the dementia is complex and has affected the family’s mental health and well-being.
  • Share a knowledge of dementia and deliver interventions as part of a multidisciplinary team where there are high levels of emotional distress (e.g. using the ‘vicious flower model’).
  • Ensure the promotion across the service of evidence based practice through the sharing of psychological knowledge and expertise.

    Engage in complex and challenging case management in care systems

  • Engage in complex case management e.g. when working with an Intermediate care, rapid intervention service, physical health or social care system.
  • Provide a psychological oversight for issues where there may be competing agency demands (e.g. housing services re hoarding, substance abuse).
  • Collaborate with other agencies to provide psychologically driven post diagnostic formulations and interventions (e.g. when working with Adult social care regarding vulnerable adults).

    To have highly specialist skills in intervening with the psychological and behavioural symptoms of distress using Individualised formulation-led interventions, including the development and delivery of bespoke training packages

  • Plan a range of interventions at a range of levels based on shared formulation and joint care planning (e.g. working with family care givers, educating the multidisciplinary team, providing face to face therapy or group work) and according to an evidence based model.
  • Use therapeutic models that may explain the psychological and behavioural signs of distress for the person with dementia, their family and others caring for them.
  • Intervene in more complex situations which require higher levels of knowledge and a variety of interventions.
  • Deliver bespoke training packages and embed and sustain learning at a team level.
  • Challenge existing practice where it does not meet with current standards of evidence based practice.

    Develop person-centred psychological interventions for people with dementia and their end of life care

  • Develop individualised person-centred psychological interventions in relation to the person with dementia and their end of life care, enabling them and their families to work with other staff to ensure their psychological needs are met.
  • Help people to acknowledge the losses which they are facing and to work with them through to a stage of acceptance in the post bereavement process.
  • Offer end of life interventions to people with more complex difficulties such as living with early onset dementia, chronic neurological conditions, or those suffering intense pain.
  • Work with the Team to enable the person with dementia and their families to communicate and implement their wishes re their end of life e.g. re personal care, Wills, Enduring Power of Attorney (EPA), Advanced Directive to Refuse Treatment (ADRT) etc.

    Work with complex, challenging issues in psychological therapy with the person with dementia and their family/care network demonstrating

    As an appropriately trained and supervised experienced psychotherapist:

  • Engage in complex psychological therapy with the client/family/situation including the provision of expert interventions , drawing upon multiple theoretical orientations and experience of integrating skills from different models.
  • Demonstrate highly developed specialist skills in one or more areas of therapy.
  • Recommend and determine what intervention approaches for a person with dementia might be helpful, including when, and why.
  • Work with complexity, where interventions need to be highly tailored and adapted to the person with dementia including where there are e.g. cognitive difficulties; acute distress; multiple problem areas; uncertain diagnosis; co morbid problems; substance misuse; physical health issues etc.
  • Work with the person with dementia’s adjustment issues whilst recognising the value of psychological defences.

  • Maintain overall focus without inappropriate switching between modalities when difficulties arise.
  • Reformulate as appropriate (e.g. if therapy is not working).

Principal Psychologists



Delivery of
Specialist and Complex Skills
Broad Definition of Skills

Post Diagnostic Interventions and Living Well with Dementia

An ability to ensure the safe and effective delivery of post-diagnostic interventions and psychological interventions aimed at helping people to live well with dementia that are in line with national guidance and best practice.

Working with Stress, Anxiety & Depression in people with dementia and their families

Highly specialist or complex therapy in situations where especially high levels of skill, knowledge and experience are required.

Person-centred care and working with psychological and behavioural signs of distress

An advanced ability to ensure that services provide standardised person-centred care approaches and appropriate evidence-based models for the psychological and behavioural management of distress in people with dementia.

End of Life

An advanced ability to ensure the provision of psychological interventions to the person, family, team and service about the person with dementias complex end of life care needs in relation to the relevant current literature and national best practice.

    Provide the team/service with psychological oversight for the care of people with dementia, their families and systems of care in the provision of evidence-based best practice, post-diagnostic and psycho-social care pathways and interventions

  • Provide psychological consultation and guidance for the implementation of psychosocial and psychotherapeutic interventions in the provision of post diagnostic support.
  • Keep abreast of current national and professional evidence base, refining care pathways based on new evidence, developing and piloting new interventions and groups within the service.
  • Ensure the appropriate delivery of post diagnostic interventions whilst being mindful of service priorities and capacity.
  • Raise concerns about gaps in service provision or unsafe practice with this client group.

    Work with more complex cases and systems involving risk and challenges

  • Work therapeutically with more complex cases, especially those involving systems and high levels of risk.
  • Provide leadership and training for other psychological practitioners in relation to the management of complex cases, including the management and reporting of Serious and Untoward Incidents.
  • Ensure detailed and systematic records are maintained re psychological interventions in complex cases.

    Ability to ensure implementation of standards

  • Ensure the implementation of MSNAP, NICE and Professional standards at service level.
  • Ensure that robust clinical supervision structures exist for psychological practitioners especially those working with complex cases.

    Provide highly specialist bespoke therapy or psychological interventions in situations involving complex and challenging presentation of mental health problems at the individual, family and care system level; drawing on multiple psychological models

  • Draw on a range of psychological theories and models to inform the process of assessment and formulation for the person living with dementia.
  • Integrate the psychological understanding with the care plan and use this to provide suitable interventions to support people with dementia with complex presentations in the early stages of dementia (including early onset dementia) and those in the moderate to late stages of cognitive decline that are experiencing mental health problems.
  • Work directly and indirectly with people with dementia using individualised psychological formulations to enable them, their families and the team to have a greater understanding of their condition.

  • Work with presentations where the evidence base is lacking or absent, by drawing on sound psychological principles and theory to inform the work they plan and initiate.
  • Work with the team, or with the person with dementia directly, in cases where person with dementia might be regarded as unsuitable for therapy, but where a psychologically-informed intervention might nevertheless be helpful.
  • ‘Hold’ and work with people with dementia whose behaviour is complex and demanding of families, care staff or the team who work to support them.
  • Engage people with dementia in a range of therapeutic activities to improve well-being, including those with whom it is hard to engage, motivate or communicate. This may include working through interpreters or family members, modifying assessment and intervention techniques to suit cultural expectations.
  • Provide psychological therapy and interventions which draw upon complex and multiple psychological models of working.
  • Work in highly specialised areas that require significant skill, knowledge and experience (e.g. situations involving complex dynamics and complex communication patterns).
  • Use the latest evidence base and current developments in relation to psychological therapy and dementia, ensuring best psychological practice across the service within the capacity available.

    Lead on audit, research and promotion for evidence based best practice in systems of care, including an advanced ability

  • Use media services effectively to promote and publicise evidence based best practice.
  • Lead on audit, research, publication and dissemination of best practice.
  • Demonstrate best practice in local teams/services and refine and develop this.
  • Develop service priorities in the delivery of post diagnostic interventions in conjunction with feedback from people and their families, national drivers and standards

    Ensure service provision of standardised person-centred care approaches and appropriate evidence-based models for the psychological and behavioural management of distress for people with dementia. Demonstrate an advanced theoretical and practical ability

  • Ensure services provide standardised and embedded approaches to person centred care and appropriate models for the psychological and behavioural management of distress.

  • Plan and implement, innovative person centred services which would reduce adverse behavioural or emotional reactions to novel environments or interventions.

    • Identification and audit and supervision of evidence-based best psychological practice within services, including an advanced theoretical and practical ability

  • Ensure that one’s own practice and that of the psychologists and teams with whom one works in the Team/service are implementing the principles of person centred care and that this is regularly discussed and audited.
  • Ensure that evidenced based best practice for person centred care in dementia is used visibly in the service and that staff who work well with people in this challenging area are recognised for their achievements.
  • Provide an oversight of psychological supervision in the service, ensuring a high standard of psychological care.
  • Provide an oversight of psychological formulations, working with team and ward managers to provide a consistency of approach n complex cases of psychological and behavioural signs of distress in dementia.
  • Provide training and supervision for colleagues working with people with dementia who are experiencing psychological and behavioural signs of distress.
  • Plan and deliver service innovations at individual, family, group or service level designed to reduce distress and events which might cause this.
  • Identify issues which might impinge on good practice.
  • Ensure that innovative practice is well researched, published and promulgated.

    Enable the person with dementia, their family, the team and the service to plan and deliver evidence-based best practice psychological interventions to meet complex end of life care needs, including an advanced ability

  • Use their skills and knowledge to enable others to develop interventions, both service and NHS Trust/Organisation wide to meet the needs of people with dementia and their families at the end of their life.
  • Share evidence based practice from related specialisms e.g. oncology and palliative care to develop a person centred service for the care of those dying with dementia.
  • Encourage service wide training and support for psychological practitioners managing complex interventions round DOLS and Capacity Assessments, Enduring Power of Attorney (EPOA), Living wills and Advance Decisions to Refuse Treatment(ADRT) in the best interests of people with dementia.
  • Provide the opportunity for supervision and reflective practice for colleagues managing complex interventions in this area.
  • Use their skills and knowledge to develop and publish the evidence base for best practice in this field.

Lead/Head Psychologists



Delivery of Organisational-Level and Competency Initiatives, Service Development, and Clinical Governance
Broad Definition of Skills

Post Diagnostic Interventions and Living Well with Dementia

An ability to ensure clinical leadership and governance in the delivery of post-diagnostic interventions and psychological interventions aimed at helping people to live well with dementia that are in line with national guidance and best practice.

Working with Stress, Anxiety & Depression in people with dementia and their families

An ability to provide oversight and governance in the delivery of psychological approaches and interventions for people with dementia and their families across the organisation.

