guidance on developing workforce training - AFT

Training to workeffectivelywith familiesAFT <strong>guidance</strong> ondeveloping workforcetrainings in familytherapy and systemicpractice in health,social care and otherkey services

AFT: TRAINING TO WORK EFFECTIVELY WITH FAMILIES 2ForewordThis document offers <strong>guidance</strong> for developing andsupporting workforce trainings in family therapy andsystemic practice across key UK services.Developing workforce trainings will help put families andcarers at the heart of high quality UK services, supporting:Family-sensitive systemic practice, promoting resilienceand well-being of all family members and supportingindividuals and families facing difficultiesbetter safeguarding of vulnerable children, young peopleand adults, identifying and challenging the seriousdifficulties and damaging behaviours that may lie behindchild and adult distressincreased staff awareness of and skills in working inpartnership with familiesa shift in culture, from working solely with individuals toworking in ways that enhance and use the strengths offamilies and other caring networksThese developments require:1. staff equipped with the skills necessary to work withfamilies effectively and safely2. Supported by robust structures of consultation andsupervision with more experienced and qualifiedprofessionals, who can work with those familiesexperiencing more serious and complex problems

AFT: TRAINING TO WORK EFFECTIVELY WITH FAMILIES 3Training to work effectively with familiesAFT, the Association for Family Therapy and Systemic Practice, has a long history ofsetting training standards and designing and monitoring systemic and family therapytrainings, from introductory modules to specialist Masters level and further training insupervision. It has the experience, skills and expertise to support and work withorganisations and services in the Public, Voluntary and Independent Sectors to developworkforce tailored to staff and client group needs.The <strong>guidance</strong> outlined here describes 6 levels of training. Together these trainingmodules create staff development pathways from very basic skills and understanding inworking with families, to full clinical and supervisory qualifications. These higher levels oftraining equip staff to work with families with serious and complex needs, and to supportworkforce development through training and supervisionThe framework thus offers a training and organisational development programme tobuild services and staff skills in working with families, couples and other networks ofcare in health, social care and other key services.The training of each workforce is based on a pyramid structure, with all staff trained tolevel 1 and increasingly smaller groups trained to more specialist levels. This structureallows the effects of training to be utilised to the full, and prevents skills being lost orunder-used. (The experience of some other trainings such as Thorne trainings in adultmental health has been that taught skills were lost quickly when there was insufficientsupervision and support in the workplace). The experience of the “Somerset Model” 1training demonstrates the importance of having a clear strategic plan to guide anddevelop training and for this to be fully understood and supported at the most seniorlevels of management.Suggested Levels of TrainingIntroductory Level 1Level 2Intermediate Level 3Level 4Advanced Level 5Level 6

AFT: TRAINING TO WORK EFFECTIVELY WITH FAMILIES 4INTRODUCTORYIn terms of delivery these introductory modules in family sensitive systemic practice could beincorporated into core professional and in-service trainings, as well as being available asdiscreet modules delivered internally or externally. There is demonstrable value in providingtraining to whole teams. The training would be specific to a particular service area.LEVEL 1AimsTo develop staff understanding of the importance of family sensitive and family inclusiveapproaches in a particular field of work. Identify particular issues and constraints and to developskills in communication with families and family members.Length and format of training2 days plus 1 follow-up day a month later to review and reinforce practice developmentTarget GroupAll staff in public and third sector services who meet with children, young people and adults in‘helping’ and/or ‘caring’ capacities, including; teachers, mental health nurses, doctors, policeofficers, GPs, general nurses, health and social care key workers.CurriculumThe importance of the family and other contexts to individual well being in the particular area ofworkThe impact on the family of stressful family and external events relevant to particular area ofworkEthics (including confidentiality)Development of some concepts and language to describe family and family interactionsBasic awareness of the importance of family beliefs, culture, structure, expectations, life cycleexperiences etcBasic listening and communications skills with more than one person in the roomBasic skills in convening, listening and talking with family groupsCompetencies to be achieved.(All competencies will relate to a particular area of work e.g. police officer, nursery worker)Basic awareness of the individual in the family contextBasic awareness of family members’ and carers’ needs, experiences, wishes and resourcesBasic understanding of the impact of the problem on the family and the family on the problemBasic sensitivity to diverse family forms and beliefsAbility to communicate more effectively with family members

