What is the view on the Clinical Associate Psychology Masters?

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Spatch
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Re: What is the view on the Clinical Associate Psychology Masters?

Post by Spatch » Mon Jan 14, 2019 5:59 pm

I have several thoughts about such para-professional psychology roles. While, I do think there does need to be a range of para-psychology roles and disciplines (like you do with Physician assistants, or HCAs for nursing), its the execution and operational elements I have questions about.

Firstly, is that their existence stands in comparison to an established and well respected role, and without any "core" identity it raises all kinds of existential issues. You see it with PWPs, Graduate Mental Health Workers and other roles that aren't psychologist, OT or CPN- They are almost more defined by what they aren't rather than what they actually are. In turn this can lead to defensiveness, feeling that one needs to overstate one's skill set and capacity which then creates further division and dissent. I can't imagine it being good for one's self esteem to be thought of as "a psychologist on the cheap". Granted, Clinical Psychology in it's earlier stages had elements of this against psychiatry, but there was always an understanding early on that Psychology was a discrete science in itself that was separate from Medicine and did things that were unique to it.

Related to this there are tensions about which "family" those roles belong to. PWPs seem more aligned with BABCP rather than "owned" by BPS/HCPC Psychologists. Graduate mental health workers never really found much of a home and I can imagine this being replicated if CAPs don't find a niche they can thrive within and for that niche to have heavy backing from a trade association like BPS/ACN or similar. Beyond therapy, I would question how much "psychology" the role involves. None of that syllabus seems particularly "psychology" based in what I see as core elements of the discipline (such as psychometrics, research, academic theory or being a scientist-practitioner)

The other question I would have also applies to the issue of retention and career progression. We have already seen IAPT bleeding PWPs heavily, as many go onto other roles or feel marginalised and exploited. Those roles have very limited career progression especially for the very able and ambitious psychology graduates who take them up. From what is being presented I can't really see CAPs faring any better (especially if their career standard grade is Band 6), and who would be happy working under close supervision of a CP for extended periods of their career with regards to autonomy and self direction. Who would you envisage holding these roles and what major draws would their be to staying in such posts? If considering a purely therapy role, why wouldn't such a person train as a straightforward CBT/Systemic therapist, counsellor or psychoanalyst, where there is room for growth and better career structure? Plus you could work privately in the future.

For me, the litmus test the question "If I was starting out, and if it meant I couldn't move up into any other related career pathway, would I want to do that job?" Would the people designing and running the course be satisfied doing those roles themselves long term or is it the sort of role for "other people".
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Re: What is the view on the Clinical Associate Psychology Masters?

Post by maven » Tue Jan 15, 2019 2:16 am

I've increasingly heard of para-psychologists who have no training beyond their original degree and some experience in graduate roles being asked to fulfil autonomous roles doing direct therapeutic work with vulnerable people. How can a psych grad with a year of care work go into a school or a job centre and provide psychological therapies without proper training and supervision. In that regard I'd prefer proper training paths like the scottish CAAP, or the PWP training. The problem is there are now volunteer and untrained staff in IAPT, and services who aren't paying for the training but still using the same job titles...
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Re: What is the view on the Clinical Associate Psychology Masters?

Post by Maango » Wed Jan 23, 2019 11:46 pm

This is a very much so interesting thread. I'm currently finishing my PWP training and have actually been offered an interview for said role of CAP in Exeter. However I'm disillusioned around the differences between the two roles. For myself I wanted to move less away from a therapy heavy role due to the burnout however I have noticed people are saying the CAP role is very much similar to a PWP role implementing low intensity cbt.

What differences are there between the two? Would this be career progression if stepping into this role from a PWP role ? If anyone could shed some light I'd be greatly appreciative. Thank you.

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Re: What is the view on the Clinical Associate Psychology Masters?

Post by Alexander » Thu Mar 07, 2019 2:50 pm

It was mentioned earlier in the thread that the current system of CP training is sufficient. I contest that view. While the competition among trainees ensures that the qualify of qualified psychologists is excellent, there are simply not enough them. There is a national vacancy rate of 14% for CP, almost as bad as psychiatry. Such high vacancy rates hamper the delivery of services as posts remain unfilled for months or, in extreme cases, years. That cannot be an efficient way of running a service and ultimately patients and service users bear the costs. One might argue that the solution is to increase HEE funding for CP training posts. I encourage everyone who feels that way to advocate for it. Given though that there is no indication that training numbers will be increased, CAP training with the option of a doctoral top-up several years after completing CAP training may provide a boost to the number of qualified CPs.

