Engagement and Assessment with People with Severe Mental Health Problems

Module title	Engagement and Assessment with People with Severe Mental Health Problems
Module code	PYC3031
Academic year	2024/5
Credits	20
Module staff	Mr Shane Fitzgerald (Convenor)

Duration: Term	1	2	3
Duration: Weeks	10	10	10

Number students taking module (anticipated)	20

Module description

This component introduces MHWPs to severe mental health problems and teaches you how to engage and form collaborative alliances with service users, carers and families. It teaches how to assess, (including person-centred risk assessment and safety-planning conversations in the context of severe mental health problems), and arrive at a collaborative, simple formulation which can guide the planning of care and/or psychologically informed interventions to be delivered by the MHWP. It will highlight the value of successful engagement as an end in its own right. There is a significant focus on core clinical skills.

Module aims - intentions of the module

The aim of this module is to develop your core ‘common factors’ competencies in communication skills and collaborative working and, along with a good understanding of severe mental health problems and evidence-based treatment choices, enabling you to apply these skills to engage service users, carers and families. Through collaborative alliances you will undertake an effective low intensity CBT-based assessment, including management of risk through person-centred risk assessment and safety-planning conversations in the context of severe mental health problems, develop a shared understanding of the problems using simple formulations and plan a collaborative treatment programme.

Intended Learning Outcomes (ILOs)

ILO: Module-specific skills

On successfully completing the module you will be able to...

1. Demonstrate core knowledge of mental health (including common and more severe mental health problems) and the NHS service context
2. Demonstrate an ability to engagement service users with warmth and empathy active listening and enquiry: questioning styles, developing a collaborative alliance, including adapting engagement style in response to needs of different service users, appropriate use of and limitations to personal disclosure;
3. Demonstrate an ability to support the service user to maintain and develop relationships within the community in line with the CHIME factors (Connectedness, Hope, Identity, Meaning and Empowerment)
4. Demonstrate knowledge of and ability to be with someone in distress, managing affect by listening and validating
5. Demonstrate knowledge of, and ability to operate within, professional and ethical guidelines
6. Demonstrate an ability to involve families and carers in engagement and assessment (with consent from service users)
7. Demonstrate understanding of cultural competence and anti-discriminatory practice, addressing inequities of access and outcome
8. Demonstrate respect for and the value of individual differences in age, sexuality, disability, gender, spirituality, ethnicity and culture
9. Demonstrate an ability to respond to peoples needs sensitively with regard to all aspects of diversity, including working with older people, the use of interpretation services and taking into account any physical and sensory difficulties service users may experience in accessing services.
10. Demonstrate knowledge of CHIME factors, understanding their link with wellbeing and recovery, and show an ability to apply this knowledge in practice.
11. Demonstrate an ability to undertake a person-centred risk assessment, safety planning and safeguarding
12. Demonstrate an understanding of, and respect for, confidentiality, consent, and the appropriate involvement of families and carers. Demonstrate ethical practice based on this knowledge
13. Demonstrate knowledge of the experience and core features of psychosis, bipolar disorder, personality disorder and eating disorders, and associated difficulties (including anxiety and depression) and helpful adaptations to engagement in the context of each of these difficulties.
14. Demonstrate an ability to make reasonable adjustments to make mental health services autism-friendly, and responsive to service users with substance misuse problems.
15. Demonstrate understanding of the relationship between adversity and presentations of severe mental health problems
16. Demonstrate ability to apply trauma-informed care principles in practice including the role of attachment and self-compassion.
17. Demonstrate an ability to undertake a collaborative assessment and formulation within the 5 Ps framework of Presenting problem, Predisposing factors, Precipitating factors, Perpetuating factors and Protective factors

ILO: Discipline-specific skills

On successfully completing the module you will be able to...

18. Summarise basic and essential factual and conceptual knowledge of the subject, and demonstrate a critical understanding of this knowledge
19. Review and evaluate established work and identify some of the strengths and weaknesses of this work

ILO: Personal and key skills

On successfully completing the module you will be able to...

