Child and Adolescent Practice Scale (CAPS-Parenting)

1. Children and Young Person’s Improving Access to Psychological Therapies

The Children and Young Person’s IAPT was launched in October 2011 with the core aims of transforming CAMHS by: Developing child/young person focused services

Routinely using outcome measures to monitor progress and assess change

Encouraging reflective practice through the development of supervision

Training in evidenced based approaches (CBT and Parenting)

The first wave of funding has been agreed to provide training for therapists, supervisors and managers in order to secure these objectives. HEIs and CAMHS providers have joined together to form training collaboratives so that academic learning and development can be firmly embedded

within clinical services. A working group commissioned by the DH produced a curriculum detailing the content of the IAPT training. Evidence based treatment

programmes were examined, core elements identified and the competencies required to deliver these specified.

2. CAMHS Competencies

An evidence based competency framework for CAMHS was commissioned by NES Scotland and developed in collaboration with UCL (Roth and Pilling). This details the knowledge and skills underpinning the various clinical activities carried out by a CAMHS service and provides a

framework which details: core competencies for working with children and young people and their Parents generic therapeutic competencies assessment and formulation skills specific therapeutic competencies meta competencies

3. Parenting competencies

The above framework provides an overview of general CAMHS competencies but is not specific to parenting. Whilst parenting competencies for CYP IAPT have been specified there is no specific tool to assess them.

4. A framework

Philosophy (CORE): At the centre of the model is the overarching CYP IAPT philosophy which should inform all work

C – Child centredO- Outcome focused

R - Reflective practitioners E – Evidence based approaches

Process (PRECISE): The middle segment defines the process of working with parents

P - Partnership working R - Right developmental level

E – EmpathicC – Creative

I – InvestigativeS – Self efficacy

E - Enjoyable

Specific Skills (A, B, Cs): The outer segment defines the specific techniques that are included in parenting programmesA – Assertive Discipline

B – Behavioural techniquesC – Cognitive techniques

D – Developing Relationships E – Encouraging positive behaviour

F – Facilitations skillsG – Group skills

Child and Adolescent Practice Scale (CAPS)

The parenting process and technique skills have been defined in CAPS where examples are provided of appropriate evidence in each area.

The scale should be completed by the trainee and reviewed with their supervisor on three occasions, at the start, mid way and end of training. This will highlight particular strengths and training needs

CAPS can also be used to assess video and audio tapes of clinical sessions. Whilst only some specific techniques may be evidenced in particular recordings the process should be rated in all sessions.

The rating scaleThe present seven point scale (i.e. a 0-6 Likert scale) extends from (0) where the trainee does not believe they currently meet competence to (6) where they believe they are

currently expert in that particular competence. Mark each competence using whole and half numbers, the level to which you think you currently fulfil each core function. 

Competence Levels   

 

* The present scale has incorporated the Dreyfus system (Dreyfus, 1989) for denoting competence. Please note that the top marks (i.e. near the 'expert' end of the continuum) are reserved for those practitioners demonstrating highly effective skills, particularly in the face of difficulties.When rating each item, you must consider whether you should be regarded as competent in that particular area.

ReferenceDreyfus, H. L. (1989). The Dreyfus model of skill acquisition. In J. Burke (ed.) Competency based education and training. London: Falmer Press.

PROCESS1. Partnership working -

collaboration & learning together

The therapist establishes a collaborative and respectful partnership with the parent

in which they are actively engaged in working towards a set of joint goals and

targets. This may be evidenced by the therapist

Encouraging and inviting the parents/carer, participation in discussions, option appraisal, solution generation and decision making

Eliciting the parents/carers understanding and views about events

Involving the parent/carer in goal and target setting, intervention planning and agreeing home activities and experiments

Encouraging the parent/carer to provide open and honest feedback about parenting sessions

Not demonstrated

2. Right developmental level - pitch, methods, family involvementThe therapist engages with the parent or family in a way, level and manner that is consistent with their understanding

This may be evidenced by the therapist Using simple, clear, jargon free

language that is respectful and not patronising

Ensuring an optimal balance between cognitive and behavioural techniques

Conducting sessions at an appropriate pace

Appropriately using a variety of verbal (direct and indirect approaches) and non-verbal techniques

Appropriately involving all family members in sessions.

N

Not demonstrated

3. Empathy - acknowledge, genuine, warm, understanding

The therapist is able to emphasise with the parent/carers through the development of

a genuine, warm and respectful relationship.

This may be evidenced by the therapist Conveying interest and concern through

the appropriate use of specific skills such as active listening, reflection and summaries

Acknowledging and appropriately responding to the parents/cares verbal and non-verbal expressions and emotional responses such as distress, excitement or anxiety

Demonstrating an open, respectful, non-judgemental caring approach

Appropriately emphasising with carers about their own difficulties and the impact of these on their ability to help their child

Not demonstrated

4. Creative - verbal and non-verbal techniques

The therapist is able to creatively adapt the ideas and concepts of parenting to facilitate parents/carers understanding and engagement.