Person-centred care and working with psychological and behavioural signs of distress

An expert ability to ensure that organisations provide standardised person-centred care approaches and appropriate evidence-based models for the psychological and behavioural management of distress in people with dementia.

End of Life

An expert ability to ensure the delivery across the organisation of evidence-based psychological interventions to meet end of life psychological needs to the person, their family, the team and service, including for situations that highly complex (e.g. where there is a strong incidence of behaviours which challenge, limited communication skills, complex family dynamics, high perceived unmet need).

    Ensure clinical leadership and governance in the delivery of post-diagnostic interventions and psychological interventions aimed at helping people to live well with dementia that are in line with national guidance and best practice

  • Provide clinical leadership and governance for the delivery of post-diagnostic, psychosocial interventions at a NHS Trust/Organisation wide level.
  • Oversee and evaluate the provision of standardised post-diagnostic information across the NHS Trust/Organisation.
  • Develop overarching strategies for post diagnostic services.
  • Develop the delivery of psychosocial interventions across the organisation based on NICE guidance and evidence based best practice.
  • Develop an oversight of areas where psychosocial interventions are not working well and take steps to remedy this.

    Manage organisation wide provision of teaching and training in psychosocial interventions in line with national guidance and best practice

  • Manage NHS Trust/Organisation wide provision of teaching and training around psychosocial interventions ensuring the standard of learning that is delivered meets national guidance.
  • Work at an organisational level to collaborate in identifying post diagnostic training needs in dementia for other professional groups (e.g. District Nurses, Crisis Teams, Staff working in physical health services).

    Ensure involvement of people with dementia and their families in service development and provision providing expertise

  • Ensure people with dementia and their families have a voice in the development of service provision.

    Provide oversight and governance in the delivery of psychological approaches and interventions for people with dementia their families across the organisation

  • Demonstrate extensive experience of working with people with dementia and their families from onset to death across the many complex presentations of the condition at both the individual and the systemic level.
  • Demonstrate to the Team and the service possible ways of working psychologically with those who are hard to reach, those who have additional difficulties due to complex physical illness, alcohol or drug addictions or requiring modified interventions due to spiritual, gender, race or physical health characteristics.
  • Develop tailored, specialised programme of care/care packages for delivery by others, encouraging co-working and observation in trainees and junior staff to enable them to understand the complexities of the work and to build competence in these areas.

    Promote innovation and evidence-based best practice in dementia care within the care network locally and nationally

  • Collaborate with other agencies, including commissioners, public health, third sector, local authority library services and GP commissioners to develop best possible service provision and strategies in relation to dementia care.
  • Share innovative developments across the NHS Trust/Organisation and other organisations.
  • Work at a national level developing national and/or professional guidance.
  • Facilitate the regular development, publication and presentation of audit and research in the field of dementia care.
  • Recognise and fill gaps in service provision.
  • Make the best use of psychological resources across the NHS Trust/Organisation.
  • Positively challenge staff to take up new ways of working to ensure best possible service provision within the resource available.

    Promote service development and evidence-based best practice at a local and national level, using an expert level of ability

  • Actively contribute at a national/international level through membership of the professional body and its committees and groups, or through relevant national agencies or working parties, sharing their scarce expertise to develop therapeutic services for people with dementia and their families.
  • Integrate services NHS Trust/Organisation wide, regionally and at a national level visualising, leading and planning service developments to meet the person with dementia’s needs at all stages of the care pathway.
  • Promote the development of robust outcome measures through audit, research and collaborative publication, presentation at local, regional and national conferences and the development of a leadership model which encourages staff in their service to feel empowered to do the same.

  • Raise expectations, develop innovative services, plan systemically across the NHS Trust/Organisation and its partner agencies to provide the best possible provision of psychological mindedness and psychological care through robust models of training, supervision and access to a current knowledge base about therapeutic interventions in dementia and dementia care.
  • Develop and implement psychological interventions in specialised areas or manage specialist services e.g. challenging behaviour units, dual diagnosis units, intermediate care services, etc.
  • Advise CEOs/directors/commissioners/politicians (local and national) on clinical governance issues in relation to the provision of equitable psychological therapies for people with dementia (e.g. speciality clinical standards / skill mix / safe evidence based clinical practice / poor practice/ resources necessary to deliver safe and effective care).
  • Recognise poor practice in dementia care and to be prepared to whistle blow.
  • Contribute to the NHS Trust/organisations development of an open culture of communication about therapeutic mistakes, by carrying out relevant reviews of serious untoward incidents, case note audits, complex case discussions etc. to develop a system of transparency.

    An expert ability to recruit and manage staff in dementia services

  • Recruit and retain staff with the relevant skill mix to deliver psychological intervention services, including the ability to monitor the safety of those with whom people work and dismiss or admonish those not working effectively.
  • Have the oversight of the service including the skills to effectively mentor and challenge those with poor working practice, and if necessary reprimand or dismiss them.
  • Argue rationally and to present evidence, including incidence and prevalence of different conditions, for commissioners and senior members of the NHS Trust/Organisation board or related local agencies, in order to develop better psychological services for people with dementia and their families.

    Ensure that organisations provide standardised person-centred care approaches and appropriate evidence-based models for the psychological and behavioural management of distress in people with dementia

  • Ensure that one’s own clinical work and that of all colleagues delivering psychological interventions is based on the principles of person centred care.
  • Ensure that person centred care is integral to NHS Trust/Organisation planning of service delivery and care pathways by, for example, acting as an advocate to people with dementia and their families, including representation at board level, in service planning, in recruitment etc. so that the organisation as a whole works to reduce psychological and behavioural signs of distress.
  • Be able to develop and use appropriate interventions to reduce psychological and behavioural signs of distress and to improve well-being.
  • Challenge unsafe practise and to act as an advocate for service improvements in dementia care.

  • Contribute to the evidence base for best practice in this area through research and publication, dissemination and teaching at a local, service wide and regional and national level.
  • Ensure governance of the service for which one is responsible including one’s own and others practice best meets the needs of people with dementia, using a person centred care approach for the management of psychological and behavioural signs of distress.
  • Challenge stigma and poor practice, leading by example to model evidenced based methods of helping people with dementia to reduce their distress and improve their well-being.
  • Ensure that the environments in which people with dementia are seen and the staff who work with them are best suited to avoiding confusion and reducing distress.
  • Engage in and promote an open culture of communication, leading on service review and evaluation.
  • Encourage audit, research, publication and dissemination contributing to this at a local, regional, national and international level through both professional and governmental bodies.
  • Ensure recruitment practices are fit for purpose and that staff are trained, supervised and supported to carry out the required tasks in relation to psychological and behavioural signs of distress.

    Work with the person with dementia, their family and the care system to meet end of life care needs in complex, challenging situations, demonstrating an expert ability

  • Work with the person with dementia, their family, staff and the NHS Trust/Organisation to devise and provide person -centred interventions to best meet the person’s needs.

    Develop best practice evidence in this area, through an expert ability

  • Enable further development of the national and international evidence base in this area through audit, research, publication, training and use of the media.

Psychological Knowledge and Awareness

    This domain is about having the underlying knowledge and awareness of psychological theory, psychological processes, and psychological understanding of mental health to enable effective working. Although all of the dimensions of the model are closely inter-related, this dimension in particular underpins several of the other dimensions.

    For instance, the ability to communicate information rests on having an understanding of that information; the ability to assess, formulate and intervene depends on having sufficient knowledge in order to do so. Increasing skill in this domain is reflected by having higher levels of formal education, more in-depth training, accreditation in specific areas of psychological skill, and higher level critical thinking.

All Service User-Facing, Clinical Staff.


Psychological Awareness
Broad Definition of Skills

Diagnosis, Post Diagnosis & Living Well with Dementia

To have a basic awareness of dementia & the impact of the condition on the person & their family

Working with Stress, Anxiety & Depression in people with dementia and their families

To have a basic awareness of the impact of anxiety, depression and stress in people with dementia and their families.

Person-centred care and working with psychological and behavioural signs of distress

To have an awareness of the impact of dementia on a person’s behaviour and how distressed/distressing behaviour represents a communication of emotions and/ or an unmet need.

To have a basic awareness of the psychological considerations when the person is at the end of their life.

    A basic recognition of risk of self-harm

  • How to recognise risk of self-harm in the person with dementia (e.g. through self-report or changes in behaviour) and a knowledge of who to go to for further advice.
    Demonstrate a basic knowledge and awareness of dementia and its impact on the person and their family

  • Knowledge of age-related changes in mind and body.
  • Knowledge and understanding of dementia including:
    • primary causes of dementia
    • early signs & symptoms that would indicate the need for further assessment
    • most common types of dementia
    • different stages of dementia
    • why an early diagnosis of dementia is important?
    • treatable causes for memory loss (e.g. depression, vitamin deficiency, thyroid problems).
  • Awareness of the steps taken to get a diagnosis and the options for post diagnostic support.
  • Understanding of the impact of dementia on individuals & their families.
  • Understanding of why it is necessary to preserve confidentiality for the person with dementia and their family.

    A basic awareness of the impact of anxiety, depression and stress in people with dementia and their families.

  • Knowledge of the range of mental health problems commonly experienced by people with dementia and their families (e.g. depression, anxiety and stress) including:
    • How dementia might affect the person’s mental health.
    • How mental health problems might present in someone with dementia.
    • How the mental health of the person with dementia’s family might be affected by the diagnosis.
    • How long term mental and physical health conditions might be affected by the person’s dementia.
  • Understanding that people’s histories, attachments and life experiences are crucial when making sense of their mental health.
    • The impact of trauma, abuse, neglect, loss.
    • That the impact of life events is significant to the individual, and cannot be generalised based on anyone else’s experiences.