20. Record accurately interviews and questionnaire assessments using paper and electronic record-keeping systems
21. Evaluate your strengths and weaknesses, challenge received opinion and develop your own criteria and judgement, and seek and make use of feedback

Syllabus plan

The module content, module-specific learning objectives, style of delivery and assessment for this module are informed by the National Curriculum for Mental Health and Wellbeing Practitioners – Specialist Adult Mental Health for the training of Mental Health and Wellbeing Practitioners to support the delivery of low intensity CBT. Teaching content will include:

Knowledge Concerning Core Competencies, Assessment of Severe Mental Health Problems

Fostering engagement and developing a collaborative alliance
Being with someone in distress and managing affect
Professional and ethical practice - codes of conduct in relation to practice as a Mental Health & Wellbeing Practitioner
Cultural competence and anti-discriminatory practice
Respect for and the value of individual differences in age, sexuality, disability, gender, spirituality, ethnicity and culture.
Responding to peoples’ needs sensitively with regard to all aspects of diversity, including working with older people, the use of interpretation services and taking into account any physical and sensory difficulties service users may experience in accessing services.
CHIME factors – Connectedness, Hope, Identity, Meaning and Empowerment: understanding their link with wellbeing and recovery;
Person-centred risk assessment, safety planning and safeguarding Confidentiality, consent, and the appropriate involvement of families and carers
Recognition of patterns of symptoms and relate these to diagnostic categories of mental health difficulties, particularly the experience and core features of psychosis, bipolar disorder, ‘personality disorder’ and eating disorders, and associated difficulties (including anxiety and depression) and autism
Understanding the relationship between adversity and presentations of severe mental health problems
Trauma Informed Care principles in practice
Collaborative assessment and formulation within the ‘5 Ps’ framework of Presenting problem, Predisposing factors, Precipitating factors, Perpetuating factors and Protective factors
Standardised symptom assessment tools and psychometric instruments
Making reasonable adjustments for service users with specific needs.
Providing a service in line with trauma focused principles

Intensive Skills Practice

Use of ‘common factors’ communication skills to effectively engage clients and develop and maintain an effective therapeutic alliance and engagement with the CBT self-help intervention process
Patient-centred information gathering; deriving a collaborative definition of the service user’s main mental health difficulties and impact on daily living
Recognising risk, assessing risk and safety management plans and safeguarding
Use of standardised symptom assessment tools and psychometric instruments
Managing the emotional content of sessions
Appreciation and understanding of the service user’s perspective or world view
Providing assessment according to 5Ps formulation

Learning activities and teaching methods (given in hours of study time)

Scheduled Learning and Teaching Activities	Guided independent study	Placement / study abroad
70	105	25

Details of learning activities and teaching methods

Category	Hours of study time	Description
Scheduled Learning and Teaching	24	Practical classes these will be used to develop clinical competencies in assessment and engagement through tutor supervised small group role-play
Scheduled Learning and Teaching	18	Lectures
Scheduled Learning and Teaching	18	Seminars these will be led by the tutor and address a range of important topics covered in the module
Scheduled Learning and Teaching	10	Tutorials these will take the form of small group sessions led by the tutor
Guided independent study	55	Reading and preparation for seminars and/or flipped classroom delivery model
Guided independent study	30	Self-practice and self-reflection on role plays of assessments with fellow students undertaken outside of teaching sessions
Guided independent study	20	Develop an understanding of service related clinical protocols, policies and procedures to inform practice, and develop knowledge of role.
Placement	10	Within the workplace, caseload supervision will be provided by any qualified Mental Health professional with training and experience working with adults with severe mental health problems Clinical skills supervision will be provided by supervisors meeting criteria outlined in the latest edition of National Curriculum for Mental Health and Wellbeing Practitioners (2024). They must be a qualified psychological professional within the current taxonomy of occupations, with training and experience working with adults with severe mental health problems, and an extensive understanding of using interventions based on cognitive behavioural therapy principles in clinical practice with this client group. Clinical skills supervisors must evidence competences in the areas covered by the MHWP curriculum and have attended MHWP supervisor training. Clinical skills supervisors should observe full sessions delivered by each trainee, and routinely and regularly use recorded clips to support skills development in supervision.
Placement	15	Programme members will be employed by their NHS Trusts as trainee MHWPs where they will work 3 - 5 days a week over the year. In this time they will accumulate a minimum of 80 contact hours with service users within an adult community mental health service (of which 40 hours should be specifically delivering low intensity interventions 15 should be assessment, and 25 should be delivering care planning in partnership). Up to 10 hours of the logged intervention hours may be guided self-help group work, co-facilitated with appropriately qualified staff. Reading and preparation around adaptations to practice, and preparation for clinical scenarios should be done within placement time.

