‘They are assets and enable broader access to our profession’

In 2019 a new Masters level apprenticeship role in applied psychology was created, the Clinical Associate in Psychology (CAP). By October this year, there will be more than 700 qualified CAPs working across health and social care services in England.

This achievement was recognised in the annual Health Service Journal (HSJ) Awards when the prestigious 'Workforce Initiative of the Year' was awarded to the CAP Trailblazer team. I led that team along with Dr Greg Wood (Essex Partnership University NHS Foundation Trust) and Dr Linda Wilkinson (Sheffield Health and Social Care NHS Foundation Trust), demonstrating the positive contribution of the Psychological Professions to the workforce crisis facing the NHS. Since then, this initiative has been shortlisted for two further HSJ Partnership Awards.

So, what do these new CAPs do? CAPs work in a very wide range of health and care settings, and under supervision from practitioner psychologists they provide psychological formulations and interventions, training, consultation and support to teams. Some of them pick up the story…

'I have a lot of autonomy within my role'

"As a CAP in our complex emotional needs pathway, I work with adult service users, assessing, developing formulations, and delivering therapeutic interventions. I support Clinical and Counselling Psychologists through co-facilitating therapeutic interventions, delivering both Dialectical Behaviour Therapy (DBT) and Systems Training in Emotional Predictability, and Problem Solving (STEPPS) groups and associated reinforcement sessions. I also work with individuals on behavioural activation, graded exposure, cognitive restructuring, and trauma-stabilisation.

 My role has helped to manage waiting times for service users; crucial, given the high demand on our service. Along with other CAPs, I have been involved in service innovation and service improvement. Through our Psychology Awareness Programme we have developed changes to our entry pathway to strengthen how we promote equality and respect difference in our work with service users. We set up and run a new project to review calls with service users on our therapy waiting list to identify any risk concerns and think together with clients about whether any additional support is needed whilst they continue to wait for therapy.

More widely, I provide consultation and training to community mental health teams, and support team reflective practice sessions. My role is well integrated and my contributions and clinical judgments are incorporated into decision making, both within the Psychology team and the wider Multi-disciplinary Team (MDT).

I have a lot of autonomy within my role, which I hugely enjoy, and I have developed my skillset, understanding, competence and confidence over 18 months of training, working with a range of individuals with different presentations alongside university teaching at Masters level. Now that I am a qualified CAP, I am beginning to build and consolidate what I have learned as a trainee and am looking forward to further training opportunities which will allow me to extend my role."

Erin Draper, SE Essex Adult Community Psychological Services

'I feel privileged to be a part of someone's recovery at many stages'

"As a CAP on an inpatient rehabilitation ward I have found the role varied and exciting. The 18 months training provided the structure for the 1:1 patient work, whilst the placement during training allowed me to see how flexibility can be applied to learning to get the best out of the diverse range of patients we work with. I offer 1:1 structured assessment and treatment, utilising principles from CBT and CAT taught on the course, as well as facilitating psychoeducational programmes for groups of individuals on the wards. I also support systemic work that is carried out with the current and future staff team, as well as patients' families, to think about how they can support patients with their recovery goals, alongside exploring the impact this has on themselves.

The CAP programme provides me with training and experience I need to take more of a leadership role amongst the staff, including supporting assistant psychologists within the team. My additional role within the psychology team also gives us flexibility to spend more time working closer with patients and staff than we could previously, allowing us to develop a better understanding of the wards and enabling us to provide adhoc support when needed. Working alongside, and having supervision from, a Clinical Psychologist throughout gives me the opportunity to observe principles in action, whilst providing the scaffolding to test out what we have learnt with their support. This includes co-facilitating formulations, running reflective practices and leading multi-disciplinary conversations to explore psychologically informed ways of working. The role is a really rewarding one and I feel privileged to be a part of someone's recovery at many stages (from an acute admission, rehab and through to the community), as well as being able to support their recovery from many angles (1:1s, groups, family work, staff support)."