  • Understanding that it is likely that different approaches may be needed at different points to support people with dementia and their families who experience mental health problems.
  • Recognition that symptoms, wellbeing, and capacity can change, in different settings, in different contexts, and over time.
  • Knowledge of the process of loss and transition associated with a diagnosis of dementia on the person with dementia and their family.
  • Knowledge of dementia specific interventions – e.g. Life Story work, Validation Therapy, Cognitive Stimulation Therapy.

    A basic awareness of risk assessment and risk management

  • Awareness of what might constitute a mental health “crisis”, and the potential impact on people's behaviour, feelings and perceptions when experiencing such a crisis.
    • Understand concepts of risk, risk assessment and risk management.
    • Understand why people self-harm and the different functions it can serve.
    • Understand the relationship between mental health crisis and other crises (e.g. physical health crisis, social crisis, financial crisis.)

    A basic knowledge and ability to signpost individuals with dementia and their families to network services

  • Ability to signpost people with dementia and their families who may be experiencing mental health problems to appropriate sources of help and support:
    • Knowledge of local systems and services to enable people to seek necessary help and support to ensure the immediate safety of someone experiencing a mental health crisis.
    • Awareness of information and local services that could assist in promoting good mental health such as access to leisure centres, welfare rights advice, Dementia Cafés, information about healthy eating, etc.
    A basic understanding of stigma and the need to respect diversity

  • Understanding of the stigma and discrimination faced by people with mental health problems.
  • Ability to understand and respect diversity (e.g. age; race; culture; disability; sex, gender and gender reassignment; spirituality, religion or belief; sexual orientation; relationship status).
    Principles and values of person-centred care and how this can provide valuable insights into the experiences of the person with dementia and support care approaches designed to meet individual needs

  • The individuality of each person with dementia
  • How the person’s response to the dementia is a result of their unique personality and life experiences.
  • How the person’s cultural background can influence their experience of dementia.
  • The importance of being able to see situations through the eyes of the person with dementia.
  • The importance of social relationships and interactions with other on the person with dementia’s well-being.
  • How the staff member’s/carers interactions can influence the behaviour of the person with dementia
  • How the role of family and carers in person-centred care & support of people with dementia.
  • How the person’s needs may change as the dementia progresses (but also that people change as they are people, not just because they have a dementia).
    A basic knowledge of psychosocial and medical interventions and their purpose.

  • Knowledge of the actions that individuals can take to reduce their risk of dementia (e.g. exercise, diet, managing alcohol intake)
  • Knowledge of how people can live well with a diagnosis of dementia (e.g. maintaining activity and social engagement, using skills to balance deficits).
  • Knowledge of the range of meaningful activities available to meet the range and level of need of people with dementia.
  • Understanding of the purpose and benefits of psycho-social interventions and the use of these techniques by qualified staff (e.g. Cognitive Stimulation Training, Validation Therapy, counselling, reminiscence and Life Story work).
  • Understanding of the purpose of commonly used medications for people with dementia (e.g. the ‘dementia’ drugs; medication for anxiety, depression, pain, sleeplessness, heart conditions, arthritis and diabetes).

    To have a basic awareness of psychological issues at the end of life for the person with dementia and their family.

  • Knowledge of how a diagnosis of dementia is a terminal diagnosis and will change someone’s life expectations.
  • Knowledge of what to expect when someone is about to die in terms of what physically may happen, and what practical and emotional preparations might be needed.
  • Understanding of a simple model of loss and bereavement (e.g. The Grief Wheel) and the ability to share that model with the person with dementia and their family.
    A basic understanding of the psychological and behavioural signs of distress in people with dementia

  • How and why dementia may change someone’s behaviour
  • The “needs” of a person with dementia (e.g. Maslow’s hierarchy)
  • How behaviour may be a communication of emotions and/or an unmet need.
  • The importance of knowing the person’s history when attempting to understand their behaviour.
  • The experience of pain in people with dementia and of how this may impact on their behaviour.
  • The impact of the physical, social and emotional aspects of the environment on the person’s behaviour
  • The nature of the person with dementia’s behaviour (e.g. is it a new behaviour, is there an increase in frequency of the behaviour, or is the behaviour avoidant, such as passivity, quietness, withdrawal?)
  • The importance of observational techniques in identifying psychological and behavioural signs of distress.

  • Observational recording techniques such as behavioural frequency charts, ABC charts etc.
  • The principles of Positive Behaviour Support.
  • The specific things that the person with dementia might find helpful to support their wellbeing i.e. distraction, supporting the use of self-soothing etc.
  • How the physical environment could be adapted to meet the changing needs of the person with dementia.

Qualified
Mental Health Professionals

(Any graduate-level healthcare professional) Without further accredited training in delivering psychological interventions

Psychologically-Informed Healthcare
Broad Definition of Skills

Diagnosis & Living Well with Dementia

To have a more detailed understanding of dementia, the causes, differential diagnosis, the impact of the condition on the person & their family and living well with dementia.

Working with Stress, Anxiety & Depression in people with dementia and their families

To have a good understanding of the impact of anxiety, depression and stress in people with dementia and their families and be able to draw upon basic psychological theory and knowledge and apply this to their work.

Person-centred care and working with psychological and behavioural signs of distress

To have a more detailed understanding of the principles and values of person-centred care, the impact of dementia on a person’s behaviours and how distressed/distressing behaviour represents a communication of emotions and / or an unmet need.

To have a more detailed understanding of the psychological considerations when the person is at the end of their life & the process of loss, bereavement and acceptance.

    Understanding of risk assessment and management

  • Understanding the signs in behaviour or in discussions with the person with dementia about ‘risk’ (e.g. in relation to self-harm and suicide) and a more detailed knowledge of who to go to for further advice.

    A more detailed understanding of the process of assessment and diagnosis of dementia and its impact on the person and their family including:

  • Knowledge of age-related changes in mind and body.
  • Knowledge and understanding of dementia including:
    • primary causes of dementia
    • early signs & symptoms that would indicate the need for further assessment
    • treatable causes of memory loss (e.g. depression, vitamin deficiency, thyroid problems).
    • most common types of dementia
    • different stages of dementia
    • why an early diagnosis of dementia is important?
  • An understanding of the difference between Mild Cognitive Impairment and dementia.
  • Knowledge of ‘dual diagnosis’ and of how to distinguish between dementia, normal age-related changes, delirium, alcohol and drugs and mental health problems such as depression.

  • Understanding the purpose of commonly used medications for people with dementia (e.g. the ‘dementia’ drugs; medication for anxiety, depression, pain, sleeplessness, heart conditions, arthritis and diabetes).
  • Understanding the process and complexity of assessment and diagnosis of dementia.
  • Awareness of possible errors that may be made in diagnosis and how this may have an impact of these on the person and their family.
  • Understanding the psychological and emotional impact of the diagnosis on the individual and their family and the process of adjustment.
  • Knowledge of the types of post diagnostic support available and the importance of timeliness in its delivery.
  • Knowledge of memory and how it deteriorates, and some compensatory cognitive strategies which may support this.
  • Understanding of why it is necessary to preserve confidentiality for the person with dementia and their family.
  • Knowledge of the importance of preserving the person’s dignity including their right to take risks and live life to the full despite the diagnosis of dementia.

    Knowledge of the range of mental health conditions and the impact of anxiety, depression and stress in people with dementia and their families. A more developed ability to draw upon basic psychological theory and knowledge and apply this to their work.

  • A more detailed knowledge of the range of mental health problems and related health issues for people with dementia including:
    • The range of presenting issues and commonly encountered problem areas in people with dementia and the relationship between physical and mental well-being.
    • An understanding of the biopsychosocial model.
    • An awareness of the process of differential diagnosis, and how psychological information can help inform this.
    • An understanding of the need to exclude physical causes for apparent mental health problems.

    Knowledge of psychosocial interventions that promote living well with dementia

  • Knowledge of the purpose and benefits of psycho-social interventions that help people live well with dementia (e.g. Cognitive Stimulation Therapy, Validation therapy, Counselling, Reminiscence and Life Story Work).
    Knowledge of and signposting to services for people with dementia

  • Knowledge of services for people with dementia.
  • Knowledge of local facilities for people with dementia and how to signpost them to them.

    A more detailed knowledge of theoretical models:

  • Knowledge of the main psychological models, how they are applied to selected interventions, and which models are likely to be most helpful in certain circumstances.
  • Knowledge of the process of loss and transition associated with a dementia diagnosis and of the differential reactions that may be experienced.
  • Knowledge of attachment theory and life transitions, and the relevance of this theory to how people with dementia may interact with services
  • Knowledge of learning theory, and how it is relevant to certain psychological interventions
  • Knowledge of models of how people relate to each other and how sometimes this means strong feelings may be experienced consciously or unconsciously towards the other person. (e.g. this is called ‘transference and counter transference’ in the literature).

    A more detailed knowledge of the impact of dementia

  • Understanding the impact of caring on families of people with dementia, for example, on relationships, changed roles, social isolation, psychological impact.
  • Knowledge of compassionate approaches and how these would be of value to people with dementia and their families.
  • Knowledge of the stress-process model and how to maintain well-being when the situation is at risk of breaking down.
    A more detailed knowledge of the reasons for self-harm and its risk management

  • Understand why people self-harm when experiencing distress.
  • Ability to reflect on the function or effect of self-harm and the aim/intention people may have when considering self-harm.
  • Understanding which approaches to self-harm may help to reduce risk.