Formative assessment

Form of assessment	Size of the assessment (eg length / duration)	ILOs assessed	Feedback method
Clinical skills competency assessment role play (Objective Structured Clinical Examination, OSCE)	45 to 60 minutes	119	Oral
Practice Outcomes - Supervisors report at the end of the first and second terms	Not specified. Workplace supervisors (both clinical skills and caseload supervisors), and programme member will contribute to the practice outcomes document.	121	Oral

Summative assessment (% of credit)

Coursework	Written exams	Practical exams
30	0	70

Details of summative assessment

Form of assessment	% of credit	Size of the assessment (eg length / duration)	ILOs assessed	Feedback method
Clinical skills competency assessment role play (Objective Structured Clinical Examination, OSCE), of an assessment of a service users mental health, using a standardised role-play scenario(s) where trainees are required to demonstrate skills in undertaking problem focused assessment and 5 P formulation. This will be video recorded and assessed by programme staff using a standardised assessment measures that measure skills in engagement, flexibility and ability to stick to task. (this assessment must be passed with a mark of 30/60 overall (achieve a minimum of 50%) and with a minimum mark of 3 on sections 2, 3 and 4; failure in this assessment will result in a maximum fail mark of 49% and lead to failure in the module and the programme)	70	50 to 60 mins	119	Written
Essay (this assessment must be passed; failure in this assessment will lead to failure in the module and the programme)	30	2000 words	119, 21	Written
Clinical practice outcome Portfolio. Assessment of service level applied competencies undertaken in clinical practice and is pass/fail only Successful completion of the following practice outcomes, to be assessed by means of a practice outcomes portfolio and supervisor report: 1) Demonstrates the common factor competencies necessary to engage effectively and involve families and carers where indicated 2) Demonstrates competence in undertaking assessments across a range of presenting problems 3) Demonstrates competence in the generation of 5 P formulations with clients. Also demonstrates minimum number of required practice hours (40 hours should be specifically delivering psychologically-informed interventions, 15 should be assessment and 25 should be delivering care planning in partnership and minimum number of hours of supervision, 20 caseload supervision and 20 clinical skills supervision). The Clinical practice Outcomes Portfolio should also include evidence that all teaching sessions for this module hav	0	Not specified. Workplace supervisors (both clinical skills and caseload supervisors), and programme member will contribute to the Practice outcomes portfolio document.	118	Written and oral

Details of re-assessment (where required by referral or deferral)

Original form of assessment	Form of re-assessment	ILOs re-assessed	Timescale for re-assessment
Clinical skills competency assessment, role play OSCE	Clinical skills competency assessment, role play OSCE	119	Four weeks from the date feedback was provided
Essay	Essay	119, 21	Four weeks from the date feedback was provided
Clinical practice Outcome Portfolio	Clinical practice Outcome Portfolio	121	Four weeks from the date feedback was provided

Re-assessment notes

Three assessments are required for this module. In all cases re-assessment will be the same as the original assessment. Where you have been referred/deferred for any form of assessment detailed above you will have the opportunity to retake within four weeks from the date that feedback was provided.

If you pass re-assessments taken as a result of deferral, your re-assessment will be treated as it would be if it were your first attempt at the assessment and the overall module mark will not be capped.

If you pass re-assessments taken as a result of referral (i.e. following initial failure in the assessment), the overall module mark will be capped at 40%.

If you fail re-assessments taken as a result of referral (i.e. following initial failure in the assessment), you will be failed in the module and as a consequence you will be failed in the programme and your registration as a student of the University will be terminated.