AFT: TRAINING TO WORK EFFECTIVELY WITH FAMILIES 5INTRODUCTORY LEVEL 2AimsTo build on LEVEL 1 to equip staff with improved skills in family sensitive and inclusiveapproaches and enabling them to convene and facilitate family meetings within which familymembers and professionals can effectively exchange views and make appropriate decisions tothe area of work Also to identify difficulties and constraints to communication.Length and Format of Training5 days (2x2-day blocks and 1 day follow up)Target GroupFor professionals who may meet with families and family members as part of their existingpractice, including health visitors, teachers in relevant roles, including those with pastoral careduties and SENCO’s; police officers, housing workers, care home staff, social workers,CurriculumConvening family meetingsEngaging family members in meaningful conversations, including those who have tended to beunder-represented in mainstream services (inc fathers; grandparents and others with significantrole in children’s lives etc).Obtaining and giving informationManaging differences that arise in conversationsIdentifying possible sources of risk and need and how to seek sources of further helpSupporting families to explore issues and experiences that may initially be difficult address.Developing basics of self-reflexive, culturally sensitive and ethical practiceBasic communication with children, and young people.Addressing and managing challenges of particular area of workCompetenciesTo keep the family in mind when carrying out designated roleTo recognise family resourcesTo gather views of family members and develop a collaborative way of workingAbility to meet and talk purposefully with more than one person in the room when carrying outdesignated role.

AFT: TRAINING TO WORK EFFECTIVELY WITH FAMILIES 6Ability to identify and work towards collaborative practice with familiesAbility to consider and consult appropriately on ethical issues of family sensitive and inclusivepracticeFacilitating family discussions of difficulties, priorities and decision makingDemonstrate awareness of cultural context and power differences within familiesAbility to identify the need for more specialised interventionINTERMEDIATE LEVELThis is a more substantial training for those likely to have significant meetings with families intheir day-to-day work, equipping them with skills to better carry out their existing roles and totake part in therapeutic family meetings and assessment processes. Helping families to setgoals, and problem solve and to identify risks in family relationships and take appropriate action.Divided into two levels which together equate to the current AFT intermediate level of training.This means that there is also a career or training progression (where this is appropriate) to thespecialist trainings in family and systemic psychotherapy (MSc level), which would equip someprofessionals to deliver highly specialised work with families and be involved in research anddevelopment of services.Level 3 and level 4 trainings could be delivered in a variety of ways including team or servicefocused trainings, trainings within local authorities or NHS trusts or provided externally. Theycould focus on a narrow area e.g. working with psychosis or be more generic. For everyonetraining at this level there would be an expectation that the skills could be more generally appliede.g. an adult mental health worker able to manage a family session to which small children wereinvited.Both level 3 and level 4 trainings would include some supervised clinical work throughout thecourse.LEVEL 3AimsTo familiarise practitioners with a range of theories relating to family and systems and to enablethem to use them in their assessment and work with families. To enable them to use a range oftechniques to intervene effectively within their professional role in order to help families toidentify their strengths, improve their decision making, problem solving and communication. Toenable them to describe and formulate family interaction, identify areas of risk and manageappropriate referral.Target Group