    Understanding of evidence based-best practice

  • Understand the concept of evidence-based and values-based best practice guidance from a range of bodies (e.g. NICE, Royal Colleges, mental health charities etc.).
  • Understand and apply guidance relevant to their role and practice.
  • Understand the network of services and referral pathways for people with dementia and their families.
  • Understand the many ways to help families of people with dementia, the availability of resources and other local services that could support them.
  • Understand of working arrangements and referral pathways with other related services, for example:
    • Intellectual disability services, Primary Care, IAPT.
    • Specialist services where they exist (e.g. within physical health).
    • Support services, including those in the third sector.
    • Speech and language therapy, physiotherapy, diabetic services etc.

    Understanding of the principles, values and models of person-centred care and how it underpins working with people with dementia who are showing psychological and behavioural signs of distress and supporting their families and care networks

  • The importance of recognising the individual perspective of the person with dementia (including cultural considerations and diversity).
  • How person-centred care can provide an insight into the experiences of the person with dementia and how this can support care approaches to meet individual needs.

  • The value that relationships and interactions with others has to the person with dementia.
  • Recognition of how the staff member’s interactions and behaviours may influence the behaviours of people with dementia.
  • The concept of positive risk taking and why this is sometimes necessary.
  • The important role family and carers have in supporting the person with dementia and assisting with the development and delivery of the person-centred care approach.
  • How the person’s needs may change as the disease progresses (but also that people change as they are people not just because they have a dementia).
  • Relevant models and approaches aimed at improving quality of dementia care (e.g. Dementia Care Mapping and Brooker’s VIPS model).
  • Knowledge of evidence-based psychological models and interventions for people with dementia who present with behavioural and psychological signs of distress (e.g. the Newcastle Model).

    A more detailed understanding and knowledge of the process of assessment of the behavioural and psychological symptoms of dementia and how to formulate interventions to address these issues.

    A more detailed awareness of who the behaviour is challenging for and that the behaviour of the person is not pathological but a response to a perceived situation

  • “Needs” (e.g. Maslow’s hierarchy) and how behaviours may be a communication of emotions or an unmet need.
  • The impact of the physical, social and emotional aspects of the environment on the person’s behaviour.
  • The experience of pain in people with dementia and of how this may impact on their behaviour.
  • The nature of the person with dementia’s behaviour (e.g. is it something new to their behavioural repertoire, is there an increase in frequency of the behaviour, or is the behaviour avoidant, such as passivity, quietness, withdrawal).
  • The importance of observational techniques in identifying psychological and behavioural signs of distress.
  • The use of observational recording techniques such as behavioural frequency charts, ABC charts etc.

    Formulation

  • The importance and value of the formulation process as a means of making sense of the information gathered in an assessment and knowledge of how to use this to help in understanding the causes of the person’s behaviours.
  • How formulations can be used to guide the intervention.

    Meeting Needs

  • How to recognise and respond to unmet need and distress in people with dementia and their families.
  • How the physical environment could be adapted to meet the changing needs of the person with dementia.
  • How the range of behaviours may have an impact on families and staff.

    Understanding of the psychological considerations when the person is at the end of their life & the process of loss, bereavement and acceptance.

  • Dementia as a terminal diagnosis and how this may impact on individuals & their families.
  • What happens when someone dies and how to share the emotional preparations with the agencies involved.
  • The psychological models of the process of loss, bereavement and acceptance (e.g. Worden reference).
  • The factors that contribute to a good death.
  • The agencies which may be able to help through this process and how to contact them.

Qualified (Uni-Model) Psychological Therapists

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Evidence-Based Skills
Broad Definition of Skills

Diagnosis, Post-Diagnosis & Living Well with Dementia

To have a specialist knowledge of dementia and up to date research and evidence.

Working with Stress, Anxiety & Depression in people with dementia and their families

To have a specialist knowledge of the impact of anxiety, depression and stress in people with dementia and their families and be able to draw upon basic psychological theory and knowledge and be able to draw upon more advanced knowledge of psychological processes and complex issues in mental health.

Person-centred care and working with psychological and behavioural signs of distress

To have specialist knowledge and understanding of the principles and values of person-centred care, the impact of dementia on a person’s behaviours and how distressed/distressing behaviour represents a communication of emotion and / or an unmet need.

To have a specialist knowledge of the psychological processes when the person is at the end of their life, including loss, bereavement & acceptance including the impact on families.

    A specialist knowledge of the evidence base for effectiveness of different psychosocial approaches for the person with dementia.

  • In relation to post-diagnostic interventions and where and how to access it.
  • For the effectiveness of different psycho-social approaches for people with dementia.

    Assessment of dementia, impact of a diagnosis of dementia on the person and their family including a specialist knowledge

  • The complexity of ageing of mind and body and of the co-morbidity that exists in people with dementia.
  • The causes, diagnostic process and course of the dementias from onset to end of life.
  • The pros and cons of relevant pre-diagnostic screens including their reliability and validity for the given population. (e.g. that some assessments are unsuitable e.g. Mini Mental State Examination and others require specific accreditation to administer e.g. Behavioural Assessment of the Dysexecutive Syndrome).
  • The impact of a diagnosis of dementia in less common circumstances (e.g. earlier in life, or for people with an intellectual disability or for people with an additional complex neurological conditions).
  • The importance of preserving confidentiality for the person with dementia and their family.
  • How to work with the person with dementia and their family around pre diagnosis, diagnosis and giving feedback.

  • How to adapt information according to the needs of the person.
  • The different ways in which people with dementia might receive the diagnosis and the implications for post diagnostic support.

    Support required by people with dementia and their families from diverse backgrounds

  • How people from different cultural or spiritual backgrounds or those with protected characteristics might require different or additional support during this process.

    Risk assessment and where to obtain further advice/intervention support

  • A specialist knowledge of how to carry out a basic risk assessment for self -harm or suicide in people with dementia, including the use of self-report measures and behavioural changes, and a specialist knowledge of who to go to and when for further advice and intervention.
  • A knowledge of Trust, organisational and professional practice policies and procedures in relation to risk.

    A specialist, comprehensive understanding of the theory underlying at least one area of psychological therapy (e.g. CBT, CAT, SFT, IPT, Systemic), its application, strengths and limitations for people with dementia and their families and/or the care system.

  • Knowledge of the skills, techniques, methods, and approaches that form part of the model.
  • Ability to think critically about the model, and critically appraise the literature (i.e. to judge whether the findings of a study in their area are valid, generalisable, applicable to their work etc.
  • An understanding of the constantly evolving evidence base for models of psychological therapy.

  • An ability to judge when the model is likely to be more helpful or less helpful to understanding or intervening with a particular client.
    • A specialist ability to explain the rationale behind interventions that form part of their model.
    • A specialist knowledge of evidence-based adaptations that can be made to the model when working with people with dementia and their families.
  • The skills to reflect on and apply knowledge to clinical situations.
  • Knowledge of the relationship between dementia and mental health difficulties in people with dementia and their families.
  • Awareness of the impact of potential losses associated with a diagnosis of dementia and an understanding of how to work to help someone to explain these losses .
  • A knowledge of family dynamics and its application to working with people with dementia, their families and the wider system.
  • An understanding of attachment theory, learning theory, therapeutic relationships, therapeutic boundaries, interpersonal processes.
  • Knowledge and understanding of group interventions and processes in relation to a specific therapeutic model (e.g. CBT groups for carers of people with dementia).

    Knowledge of the principles and values of person-centred care and how it underpins working with people with dementia who are showing psychological and behavioural signs of distress, including an ability to critique this model at a specialist level.

  • Understanding the value of person-centred care in therapeutic relationships and in communication with people with dementia.
  • Understanding how the behaviours of a person with dementia may reflect their emotions or unmet needs and how these will have an impact on their family members, carers or therapists and how this may lead to unhelpful patterns of communication.

    A specialist understanding of the progression of dementia

  • Understanding the difference between cortical and sub-cortical types of dementia and how each may result in different patterns of behaviour.

  • Understanding of how some forms of behaviours may be due to changes in the progression of a dementia and/or to reactions to commonly administered drugs and physical health status.

    A specialist knowledge of the evidence based interventions available for dementia care and how to implement them

  • How systematic, person centred interventions reduce psychological and behavioural signs of distress.
  • How to integrate the basic tenets of person centred care for people with dementia into their preferred therapeutic model through which interventions will be delivered.
  • How to plan and re-plan therapeutic interventions in a person centred way to improve well-being.

    Understanding of observational techniques and psychometric measures

  • The importance of observational techniques in identifying psychological and behavioural signs of distress.
  • Specific scales and questionnaires that can be used when working with people with psychological and behavioural signs of distress.

    Knowledge of psychological processes for the person with dementia at the end of their life and their families

  • A specialist knowledge and a comprehensive understanding of the process of what happens when someone dies, for example, in the agency in which one works, the local services involved and how to contact them.
  • A specialist knowledge of one model of loss, bereavement and acceptance on which to base one’s practice.

Highly Trained Psychological Workers

Who are able to draw on multiple models and theories (e.g. clinical or counselling psychologists).

Delivery of
Specialist Skills
Broad Definition of Skills

Diagnosis, Post-Diagnosis & Living Well with Dementia

To have highly developed, specialist knowledge of diagnosis and post diagnostic interventions and, up to date research, evidence and theory.

Working with Stress, Anxiety & Depression in people with dementia and their families

To have a specialist knowledge of the impact of anxiety, depression and stress in people with dementia and their families and be able to draw upon basic psychological theory and knowledge and be able to draw upon more advanced knowledge of psychological processes and complex issues in mental health. Ability to support other people’s learning at different levels.

Person-centred care and working with psychological and behavioural signs of distress

To have highly developed, specialist knowledge of person-centred care and the theoretical background. To be aware of the current evidence base for working with the Behavioural and Psychological Symptoms of Dementia.

To have highly developed, specialist knowledge of the psychological processes when the person is at the end of their life, including loss, bereavement & acceptance including the impact on families and systems.