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Re: What is the view on the Clinical Associate Psychology Masters?

Post by JB99 » Thu Mar 07, 2019 3:30 pm

I do wonder whether people will see this as a paid stop gap between being an AP and a CP, similar to PWP. From the position of an AP like me, it would offer a funded master's degree, saving me £10k+, a formal qualification or certification in therapy (which an AP post rarely offers), and a two band pay rise. I imagine many fellow APs would see this role as a middle step, rather than a long term goal. This makes me question the extent to which this role would truly be economical, particularly if APs get onto funded CP training merely a year after their expensive masters qualification is paid for.

An even more skeptical part of me wonders whether this role can be used to justify decreased funding to CP training, because this would present an "alternative option" for those who cannot afford defunded CP training. This is highly speculative, but it has been brought to my mind by Leeds Clearing House and several of the DClinPsy course centres mentioning on their website that this may be subject to review (although this has been rumoured for decades).

Even though I completely understand the need for close supervision, it can feel a little frustrating to be signing off formal letters to colleagues with "under the supervision of...". I feel this particularly when compared to professions where only the three-year undergraduate is required to lift these bicycle training wheels, such as physiotherapists and occupational therapists. The idea of this being a permanent feature on my clinic letters, particularly if I were to have decades more experience than the CPs that supervise me, is pretty off-putting.

N.B I fully understand why APs differ in the supervision needs from physios or OTs. However, other professions may not. I am personally okay with needing to do so, as it is good that I am protected from complaints or worse, but not as a long-term picture.

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Re: What is the view on the Clinical Associate Psychology Masters?

Post by Psyfer » Sun Mar 17, 2019 2:20 pm

JB99 wrote:
Thu Mar 07, 2019 3:30 pm

Even though I completely understand the need for close supervision, it can feel a little frustrating to be signing off formal letters to colleagues with "under the supervision of...". I feel this particularly when compared to professions where only the three-year undergraduate is required to lift these bicycle training wheels, such as physiotherapists and occupational therapists. The idea of this being a permanent feature on my clinic letters, particularly if I were to have decades more experience than the CPs that supervise me, is pretty off-putting.
As a CAAP in Scotland I don't have to have anyone sign off my letters. Many CAAPs simply dictate them and sign them themselves.

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Re: What is the view on the Clinical Associate Psychology Masters?

Post by JB99 » Wed Mar 20, 2019 3:50 pm

Psyfer wrote:
Sun Mar 17, 2019 2:20 pm
As a CAAP in Scotland I don't have to have anyone sign off my letters. Many CAAPs simply dictate them and sign them themselves.
Ah thanks for correcting me, I was unaware that this was the case.

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Re: What is the view on the Clinical Associate Psychology Masters?

Post by lemon13 » Fri Mar 22, 2019 11:03 pm

Maango wrote:
Wed Jan 23, 2019 11:46 pm
This is a very much so interesting thread. I'm currently finishing my PWP training and have actually been offered an interview for said role of CAP in Exeter. However I'm disillusioned around the differences between the two roles. For myself I wanted to move less away from a therapy heavy role due to the burnout however I have noticed people are saying the CAP role is very much similar to a PWP role implementing low intensity cbt.

What differences are there between the two? Would this be career progression if stepping into this role from a PWP role ? If anyone could shed some light I'd be greatly appreciative. Thank you.
My understanding is that CAAP in Scotland is similar to High Intensity work. Not sure about the new role in England.

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Re: What is the view on the Clinical Associate Psychology Masters?

Post by lemon13 » Fri Mar 22, 2019 11:16 pm

Spatch wrote:
Mon Jan 14, 2019 5:59 pm
I have several thoughts about such para-professional psychology roles. While, I do think there does need to be a range of para-psychology roles and disciplines (like you do with Physician assistants, or HCAs for nursing), its the execution and operational elements I have questions about.

Firstly, is that their existence stands in comparison to an established and well respected role, and without any "core" identity it raises all kinds of existential issues. You see it with PWPs, Graduate Mental Health Workers and other roles that aren't psychologist, OT or CPN- They are almost more defined by what they aren't rather than what they actually are. In turn this can lead to defensiveness, feeling that one needs to overstate one's skill set and capacity which then creates further division and dissent. I can't imagine it being good for one's self esteem to be thought of as "a psychologist on the cheap". Granted, Clinical Psychology in it's earlier stages had elements of this against psychiatry, but there was always an understanding early on that Psychology was a discrete science in itself that was separate from Medicine and did things that were unique to it.