AFT: TRAINING TO WORK EFFECTIVELY WITH FAMILIES 7Relevant staff groups include hospital family and carer liaison workers, teachers with specifichome-school liaison responsibilities, health visitors, General Practitioners wishing to developtheir skills in working with children, vulnerable adults and families., social workers, communitymental health nurses, occupational therapists, psychiatrists and all CAMHS workers.Length and format of training15 days over 6 months to 1 yearCurriculumA range of theories and techniques relating to systemic practice.Advanced interviewing skillsMaking therapeutic relationships which enable professional to support family to changeThe family life cycle and critique and limitationsSocial constructionism and the shaping of ideas, behaviours and relationships by socialcontexts.Family formulationEvidence base for family interventionsHow to carry through a number of key techniques focused on change.Supervised and live supervised practiceCompetenciesTo be able to demonstrate advanced interviewing skillsTo successfully convene families and parts of families as appropriateTo make and maintain effective therapeutic relationshipsTo formulate families and family relationshipsTo plan and carry out a piece of therapeutic work focused on a particular problem or issueTo understand and apply the evidence base to clinical decision making.To understand the impact of practitioners own ways of thinking and reacting on the workTo understand the impact of the work on themselvesTo build on family strengths

AFT: TRAINING TO WORK EFFECTIVELY WITH FAMILIES 8To communicate about families and their relationship to difficulties in both spoken and writtenformTo manage the ethical complexities of work with families, identify risk and take appropriateactionTo apply theories in practice and use interventions appropriatelyTo be able to apply a manualised version of therapy in one area of work e.g. parent trainingTo identify the need for more specialist referral.LEVEL 4AimsTo build on the knowledge and skills gained at Level 3 and to help the practitioner to developskills and ability and to apply a range of theory and techniques to families in order to help thempositively change their relationships beliefs and behaviour. This would go beyond problemsolving to make changes that would enable them to manage life better in the future.To develop aspects of relationship that are connected with resilience. To address powerdifferences in the therapy and to develop a sophisticated awareness of addressing and workingwith difference of all kindsLength and Format of training15 days over 6 months to 1 yearTarget GroupRelevant staff groups include hospital family and carer liaison workers, teachers with specifichome-school liaison responsibilities, health visitors, General Practitioners wishing to developtheir skills in working with children, vulnerable adults and families, social workers, communitymental health nurses, occupational therapists, psychiatrists and all CAMHS workers, who wantto take their training further and to improve competence in working for more sustained change infamily relationships.CurriculumDeveloping culturally sensitive practiceWorking with power and differenceManagement of a series of sessions into a useful piece of workMaking the most of endingsHelping families to develop more hopeful narratives

AFT: TRAINING TO WORK EFFECTIVELY WITH FAMILIES 9Managing child protection issues.Parenting approachesFamily interventions and other specific interventionsManaging a series of sessions with beginning middle and endDealing with endings in an effective wayWorking with conflictWorking with families around illness and disabilityFamily and parenting assessmentWorking with couplesTo actively use self reflexivity in sessionsSupervised and live supervised practiceCompetenciesTo apply a wide range of interventions appropriatelyTo successfully manage an extended piece of workTo reflect and use reflections on self of therapist and how it impacts on workTo critically appraise work and actively seek the feedback from clients through the work.To work in more difficult areas of conflict and child protectionTo develop a greater range of strategies for engaging children and adolescentsTo apply thinking and practice to professional systems.To be able to apply a manualised version of therapy in one area of work e.g. parent trainingTo identify the need for more specialist referral.To be able to use measure for assessing effectiveness of interventionsUp to this point in professionals are being trained to work with families in the context of their ownprofessional area of expertise. In this current atmosphere of cost cutting we will have to make avery positive case for the need for more highly qualified provision. We need to be clear aboutthe extra value of someone who has done the full psychotherapy training. The specificcompetencies will be developed in the revision of the Blue Book but below I will outline somepossibilities.