    To offer specialist teaching and training in this area

  • A highly developed specialist ability to share this knowledge through individual and small group teaching and training in a local context.

    Knowledge of dementia formal assessments, diagnosis and post diagnostic interventions and, up to date research, evidence and theory, including a highly developed specialist knowledge

  • Age related changes in mind and body.
  • The stages and process of diagnosis, the impact of the diagnosis on the person with dementia and their family and the options available for timely post diagnostic support.
  • The available tools for pre-diagnostic screening.
  • The range of neuro-psychological assessments that can be used in the more detailed assessment of dementia, including recommended standard batteries, reliability and validity of the tests.
  • The importance of preserving confidentiality for the person with dementia and their family.
  • The research evidence in relation to dementia & dementia care including new and emerging psycho-social approaches and evidence based interventions and developments.

  • How to contribute towards the development of new psychological interventions for people with dementia and their families.
  • How to promote and disseminate evidence based interventions and developments in dementia care within the Team.

    Ability to conduct detailed risk assessment of self-harm/suicide, at a highly specialist level

  • Understand the signs in behaviour or in discussions with the person with dementia about ‘risk’ (e.g. in relation to self -harm and suicide).
  • Carry out a detailed risk assessment for self -harm or suicide, including the use of standardised self -report measures
  • Decide who to go to and when for further advice and intervention in relation to concerns about self-harm and suicide.

    A highly developed specialist knowledge of the full range of mental health problems, underpinned by theory, a critical evaluation of research and the evidence base and experience and competence in several models of therapy.

  • A highly specialist knowledge and understanding of more than one model of psychological therapy including an awareness of:
  • Complex areas of mental health, such as medically-unexplained symptoms, trauma and psychosis.
  • Functional behaviour, maladaptive coping, and self-defeating patterns that can underpin assessment, formulation and intervention (especially in relation to risk).
  • General psychological knowledge that helps underpin applied practice (knowledge that is typically acquired via an undergraduate psychology degree), e.g.:
    • developmental psychology
    • functional neuroanatomy
    • attachment
    • social learning theory
    • cognitive science

  • Knowledge and experience of working in different settings, including:
    • Intellectual disability services
    • Physical health services
    • Care Home Settings
    • IAPT services

    Application of psychological knowledge in novel or complex situations using multi-model approaches

  • Reflect on and apply psychological knowledge in a creative way, in novel clinical situations using a range of different theories and models.
  • Understand and critically appraise research, literature, and the broad evidence base for a range of approaches and theories.

    Understanding of research methodology and evidence and its applications

  • A highly developed understanding of research methodology and statistics in relation to outcome measures, service evaluations, and audits.
  • A highly developed specialist ability to be self-sufficient in researching and understanding applied psychology in areas that fall outside current expertise, seeking further education, training and support where appropriate.

    Contribute highly developed specialist knowledge and to person-centred care at the organisational/care system level

  • A highly developed, specialist knowledge and ability to make a positive contribution about the value of person centred care (e.g. for CQC and Mental Health assessments, NHS Trust/Organisation audits and reviews, and to adult social care and other agencies where their work is involved with people with dementia on their own or the Teams caseload).

    Understanding of the principles, values of person centred care and psychological models for intervention and how they underpin working with people with dementia who are showing psychological and behavioural signs of distress, including a highly developed specialist knowledge

  • The complex neurological presentations of dementia and the potential impact of these presentations on a person with dementia’s behaviour.
  • Psychological theories and therapeutic models that may explain the psychological and behavioural signs of distress for the person with dementia, their family and others caring for them.
  • How to use a psychological formulation to devise and implement a systematic jointly delivered care plan that may be delivered at several steps of the care pathway.
  • Psychological models for intervention with people with dementia who are exhibiting signs of psychological and behavioural distress (e.g. see work by Ian A. James/Newcastle model; Tom Kitwood; Jane Fossey; Dawn Brooker/Dementia Care Mapping).
  • Psychosocial models in order to challenge prevailing medical/drugs based models for managing behaviours that challenge by offering a robust evidence base for other therapeutic approaches.

Principal Psychologists



Delivery of
Specialist and Complex Skills
Broad Definition of Skills

Diagnosis, Post-Diagnosis & Living Well with Dementia

An advanced psychological knowledge of diagnosis and post diagnostic interventions knowledge that includes the wider health context, national frameworks, and future direction of care.

Working with Stress, Anxiety & Depression in people with dementia and their families

To have advanced theoretical and practical knowledge of the psychological impact of dementia on the person, their family and supporting systems, and of the evidence-base and theory of the range of psychological interventions including individual, group, system and organisational.

Person-centred care and working with psychological and behavioural signs of distress

To have advanced theoretical and practical knowledge of working with the Behavioural and Psychological symptoms of Dementia in people with complex neurological presentations.

To have an advanced understanding and be able to advise on the delivery of person-centred care and work with the Behavioural and Psychological signs of Dementia within a service.


To have highly developed, specialist knowledge of the psychological processes when the person is at the end of their life, including loss, bereavement & acceptance including the impact on families and systems.

    Assessment, diagnosis and post diagnostic interventions knowledge, including an advanced theoretical and practical knowledge

  • Normal and abnormal ageing and its effects on mind and body.
  • Dementia and dementia care, including current research, evidence and theory, (including the different types and stages of dementia).
  • The stages and process of pre-diagnosis, diagnosis and post diagnostic support for people with dementia, including the multiple presentations of dementia and more complex or unusual presentations.
  • The complexities of assessment and the impact of the diagnosis.
  • Relevant pre-diagnostic screening measures, including evidence-base and best practice recommendations.
  • The range of neuro-psychological assessments that can be used in the more detailed assessment of dementia, including recommended standard batteries, reliability and validity of the tests, and use in the assessment of people with more complex presentations.
  • The complexities of confidentiality.

  • An advanced understanding of the purpose of commonly used medications for people with dementia (e.g. the ‘dementia’ drugs; medication for anxiety, depression, pain, sleeplessness, heart conditions, arthritis and diabetes); an awareness of the common side effects of each of these.

    Knowledge of current, new and emerging psychosocial interventions and the ability to promote their implementation as part of an advanced theoretical and practical knowledge

  • Psychosocial interventions. psycho-social approaches, evidence based interventions and new developments for people with dementia and their families including a knowledge of how these can be integrated within the local service pathways.
  • Development of new psychological interventions for people with dementia and their families and a knowledge of how to integrate this within the service.
  • How to promote and disseminate evidence based interventions and developments in dementia care within the Service.

    Theoretical and practical knowledge of managing complex risk

  • An advanced theoretical and practical knowledge and experience of managing the highest levels of risk.
  • An advanced knowledge of how to carry out a detailed and complex risk assessment for self -harm or suicide, including the use of standardised self -report measures and the NHS Trust/Organisation’s risk reporting strategies.
  • An advanced knowledge of who to go to and when for further advice and intervention in relation to concerns about self-harm and suicide and an ability to advise and support more junior members of the service requiring this information.

    To have advanced theoretical and practical knowledge of the psychological impact of dementia on the person, their family and support systems, and of the evidence-base and theory supporting the range of psychological interventions at individual, group, system and organisational levels.

    An advanced knowledge of the full range of mental health problems, underpinned by theory and experience including:

  • Complex areas of mental health, such as medically-unexplained symptoms, dissociation, trauma and psychosis.
  • Functional behaviour, maladaptive coping, and self-defeating patterns that can underpin assessment, formulation and intervention (especially in relation to risk).
  • General psychological knowledge that helps underpin applied practice (knowledge that is typically acquired via an undergraduate psychology degree), e.g.:
    • developmental psychology
    • functional neuro-anatomy
    • attachment theory
    • social learning theory
    • cognitive science

  • An advanced knowledge and experience of working in different settings, including:
    • Intellectual disability services
    • Physical health services
    • Care homes
    • IAPT services
    • Organisational structures

    An advanced ability to apply psychological knowledge in novel situations

  • An ability to reflect on and apply psychological knowledge in a creative way, in novel clinical situations

    An advanced ability to critically appraise research and practice-based evidence in relation to innovation and service development and to promote their dissemination/implementation in the organisation

  • Understand and critically appraise research, literature, and the broad evidence base for a range of approaches and theories.
  • Knowledge of evidence-based innovations and developments in dementia interventions and care and to be able to promote and disseminate these within the service.

    Principles and values of person-centred care and how these underpins working with people with dementia who are showing psychological and behavioural signs of distress, based on advanced theoretical and practical knowledge

  • Professional experience, gained through working with people with dementia and the complex neurological presentations that have an impact on their behaviour.
  • How to plan systematic evidence based interventions for people with dementia who present with behavioural and psychological signs of distress. .
  • How to work with the distress experienced by Teams and Services in relation to the impact of working people with dementia whose behaviour may be perceived as ‘challenging’.
  • National and professional guidance, recommendations and best evidence practice in the field of dementia care.

  • Working at a service wide level within systems for the development of services that ensure the delivery of person centred care and best-practice interventions for the management of the behavioural and psychological symptoms of dementia.
  • How working with the media can help to disseminate best practise in dementia care.

    Psychological processes when the person is at the end of their life, including loss, bereavement & acceptance including the impact on families and systems; including advanced theoretical and practical knowledge

  • An ability to reflect on and apply psychological knowledge in a creative way, in novel clinical situations
  • Current best practice in relation to the literature for care of the dying and end of life care, in particular for people with dementia and their families.
  • Areas in which people might like to make choices, including understanding some of the complexities around making wills, power of attorney, advanced decisions to refuse treatment, funeral services, bequests and other preferences and how these relate to better management of their psychological needs in the loss process.
  • How national guidance is interpreted by the NHS Trust/Organisation and agencies at a local level and to be able to share this with colleagues.
  • An advanced ability to share this theoretical knowledge to help to inform service provision and development for people with dementia and their families, NHS Trust/Organisation wide.
  • An advanced ability to share this knowledge with other staff working psychologically with people with dementia through training and supervision to help them integrate this into their practice.