Related to this there are tensions about which "family" those roles belong to. PWPs seem more aligned with BABCP rather than "owned" by BPS/HCPC Psychologists. Graduate mental health workers never really found much of a home and I can imagine this being replicated if CAPs don't find a niche they can thrive within and for that niche to have heavy backing from a trade association like BPS/ACN or similar. Beyond therapy, I would question how much "psychology" the role involves. None of that syllabus seems particularly "psychology" based in what I see as core elements of the discipline (such as psychometrics, research, academic theory or being a scientist-practitioner)

The other question I would have also applies to the issue of retention and career progression. We have already seen IAPT bleeding PWPs heavily, as many go onto other roles or feel marginalised and exploited. Those roles have very limited career progression especially for the very able and ambitious psychology graduates who take them up. From what is being presented I can't really see CAPs faring any better (especially if their career standard grade is Band 6), and who would be happy working under close supervision of a CP for extended periods of their career with regards to autonomy and self direction. Who would you envisage holding these roles and what major draws would their be to staying in such posts? If considering a purely therapy role, why wouldn't such a person train as a straightforward CBT/Systemic therapist, counsellor or psychoanalyst, where there is room for growth and better career structure? Plus you could work privately in the future.

For me, the litmus test the question "If I was starting out, and if it meant I couldn't move up into any other related career pathway, would I want to do that job?" Would the people designing and running the course be satisfied doing those roles themselves long term or is it the sort of role for "other people".
Again,can only talk about Scottish CAAP. The syllabus contains all the elements you have listed (at least the Adult course). Some people will regard this role as a ‘career stop’. However there are several who are satisfied with it. Career progression may mean different things e.g. CAAPs can be supervisors, can deliver other (not CBT) therapies etc. Not sure what do you mean by close supervision? Normally it’s a standard monthly supervision and CAAPs have authonomy within their role. Obviously in England their are several similar roles, so it does become confusing (also for people using services) but I do believe that Scottish system works well.

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Re: What is the view on the Clinical Associate Psychology Masters?

Post by Spatch » Mon Mar 25, 2019 12:29 pm

Again,can only talk about Scottish CAAP. The syllabus contains all the elements you have listed (at least the Adult course). Some people will regard this role as a ‘career stop’. However there are several who are satisfied with it. Career progression may mean different things e.g. CAAPs can be supervisors, can deliver other (not CBT) therapies etc. Not sure what do you mean by close supervision? Normally it’s a standard monthly supervision and CAAPs have authonomy within their role. Obviously in England their are several similar roles, so it does become confusing (also for people using services) but I do believe that Scottish system works well.
Only having read the consultation documents, I fully admit to being ignorant about how CAAPs work in Scotland, and I am sure that individually they do a good job in working to support their clients. I guess what I am left wondering is if CAAPS have the same training and do all of the clinical work, leadership, psychometrics, research, consultation etc what would you need a fully registered practitioner psychologist for? What is it that they don't do or would expect a CP to do in an AMH context?

Also a current service clinical lead, I have to balance recruitment costs, workforce mix and high quality, safe service delivery. What could I expect to find if I was to hire one for my team?

Beyond that I wonder about the larger scope of how new roles evolve and develop. Will there be a ladder from newly qualified up through clinical lead to consultant grade CAAPs/CAPs then Band 9 Head of Services. Will a CAP/CAAP be able to be designated as a principle investigator on a NIHR research grant? Will they able to be legitimately viewed as expert witnesses in court cases? Will insurance companies recognise them and authorise payments for independent working if they later seek to go private?

At an academic level, I am generally curious about this as it is part of how a profession gains legitimacy and occupies a disciplinary niche. The way CP did this is a fascinating story, but a really hard and challenging one that happened at an international level. It would be good to have some idea about the "endgame" for CAPS/CAAPS.
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Re: What is the view on the Clinical Associate Psychology Masters?

Post by maven » Tue Mar 26, 2019 10:45 pm

I don't think it is designed as a parallel pathway to clinical psychology. I think it is designed as another lower level cheaper alternative that might be able to take on some of the workload and let the qualified CPs focus on the most complex cases and the indirect roles. So as I understand it they are not intended to be a role with a career pathway that goes above band 7, to supervise professionals above their own banding, or act as an expert witness. I don't think the issues of insurance payers and independent practise will have been resolved yet, but I'd guess it would depend on having sufficient accreditation with a professional body.
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Wise men talk because they have something to say, fools because they have to say something - Plato
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Re: What is the view on the Clinical Associate Psychology Masters?

Post by lakeland » Tue Apr 02, 2019 7:27 am

https://acpuk.org.uk/acp_response_to_cap_role/ ACP-UK response to the proposals.

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