AFT: TRAINING TO WORK EFFECTIVELY WITH FAMILIES 10ADVANCED LEVELLEVEL 5Level 5 comprises of two years post graduate training (part time) resulting in a clinicalqualification as Family and Systemic Psychotherapists. This equips professionals to offer ahighly specialised service to families and family members experiencing serious and complexdifficulties, consult to teams and organisations and deliver trainings to professionals with lowerlevels of qualification and experience. Professionals trained at this level would have the skill andflexibility of application to work across the age ranges and presentations so is well placed to leadand develop family sensitive services.It would be suitable for practitioners within CAMHS, adult mental health, and social care .whowish to develop advanced skills in working therapeutically with families experiencing seriousdistress and complex difficulties. Someone trained at this level would be able to support thework of those with lower levels of training.It would be equivalent to the current MSc in Family and Systemic Psychotherapy. Graduatesfrom this training would be eligible to apply for registration as a psychotherapist. They would beequipped to work as lead and/or sole therapist with families with complex difficulties and to takefull clinical responsibility for family work and contribute specialist skills to a multi- disciplinaryteam. They would have the skills to evaluate work and develop and support services and newinitiativesCurriculumAdvanced understanding and application of a wide range of theories into practice.Practice across a range of presentations and agesPost graduate researchWorking with teams and organisationCombining family and systems approaches with other psychological and physical therapiesAdvanced application of 2 manualised approachesSelf and relational reflexivityWorking in situations of high risk, conflict and distressSupervised and live supervised practice of complex work across age ranges and presentationsCompetenciesThere are a wide range of competencies and below is only a summary. Thesecompetencies are well reflected in the Skills for Health occupational standards forSystemic Psychotherapy. AFT was centrally involved in the development of these

AFT: TRAINING TO WORK EFFECTIVELY WITH FAMILIES 11standards. Other information can be found in the AFT “Blue Book” (training standardsand system of accreditation).To demonstrate ability to adapt practice to a wide range of client groups and presentationsacross the age range.An ability to work at high level of complexity and with serious and entrenched difficulties.An ability to work appropriately in situations of high risk, conflict and distress.An ability to adapt work to different client presentationsAn ability to make decisions about the care plan elements and how these may be deliveredAn ability to develop ways of working that are sensitive to differences of culture, race, age,sexuality e.t.c.An ability to facilitate multi disciplinary network meetings and consult to organisational teams.An ability to combine work with other approaches and deliver 2 manualised approaches e.g.parenting approaches, IPT or Systemic CBTAbility to use self reflexivity in their workAdvanced ethical understanding and its application in practiceAn ability to make detailed and complex assessments including those for court proceedingsAn ability to work in a collaborative way which enhances family strengths and develops familyresilience.An ability to make complex assessments and provide expert reports for courts.An ability to audit and research practice and service deliveryCompetence in working independently as part of a team or in individual private practice.SUPERVISORY/CONSULTANTLEVELLEVEL 6While psychotherapists at level 5 are equipped to offer consultation and supervision to a basiclevel, there is great value in specialist supervision trainings. Because of the systemicframeworks ability to look at things in a complex and holistic fashion the supervision trainingenables them to provide consultation across disciplines.These trainings run over a year and involve a high level of supervisory practice to individualsand groups and include skills in live supervision. Practitioners at this level are able to offer highlevel training to different levels and are a valuable resource within services. Sometimes thesupervision training is combined with a research dissertation and/or study in a particular clinicalarea to lead to a clinical doctorate.

AFT: TRAINING TO WORK EFFECTIVELY WITH FAMILIES 12REFERENCES1Stanbridge,R.I. and Burbach,F.R. (2007) Developing Family Inclusive Mainstream Mental Health Services.Journal of Family Therapy. Vol 29:1 21-44.Stanbridge, R. and Burbach, F. (2007) Involving carers Part 1: Including carers in staff training and servicedevelopment in Somerset, U.K. Chapter 5 in: Families as Partners In Care: A Guidebook forImplementing Family Work. Toronto: Worldwide Fellowship for Schizophrenia and AlliedDisorders.Burbach, F. and Stanbridge, R. (2008) Training to develop family inclusive routine practice and specialistfamily interventions in Somerset. Journal of Mental Health Workforce Development. Vol 3:2 23-31.Stanbridge,R.I.,Burbach,F.R.,and Leftwich,S. (2009) Establishing family inclusive acute inpatient mentalhealth services: a staff training programme in Somerset. Journal of family Therapy.Vol 31: 1-17(inpress – July publication).AFT, the Association for Family Therapy and Systemic Practice,7 Executive Suite,St James Court,Wilderspool Causeway,WarringtonCheshireWA4 6PS.Tel 01925 444414 .