Lead/Head Psychologists



Delivery of Organisational-Level and Competency Initiatives, Service Development, and Clinical Governance
Broad Definition of Skills

Diagnosis, Post-Diagnosis & Living Well with Dementia

An expert knowledge of diagnosis and post diagnostic interventions that includes the wider health context, national frameworks, future direction, and knowledge of commissioning processes in relation to mental health and psychology specifically.

Working with Stress, Anxiety & Depression in people with dementia and their families

An expert knowledge of evidence-based innovations and developments in dementia interventions and care and to be able to promote and disseminate these at an organisational and a national level.

Person-centred care and working with psychological and behavioural signs of distress

To have an expert knowledge and understanding of the principles and values of person-centred care and how it underpins working with people with dementia who are showing psychological and behavioural signs of distress and an ability to disseminate this knowledge at a NHS Trust/Organisation wide level in order to ensure best practice.

To have extensive experience and expert theoretical and practical knowledge of the psychological processes which occur when the person is at the end of their life, including highly advanced knowledge of current models of loss, bereavement and acceptance. To have an expert awareness of the impact of this process on individuals and on their families, on staff and the wider systems within which they work.

    An expert knowledge of diagnosis and post diagnostic interventions that includes the wider health context, national frameworks, future direction, and knowledge of commissioning processes in relation to mental health and psychology specifically

  • An expert knowledge of dementia in all its presentations and stages, including the complexity of rarer forms of dementia
  • An expert knowledge of the process of pre-diagnosis, diagnosis and post diagnostic support, including the evidence base and national guidance about best practice.
  • An expert knowledge of pre-diagnostic screens and neuropsychological assessments used during the diagnostic process, included current national guidance and best practice.
  • An expert knowledge of issues relating to confidentiality and the highest levels of risk management.
  • An expert knowledge of how to promote and disseminate best practise in dementia care within the service, NHS Trust/Organisation, region and nationally.

  • An expert theoretical and practical knowledge of research evidence and national guidance in dementia & early stage dementia care, including psycho-social interventions and other evidence-based innovations and developments that enable people to live well with their condition.
  • An expert knowledge of how to share evidence-based best practice at a professional, health system and NHS Trust/Organisation-wide level for the benefit of people with dementia and their families.
  • An expert theoretical and practical knowledge of health politics including an understanding of the local NHS Trust/Organisation direction and policies that impact on the delivery of psychological services for people with dementia.
  • An expert knowledge of local and national health, social care and voluntary systems involved in the field of dementia care and how to access and work with these.
  • An expert knowledge of national and professional drivers, frameworks and guidance in the field of dementia care.
  • An expert knowledge of local and national commissioning arrangements and opportunities for service developments and reorganisation.
  • An expert knowledge of the use of all forms of media to promote best practise in dementia care.
  • An expert knowledge of health politics including an understanding of the local NHS Trust/Organisation direction and policies that impact on the delivery of psychological services for people with dementia.

    Expert ability to conduct complex risk assessments for self-harm and suicide and to support junior staff in this area

  • An expert understanding of the signs in behaviour or in discussions with the person with dementia about ‘risk’ (e.g. in relation to self -harm and suicide).
  • An expert knowledge of how to carry out a detailed and complex risk assessment for self -harm or suicide, including the use of standardised self -report measures and the NHS Trust/Organisation’s risk reporting strategies.
  • An expert knowledge of who to go to and when for further advice and intervention in relation to concerns about self-harm and suicide and an ability to advise and support more junior members of the service requiring this information.

    An expert knowledge of evidence-based innovations and developments in dementia interventions and care and to be able to promote and disseminate these at an organisational and a national level.

  • An advanced applied knowledge of complex areas of mental health, such as medically-unexplained symptoms, dissociation, trauma and psychosis.
  • An expert understanding of functional behaviour, maladaptive coping, and self-defeating patterns that can underpin assessment, formulation and intervention (especially in relation to risk).
  • An expert ability to be self-sufficient in researching and understanding applied psychology in areas that fall outside current expertise, seeking further education and training where appropriate
  • An expert knowledge of evidence-based innovations and developments in dementia interventions and care and an expert ability to promote and disseminate these within the service.

  • An expert level of general psychological knowledge that helps underpin applied practice (knowledge that is typically acquired via an undergraduate psychology degree), e.g.:
    • developmental psychology
    • functional neuro-anatomy
    • attachment theory
    • social learning theory
    • cognitive science
  • An expert knowledge and experience of working in different settings, including:
    • Intellectual disability services
    • Physical health services
    • Care homes
    • Organisational structures
    • National and professional organisations
  • An expert ability to reflect on and apply knowledge in a creative way, in novel clinical situations.
  • An expert understanding of research methodology and statistics in relation to outcome measures, service evaluations, and audits.

    Knowledge and understanding of the principles and values of person-centred care and how it underpins working with people with dementia who are showing psychological and behavioural signs of distress and an ability to disseminate this knowledge at a NHS Trust/Organisation wide level in order to ensure best practice

  • How to work at an organisational level with systems in the development of services that ensure the delivery of person centred care and best-practice interventions for the management of the behavioural and psychological symptoms of dementia.
  • How to engage with organisational systems to disseminate national developments and standards in dementia care.

    Extensive experience and expert theoretical and practical knowledge of the psychological processes which occur when the person is at the end of their life, including highly advanced knowledge of current models of loss, bereavement and acceptance

    An expert awareness of the impact of this process on individuals and on their families, on staff and the wider systems within which they work.

  • An expert knowledge of the theoretical literature and national best practice in relation to end of life care, in particular in relation to meeting the psychological needs of people with dementia and their families.
  • An expert ability to share this knowledge in the local service in which one works through teaching, training, supervision and case management, enabling people from a range of professional groups to develop their skills and confidence in working in this area.

  • An expert ability to share this knowledge and expertise with professional colleagues in psychology nationally through working groups, audit, research and publication and through contributing with other professional colleagues to the development of national guidance in best practice in end of life care.
  • An expert ability to lead within the NHS Trust/Organisation and the region in making strong provision to support staff working in this area to manage the impact on their professional and personal lives.

Professional Development, Supervision and Training

    This domain covers three related areas. Professional development and training includes taking responsibility for one’s own continued skills and knowledge development needs in relation to psychological practice, which may not be already adequately specified by the minimum standards for different professional groups.

    At higher levels, there is the expectation that training will also include an ability to train others. Supervision is included here both from the perspective of being able to receive and utilise supervision, and also the ability to offer and deliver supervision to those at lower levels.

All Clinical Staff Who Deal With People


Psychological Awareness
Broad Definition of Skills

To be aware of the purpose of clinical supervision and how to utilise it effectively. To be aware of individual CPD needs and how these align with agreed service delivery.

To have an awareness of the importance of service evaluation, audit and research.

    To be aware of the purpose of clinical supervision and Continuing Professional development needs and to recognise limits of one’s competence and knowledge

  • A basic understanding of the difference between clinical supervision and other forms of supervision e.g. managerial supervision, line management.
  • A basic awareness of the purpose of various forms of supervision (professional development and reflective practice/caseload management etc.).
  • A basic ability to use supervision appropriately as follows:
    • To confidentially discuss and reflect on one’s work including one’s personal and professional responses to it.
    • To discuss and form intervention plans and overcome problems that arise.
    • To promote one’s own personal and professional development.
  • A basic ability to recognise the limits of one’s own individual competence/gaps in one’s knowledge and seek help or signpost on when appropriate.
  • Staff at this level would not normally be expected to be supervising others.

    To have a basic knowledge of the importance of research

  • A basic knowledge of why research is important, who might conduct research and how the findings might improve care.

Qualified
Mental Health Professionals

(Any graduate-level healthcare professional) Without further accredited training in delivering psychological interventions

Psychologically-Informed Healthcare
Broad Definition of Skills

To have a more detailed understanding of the purpose of clinical supervision and how to use it effectively. To have a more detailed understanding of individual CPD needs and how these align with agreed service delivery.

To be able to deliver basic training to carers & staff. To have a more detailed understanding of the importance of service evaluation, audit and research.

    To have a more detailed understanding of the effective use of clinical supervision

  • An awareness of different supervision methods, and an ability to seek, set-up, and utilise them as appropriate, e.g. peer supervision, group supervision, one-to-one supervision, specialist supervision.
  • An understanding that being an effective supervisee is an active process, requiring a capacity to be reflective and open to criticism, willing to learn and willing to consider (and remedy) any gaps in competence which supervision reveals.
  • An ability to prioritise material for discussion within supervision, selecting the most important and relevant material.
  • An understanding of the need to recognise, address, and overcome avoidance in relation to supervision.

  • Consultation usually focuses on seeking advice, suggestions, or opinion.
  • An awareness of the difference between consultation and supervision, and when each might be appropriate including that:
    • Supervision is broader in focus with more depth of detail than consultation, usually in the context of an on-going developmental relationship.
    • Components which make up good supervision include e.g. setting and reviewing contracts; negotiating protected time; dealing with thorny issues; adhering to the organisation's supervision policy.

    An ability to deliver basic training to carers and staff, including a more detailed awareness

  • The need to educate others.
  • Having the ability to deliver training to carers and staff to promote an understanding of dementia.
  • How to encourage others to use strategies to manage the communication and behavioural issues that may be the result of a person having a diagnosis of dementia.