Fay Bainbridge, Acute Inpatient and Rehabilitation Service, Sheffield Health & Social Care Trust

'The ethos can create a longstanding positive impact on the people we support'

"A day in the life of a CAP is multi-dimensional to say the least. I am part of a Psychology Team based within our Community Mental Health Transformation Project which aims to provide mental health care with a 'Population Health' approach. This means actively engaging with communities, third sector organisations and working together as a multi-disciplinary team. I have had opportunities to co-create and co-facilitate workshops at our local recovery college with experts by experience including spoken-word courses mixed with Narrative Psychology approaches, Self-esteem courses with CFT-informed activities and a Psychoeducation course on ADHD & Autism. Being able to use my personal passions of creative writing and personal experiences of being neurodivergent has been an amazing combination. Being able to co-create and facilitate alongside experts by experience, where we both bring our expertise to provide a space that focuses on strengths and recovery, has been a highlight of my role. Besides running courses, I do joint work with local third-sector organisations and specialist services

Within the service, I provide tailored interventions to local residents in Hackney drawing from models such as SCM, DBT, CBT, Narrative-informed and psychoeducation. I have also co-facilitated groups with a trauma-informed approach, exploring stabilisation and grounding techniques. In the spirit of the Transformation Project, we based our group within a community café to reduce the intimidation some residents have reported they feel when accessing mental health facilities.  

I also sit within two Neighbourhood Team meetings where we discuss complex referrals as a multi-disciplinary team which includes psychotherapists, community connectors, support workers, social workers, psychiatrists and teams from third sector organisations involved in joint work such as drug and alcohol services, IAPT, housing support services and many more. Our Neighbourhood Psychology Team has managed to close certain gaps within our boroughs services where we can often support residents who IAPT are unable to support but also do not fit the criteria for our Specialist Psychotherapy service. This experience has been challenging and exciting at the same time.

As a CAP I am hopeful about how we can continue to provide tailored support, community-based activities and collaborative working within this new approach. I feel the ethos and new approach to working, with the right framework and resources can create a longstanding positive impact on the people we support that centres them, as a person, with the many complexities they may hold."  

Vivienne Isebor, City & Hackney Community Transformation Programme

As a new role, there have inevitably been challenges, not only for the CAPs who have had to inform and shape these new roles so that they can most effectively contribute to services during and after training, but also for services which have had to learn very quickly how to provide support and training for their new apprentices. Has it been worth it? Here's the story from Dr Kerry Mayers, Head of SE Essex Adult Community Psychological Services…

'I've always thought it a travesty that our profession hasn't offered a more flexible and supportive approach to recruitment'

"The introduction of 4 CAP apprentice roles in a busy high demand adult community psychological service in May 2021 was both exciting and uncertain. The potential to develop a new clinical role was evident. At the same time there was a lot to learn and be proven about the robustness of training to develop capabilities, how the CAP role could evolve and the impact of this new resourcing on service delivery. The supervisory loading was high, with supervisors also needing to navigate and best support their apprentices. At times this was challenging yet the investment in learning together to shape our emerging CAP roles has proven to be one of the most inspiring outcomes of my career to date.

18 months on, our four apprentices have all passed their apprenticeship training. Each one of them has gained competencies and confidence in assessing complex needs, undertaking risk and safety plans and developing formulations. They have gained highly advanced skills in delivering psychological interventions meaning that the service has considerably boosted access to both group and individual sessions at the earliest opportunity. Each CAP has strengthened service delivery through quality improvement initiatives and post training are passionate about continuing to lead on service evaluation projects.

Perhaps most rewarding is witnessing each CAP hone their own strengths, building on these to develop as individuals in their professional roles. Some are championing training in MDTs, helping to instill and foster psychological skills and awareness in colleagues, while others are involved in developing supervisory and leadership resources to support assistant psychologists, students on placement and team colleagues. Our four CAPs are forming a highly respected professional identity that both complements and enhances what the service can offer.

Through ongoing conversations with our CAPs, a common theme of the CAP role as more aptly suiting them at their current stage of career development is striking. Some talk about not wanting to pursue doctoral level training, yet also recognising the limits of assistant psychologist roles. I have seen so many talented and brilliant assistant psychologists leave the NHS to pursue other careers driven by financial needs or wanting to secure progression. I've always thought it a travesty that our profession hasn't offered a more flexible and supportive approach to recruitment, one which might recognise potential benefit in the different experiences aspiring psychologists from varied backgrounds bring. Afterall, for a profession that stands up for the value of being uniquely different in our humanness it seems so very fitting that an increasingly diverse training pathway has been opened up for people with notable talent. I am delighted that all four CAPs have opted to remain in the service in their first year post qualification and the service remains committed to further investing in them. They are assets and enable broader access to what has become an increasingly inaccessible profession for so many. We should be proud of this and what it represents."