This may be evidenced by the therapist: Using an appropriate range and type of

verbal and non-verbal methods to facilitate understanding and engagement

Creatively using a range of methods e.g. talking, drawing, questionnaires, metaphor, role play, puppets, etc to convey ideas and concepts.

Tailoring and adapting concepts and methods of parenting around the interests of the child and or parent.

Responding to the preferred media/learning style of the parent e.g. verbal. visual, computer

Not demonstrated

5. Investigation - discovery, reflectionThe therapist adopts an open and curious stance that facilitates guided discovery and reflection.

This may be evidenced by the therapist:

Creating a process of collaborative inquiry in which the parent’s/carers thoughts and behaviour are subject to objective evaluation

Involve parent/carer in designing and testing out ideas and skills

Helping the parent’s /carers to generate alternative ideas and explanations about events

Encouraging the parent/carer to reflect on the outcomes of assignments

Not demonstrated

6. Self efficacy - build on strengths and ideas

The therapist adopts an empowering and enabling approach in which self-efficacy and positive attempts at change are promoted.

This may be evidenced by the therapist:

Identifying and highlighting parents/carers strengths and personal resources

Helping the parents/carers to identify their skills and strategies which have shown some past success

Developing and shaping the parents/carers ideas and coping strategies.

Praising and reinforcing the parents/carers use of new skills

Not demonstrated

7. Enjoyable - fun and engaging

The therapist is able to make therapy session appropriately interesting and engaging

This may be evidenced by the therapist

Using an appropriate mix of materials, activities, humour.

Ensuring that sessions are not too long

Maintaining an appropriate balance between task and non-task (relationship strengthening) activities.

Attending to the parent’s and child’s interests and appropriately incorporating these into the intervention.

SKILLSAssertive discipline - rules, instructions, planned ignoring, time out The therapist promotes a positive approach to managing challenging behaviour through the development of clear rules, positive commands, planned ignoring and timeout. This may be evidence by the therapist

Encouraging consistent application of clear rules and consequences

Encouraging calm, clear age appropriate requests and instructions

Developing parental monitoring and supervision of their children

Promoting the use of positive commands which tell the child what they are expected to do

Encouraging planned ignoring for minor or inappropriate child misbehaviour

Developing natural and logical consequences

Developing a clear rationale and implementing the safe use of brief time out

Not demonstrated

Behavioural techniques - rewards, small steps, problem solving

The therapist encourages use of a variety of behavioural techniques to facilitate therapeutic change

This may be evidenced by the therapist

Promoting an understanding of applied behaviour analysis and the effects of antecedents and consequences on child behaviour

Identifying and implementing reward and sticker charts and contingency plans

Breaking goals into small, sequential achievable steps

Modelling appropriate interactions and behaviour (polite, positive respectful language)

Coaching to encourage and develop skills such as turn taking, asking,

Use of structured problem solving approaches

Not demonstrated

Cognitive - awareness, identification, challenge, cognitive reframe

The therapist demonstrates use of a variety of cognitive techniques to facilitate therapeutic change

This may be evidenced by the therapist

Identifying & challenging unrealistic parental expectations

Catching & challenging unhelpful attributions and assumptions about their child’s behaviour

Developing alternative, less personal and critical explanations

Enhancing parental self-esteem and coping self-talk

Not demonstrated

Developing relationships - child, family relationships

The therapist uses a variety of methods to facilitate the development and strengthening of the parent/child and family relationships

This may be evidenced by the therapist Encouraging parents and children to

spend time together to play and have fun

Encouraging parents to redress the power imbalance and let their child lead activities

Encouraging parents to use descriptive praise and commentary

Raising awareness of the effect of emotions on parenting and child behaviour

Encouraging parents to address their own needs and to look after themselves

Not demonstrated

Facilitation Skills - planning, timing and organisation of sessions

The therapist is well prepared and conducts session in a calm and organised way

This may be evidenced by the therapist:

Preparing and bringing the necessary materials and equipment for the session

Ensuring that sessions have an agenda, clear goals and are appropriately structured

Ensuring good timekeeping and that all tasks are completed.

Ensuring that session are appropriately paced and are flexible and responsive to the needs of the parents.

Not demonstrated

Group skills - group management and cohesion

The therapist attends to and manages group process and dynamics in a constructive way.

This may be evidenced by the therapist:

Actively engaging and including group members who are quiet and managing those who are more vocal or demanding

An ability to manage disagreements

and emotional reactions of participants and to maintain group cohesion

An ability to be flexible, responsive and able to manage/use unexpected situations in a positive way

An ability to synthesise information and to clearly draw out and highlight themes and principles

An ability to effectively balance between leading and being directive and allowing the group to generate ideas and solutions