    A more detailed understanding of the value of research and how to critically evaluate evidence to inform interventions including:

  • The purpose of research, how research questions are asked and why, simple models of research practice, an awareness of common flaws in research findings, a knowledge of where to look for good research as opposed to bad (e.g. A peer reviewed journal, rather than the tabloids).
  • An ability to select between evidence based interventions with support and guidance, with sound reasons for why one might be preferable to another.

Qualified (Uni-Model) Psychological Therapists

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Evidence-Based Skills
Broad Definition of Skills

To be able to provide clinical supervision to unqualified or qualified staff from a specific therapeutic modality.

To be able to deliver training in a specific therapeutic modality to unqualified and qualified staff. To have skills in service evaluation, audit and research.

    Providing advice, supervision and consultation

  • The ability to adapt one’s communication style to provide support/supervision/ consultation/advice to staff of varying experience/knowledge/skill working with one particular model.

    Make effective use of supervision

  • Give and receive accurate and constructive feedback.
  • Work productively with their clinical supervisor to manage difficulties within the supervisory relationship.
  • Use a variety of methods within supervision, including direct observation and/or audio/video recording clinical sessions for viewing within supervision.
  • Use self-rating and peer-rating of in-session competence.
  • Demonstrate effective skills in clinical supervision & mentorship following appropriate training.
  • Set up and structure an approach to supervision that is appropriate to the model of psychological therapy which is being delivered. (N.B Supervisors need to have direct knowledge of the models they are applying and personal expertise in the therapeutic approaches they are supervising).
  • Develop and work in accordance with terms of a specified supervision contract e.g.
    • A specialist ability to work with the supervisor or supervisee to establish learning needs, boundaries, decide upon issues such as timing, frequency and record keeping as well as appropriate content.

    Supervision of psychological skills of staff (Levels 1, 2 and 3)

  • Supervise the application and understanding of psychological skills of Level 1, Level 2 and other Level 3 staff from within the model in which they are accredited.
    • To identify and discuss any misconceptions that the supervisee may hold regarding the model and its associated techniques
  • Help the supervisee practice and develop specific skills within the supervisory relationship.
  • Help the supervisee judge how to balance risk aversion against appropriate risk taking.
  • Support other staff in achieving accreditation, which would normally include an evaluative element, through close supervision.

  • Offer consultation to others regarding issues relating to the specific therapy in which they are accredited.
  • Balance a focus on the supervisee’s educational development with an obligation to identify and prevent practice which could be harmful or unhelpful to client.
  • Offer flexibility in approach to supervision, according to the staff member's level of skill and knowledge.
  • Help staff to identify triggers to their emotional reactions, spotting patterns over the course of a supervisory relationship.
  • Deliver group supervision, including being able to recognise and address group dynamic issues, support and maximise engagement of supervisees with each other, and ability to take an active, assertive but non-authoritarian leadership role.
    To demonstrate supervision and Continuing Professional Development in line with accreditation requirements

  • A specialist ability to demonstrate on-going supervision and CPD in line with the professional accrediting organisations requirements (e.g. BABCP).

    Train staff in a specific therapeutic modality

  • Train staff in skills and techniques in a specific therapeutic modality.
  • Deliver group presentations and facilitate case discussions.
  • Demonstrate a specialist understanding of the issues which make it difficult for colleagues to use the skills learned when they return to their place of work. (e.g. being a lone practitioner, conflicting shift patterns, lack of time and resources, unsupportive management or colleagues).

    Ability to critically evaluate research and select appropriate interventions within a single therapeutic model

  • An ability to select evidence based interventions within a single therapeutic model, recognising the strengths and weaknesses of each.
  • A knowledge of research purpose, methods, results and findings including the knowledge of how to plan and carry out a simple research project, e.g. Identifying a question, asking it in a non-biased way, recruiting a sample, planning a consistent methodology, obtaining, recording and interpreting results, recognising the limitations of the research, knowing where and how to share and disseminate it for good effect.
  • A knowledge of what constitutes good research evidence in relation to psychological assessment, formulation, interventions and therapy.

Highly Trained Psychological Workers

Who are able to draw on multiple models and theories (e.g. clinical or counselling psychologists).

Delivery of
Specialist Skills
    Critically evaluate, communicate research findings and conduct research within teams and networks

  • Communicate the importance of research and good research practice to people who use services, their families and colleagues in the team.
  • Review and select from the research literature to determine appropriate interventions for people who use mental health services and their families.
  • Identify the difference between good and poor research and to be able to describe their reasons for thinking this.
  • Understand common research methodologies used in mental health settings and particularly in psychological practice.
  • Understand how to conduct a research study about their own or the team’s practice which would be acceptable to a peer reviewed journal and submit it for publication.

    Deliver and evaluate bespoke training from a multi-model perspective and to promote embedding or transfer of training within the organisation, involving highly developed specialist skills

  • Ability to support the education and learning of other staff members through clinical supervision, training, and mentoring relationships.
  • Knowledge of learning needs and styles and how to develop education and training to meet these needs and interests.
  • AAbility to recognise the purpose and limitations of training and to have an awareness of specialist training available.
  • Ability to conduct meaningful evaluation of training.
  • Understanding of effective skills transfer processes, potential blocks and means of overcoming these. (I.e. of the difficulties of embedding new learning in a person or organisation and ensuring effective changes in behaviour and knowledge).
  • Ability to demonstrate effective leadership skills when working within a team.

    Coordinate and provide clinical supervision and consultation from a multi-model perspective to less experienced staff

  • Supervise staff at lower and similar levels from a multi-model perspective following appropriate training.
  • Be flexible in adapting supervision to the different needs of supervisees, maximising learning and engagement.
  • Use professional judgment in order to balance the need to ensure that the supervision agenda is comprehensive in its coverage, against the need to be responsive to current and specific supervisee needs.
  • Demonstrate knowledge of different supervision models and when to use them.
  • Offer supervision of clinical supervision delivered by others.
  • Offer consultation on a wide range of areas.
  • Coordinate clinical supervision within a team.

Principal Psychologists



Delivery of
Specialist and Complex Skills
Broad Definition of Skills

Be able to provide clinical supervision to less experienced psychologists, trainee psychologists and assistant psychologists & be able to develop and co-ordinate a service-wide clinical supervision strategy.

To be able to develop and co-ordinate Service/Specialism-wide psychological training strategy. To have advanced skills in service evaluation, audit and research and to be able to contribute to the research agenda at a service wide level.

    An advanced knowledge and understanding of the provision of clinical supervision and consultation, including the development of organisation wide supervision strategies and governance.

  • An advanced knowledge and understanding of models of psychological supervision and consultancy.
  • An advanced ability to supervise the work of less experienced psychologists, counsellors, assistants and clinical psychology trainees (e.g. level 4 and below) to individuals or groups and to provide peer supervision if required.
  • An advanced ability to develop and implement supervision strategies within specialism/service.
  • An advanced ability to provide consultation in specialist areas.
  • An advanced ability to contribute to clinical governance throughout the service.
  • An advanced ability to use skills in reflective practice (for example where the process can split Teams.

    Assess training needs, skills gaps and ensure transfer of psychological practice skills in the organisation

  • Advise on staff competency and development in psychological practice skills.
  • Plan, develop, monitor and review the recruitment, deployment and management of psychological skills within the service area in which one works.
  • Ensure effective and safe transfer of psychological practice skills and to have a knowledge of how best these can be achieved within the service.
  • Intervene at a service level to manage any blocks to effective skills transfer.
  • Manage poor performance and unsafe practice using organisational and professional procedures to do so.

    Use of psychological knowledge to identify training needs across the organisation and to plan and an implement training strategy in relation to psychological practice skills

  • Use the psychological knowledge base to identify training needs across the service (e.g. in line with current best practice guidelines).
  • Develop and co-ordinate training in the service and specialism, including evaluation and review.

    Lead service development and improvement, based on advanced theoretical and practical knowledge of models of leadership and management

  • Lead specific service-wide developments in specific areas of psychological practice.
  • Demonstrate theoretical and practical knowledge of models of leadership and management theory and basic organisational psychology.
  • Demonstrate clinical leadership skills within the service, including aspects such as:
    • Understanding and rising to the challenges of service improvement.
    • Understanding the local and national context in which services are to be improved in relation to National policy imperatives, the local environment and the people living in it.
    • Understanding the characteristics of the populations involved and building on their diversity.

    Lead service development and improvement, based on advanced theoretical and practical knowledge of models of leadership and management

  • Lead specific service-wide developments in specific areas of psychological practice.
  • Demonstrate theoretical and practical knowledge of models of leadership and management theory and basic organisational psychology.
  • Demonstrate clinical leadership skills within the service, including aspects such as:
    • Understanding and rising to the challenges of service improvement.
    • Understanding the local and national context in which services are to be improved in relation to National policy imperatives, the local environment and the people living in it.
    • Understanding the characteristics of the populations involved and building on their diversity.

    To critically evaluate research effectiveness from published studies and to support local research and audit initiatives in terms of design of research, engagement and dissemination of findings

  • Communicate about how good research practice will improve local services, demonstrating an advanced ability to communicate the dangers of making inferences from poor research findings when planning local service provision.
  • Demonstrate advanced knowledge of how to evaluate the effectiveness of competing studies and to select the most relevant to ensure effective service delivery at a service wide level.
  • Demonstrate advanced knowledge of how to develop a research intervention to improve practise at a service level.
  • Demonstrate advanced knowledge of how to engage and support practitioners in the process of audit, research and publication, including a knowledge of how to obtain funding for research, how to obtain ethical approval, how to disseminate research findings to appropriate audiences, how to share these findings with disparate groups of people including one to one or through the media.

Lead/Head Psychologists



Delivery of Organisational-Level and Competency Initiatives, Service Development, and Clinical Governance
Broad Definition of Skills

To be able to provide clinical supervision to less experienced psychologists and to be able to develop and co-ordinate NHS Trust/Organisation-wide clinical supervision strategy.

To be able to develop and co-ordinate NHS Trust/Organisation-wide psychological training strategy. To have expert skills in service evaluation, audit and research and to be able to contribute to the research agenda at a NHS Trust/Organisation wide level

    Offer clinical supervision and consultation at a senior level and to develop and deliver policy, guidance and governance at the organisational level

  • Ability to plan, develop, monitor and review the recruitment, deployment and management of psychological skills and strategy across the NHS Trust/Organisation.
  • Knowledge and understanding of models of psychological supervision and consultancy.
  • Ability to offer clinical supervision and consultation at the most senior levels.
  • Ability to develop and coordinate a NHS Trust/Organisation-wide supervision Policy in line with national guidance and best practice.
  • Ability to manage the governance and delivery of safe and effective clinical supervision across the organisation.

    Advise on staff competency and psychological practice and to develop and coordinate an organisation-wide psychological training strategy

  • Develop and co-ordinate a NHS Trust/Organisation-wide psychological training strategy.
  • Advise on staff Competency and development in psychological practice skills.
  • Advise on profession standards through consultation with professional and regulatory bodies (e.g. BPS National Assessor Scheme, development of Professional Guidance and Consultations, HCPC, therapy specific organisations e.g. ACAT, BABCP).
  • Advise on staff competency in relation to psychological practitioners trained outside the UK, in association with HCPC.
  • Advise the organisation on change processes and effective skills transfer.

    An expert ability to lead specific organisation-wide developments in specific areas of psychological practice, based on theoretical and practical knowledge of models of leadership and management.

  • An expert theoretical and practical knowledge of models of leadership and management theory and basic organisational psychology and their implementation.

    Promote service improvement

  • Set the context which guides and informs service improvements
  • Guide and advise from a specialism perspective on psychological needs for different strategies (e.g. Organisation Development, Staff Well-being, Sickness and Absence).
  • Apply psychological knowledge at the level of the team, service and NHS Trust/Organisation to ensure that knowledge about psychological practice is embedded throughout the service.

    Promote research methods, application and governance at a local, national and international level

  • Ability to engage in and promote an open culture of communication, leading on service review and evaluation.
  • Knowledge of research methods and research governance built on knowledge gained at earlier skill levels.
  • Ability to encourage audit, research, publication and dissemination contributing to this at a local, regional, national and international level through both professional and governmental bodies.

Well-Being, Self-Awareness and Self-Care

    These skills reflect the importance of acknowledging and prioritising the well-being of staff working in caring and supportive roles. Promotion of psychological well-being, awareness and self-care is important at all levels and not only from an individual perspective, but also that of a Team and Organisation. At higher levels there is a recognition of the impact of organisational stressors and an expectation of the use of higher level psychological skills in assessing, formulating and intervening to reduce these.

All Service User-Facing, Clinical Staff.


Psychological Awareness
Broad Definition of Skills

For staff to have an awareness of stress levels and effective ways of managing these. For staff to have a basic awareness of emotional intelligence.

    Identify and address sources of personal stress and promote one’s psychological well-being including a basic ability

  • Identify different emotional states within oneself and others.
  • Recognize one’s own personal signs of stress.
  • Use of effective coping skills for stress management.
  • Understand how to access appropriate support/supervision as well as how to self-care/manage when required.
  • Have awareness of one’s own triggers for intense emotional reactions.
  • Understand how one can choose to respond to (as opposed to immediately react to) the triggering of strong emotions (e.g. tolerating and working with high levels of distress, sitting and working with difficult feelings, “not being able to make it better”).
  • Understand the relationship between intrapersonal and interpersonal processes (for example, basic insight into the potential for others people’s behavior and experiences to evoke sometimes strong feelings in oneself).

  • Understand the concept of resilience (or ability to cope and survive) as well as the common factors that underpin it (internal and external).
  • Understand what self-compassion is and what individuals need to in order to nurture self-compassion.
  • Recognise how experiencing loss and grief in one’s own life may make working with people experiencing loss and bereavement more difficult or at times overwhelming emotionally.
  • Recognise that one may be over identifying with someone else’s grief and that there may be a need to seek personal supervision or support.
  • Identify personal feelings, beliefs or attitudes that may affect relationships with people with dementia & their families/carers.
  • Recognise the emotional impact of working with people with dementia / family and carers and seeking supervision and support.

Qualified
Mental Health Professionals

(Any graduate-level healthcare professional) Without further accredited training in delivering psychological interventions

Psychologically-Informed Healthcare
Broad Definition of Skills

For staff to have a more detailed understanding of stress levels and effective ways of managing these.

For staff to have a basic awareness of emotional intelligence

    Identify of sources of personal stress and effective ways of managing these issues

  • Understanding of one’s own triggers for emotional reactions and sensitivities and recognition of one’s own ways of dealing with difficult emotions.
  • Ability to choose an appropriate response based on one’s own emotional reactions (this may often be about recognising personal challenges and taking these to supervision).
  • Understanding of the relationship between one’s inner feelings and the feelings of others (for example, a more advanced ability to recognise and distinguish personal issues from professional issues and deal with these appropriately, e.g. within clinical supervision, managerial supervision, or via external support).
  • Understanding of how to recognise signs of stress in oneself and others, especially those for whom one has a supervisory or line management responsibility.
  • Understanding of how to prevent and manage personal stress and respond to stress in others.
  • Understanding of how to support effective coping skills in others.

Qualified (Uni-Model) Psychological Therapists

(Any graduate-level healthcare professional with further post-graduate accredited training in a recognised psychological therapy)

Delivery of
Evidence-Based Skills
Broad Definition of Skills

To be able to deliver self-care initiatives



    Recognise one’s own emotional reactions, values and limitations

  • Recognise and use one’s own emotional reactions within the moment, rather than only within the context of supervision.
  • Reflect upon and evaluate personal values, clinical competence and limitations as psychological therapist.

    Support other staff in identifying and attending to their emotional reactions, involving a specialist ability

  • Help support others to attend to emotional triggers and reactions through clinical supervision.
  • Deliver compassionate self-care initiatives to staff.
  • Understand how people manage stress and adversity and what helps to build their coping skills or resilience.
  • Understand psychological models of shame and compassion and an ability to recognise conditions which trigger shame for oneself and others, and conditions which support being compassionate to one-self.

Highly Trained Psychological Workers

Who are able to draw on multiple models and theories (e.g. clinical or counselling psychologists).

Delivery of
Specialist Skills
Broad Definition of Skills

To be able to develop specialised programmes and interventions for promoting self-care and psychological well-being for staff.

To be able to assess formulate and advise on interventions for the impact of stress within the Team.

    Recognise one’s emotional reactions in challenging contexts and to address these issues as supervisor or supervisee

  • Recognise and utilise one’s own emotional reactions within the moment, in particularly challenging contexts.
  • Identify and name emotional states within one-self and others and to be able to communicate clearly about this.
  • Attend to different levels of need within the supervisory relationship, both from the position of supervisee and supervisor.

    Identify, assess, and formulate and help to manage stress in challenging situations within the team involving a highly developed specialism

  • Understanding of systemic issues that influence staff stress and use models to inform understanding in teams.
  • Ability to advise on/develop team interventions/specialised programmes for the management of team stress and to enhance team resilience.
  • Understanding of the concept of psychological resilience and how to support a culture that fosters this within the organisation.
  • Understanding of psychological models of shame and self-compassion and an awareness of the conditions individuals need to nurture compassion in themselves and in others.
  • Ability to debrief after critical events (with appropriate additional training and supervision).

Principal Psychologists



Delivery of
Specialist and Complex Skills
Broad Definition of Skills

To be able to assess, formulate and advise on interventions for the impact of organisational stress within the service/specialism. To develop and co-ordinate self-care and psychological well-being initiatives across the service/specialism.

    Identify, assess formulate and develop interventions to address stress at the individual or organisational level

  • Understanding of the systemic issues that influence staff stress and the ability to use psychological and organisational models to inform understanding within the service.
  • Ability to advise and develop interventions for the management of stress within the service/specialism and to enhance resilience.
  • Understanding of psychological models of shame and self-compassion and an awareness of the conditions individuals need to nurture compassion in themselves and in others across the organisation.
  • Ability to debrief after critical events including the ability to identify triggers for poor practice and to take steps within the organisation to remedy these.

Lead/Head Psychologists



Delivery of Organisational-Level and Competency Initiatives, Service Development, and Clinical Governance
Broad Definition of Skills

To be able to assess, formulate and advise on interventions for the impact of organisational stress within the NHS Trust/Organisation.To develop and co-ordinate self-care and psychological well-being initiatives across the NHS Trust/Organisation.

    An expert ability to manage challenging situations associated with critical events which have had organisational impact

  • An expert ability to manage challenging situations and to identify and manage the need to debrief after critical events across the organisation and the profession.

    Identify, assess, formulate and manage stress and promote resilience at the organisational level, involving expert

  • Understanding of systemic issues that influence staff stress and an expert ability to use psychological and organisational models to inform understanding within the NHS Trust/Organisation.
  • Ability to advise and develop interventions for the management of stress within the NHS Trust/Organisation and to enhance the resilience of staff working in the organisation and the profession

    Understanding of psychological models to promote self-care and compassion involving expert

  • Understanding of psychological models of shame and compassion and an awareness of the conditions individuals need to nurture compassion in themselves and in others.
  • Ability to develop organisational models with colleagues which reduce shame and poor performance and which develop self-care and an enabling environment.