Indicative learning resources - Basic reading

Core reading:

Bennett-Levy, J., Richards, D., Farrand, P. et al (2010). Oxford Guide to Low Intensity CBT Interventions. Oxford: Oxford University Press.
Bennett-Levy, J., Thwaites, R., Haarhoff, B. & Perry, H. (2015). Experiencing CBT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists. Guilford, New York.
Farrand, P. (2020). Low-Intensity CBT Skills and Interventions. London: SAGE.
Kennerley, H. (2021). The ABC of CBT. SAGE.
Law, D. (2019). The goal-based outcome (GBO) tool: Guidance notes. MindMonkey Associates.
Silverman, J., Kurtz, S. and Draper, J. (2005). Skills for Communicating with Patients . Oxford: Radcliffe.
Leamy M, Bird V, Le Boutillier C, Williams J, Slade M. (2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. Br J Psychiatry, 199: 445–52. doi: 10.1192/bjp.bp.110.083733

Wider reading:

American Psychiatric Association. (2013). Desk reference to the diagnostic criteria from DSM-5. Washington, DC: American Psychiatric Publishing.
BPS Ethics Committee. (2021). Ethics and morality, professional practice, research code of ethics and conduct. The British Psychological Society. DOI: https://doi.org/10.53841/bpsrep.2021.inf94
British Association of Cognitive and Behavioural Psychotherapy. (2022). BABCP Standards of Conduct, Performance and Ethics. British Association of Cognitive and Behavioural Psychotherapy. https://babcp.com/Standards
Bazire, S. (2018). Psychotropic Drug Directory 2018: The Professionals Pocket Handbook and Aide Memoire. Salisbury: Fivepin Publishing.
Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics. Oxford University Press. https://doi.org/10.1093/occmed/kqu158
Beck, A. (2016). Transcultural cognitive behaviour therapy for anxiety and depression: A practical guide. Routledge.?
Bennett?Levy, J. (2005). Therapist skills: A cognitive model of their acquisition and refinement. Behavioural and Cognitive Psychotherapy, 34(1), 57–78. https://doi.org/10.1017/s1352465805002420
Bennett?Levy, J., Turner, F. W., Beaty, T., Smith, M., Paterson, B., & Farmer, S. (2001). The value of self-practice of cognitive therapy techniques and self-reflection in the training of cognitive therapists. Behavioural and Cognitive Psychotherapy, 29(2), 203–220. https://doi.org/10.1017/s1352465801002077
Bennett-Levy, J., Richards, D., Farrand, P. et al (2010). Oxford guide to low intensity CBT interventions. Oxford University Press.
Bennett?Levy, J., & Lee, N. K. (2012). Self-practice and self-reflection in cognitive behaviour therapy training: What factors influence trainees’ engagement and experience of benefit? Behavioural and Cognitive Psychotherapy, 42(1), 48–64. https://doi.org/10.1017/s1352465812000781
Bennett-Levy, J., Thwaites, R., Haarhoff, B. & Perry, H. (2015). Experiencing CBT from the inside out: A self-practice/self-reflection workbook for therapists. Guilford.
Carr, S., Hardy, A., & Fornells-Ambrojo, M. (2018). The trauma and life events (TALE) checklist: Development of a tool for improving routine screening in people with psychosis. European Journal of Psychotraumatology, 9(1). DOI: 10.1080/20008198.2018.1512265
Cooke (2017). Understanding psychosis and schizophrenia: Why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality… and what can help. British Psychological Society. Accessed https://www.bps.org.uk/sites/www.bps.org.uk/files/Page%20-%20Files/Understanding%20Psychosis%20and%20Schizophrenia.pdf
Department of Health. (2003). Confidentiality NHS code of practice. Department of Health. https://assets.publishing.service.gov.uk/media/5a7c13f0ed915d210ade16fb/Confidentiality_-_NHS_Code_of_Practice.pdf
Department for Education. (2015). Child abuse concerns: guide for practitioners. https://www.gov.uk/government/publications/what-to-do-if-youre-worried-a-child-is-being-abused--2
Division of Clinical Psychology. (2017). Understanding psychosis and schizophrenia. The British Psychological Society. https://www.bps.org.uk/guideline/understanding-psychosis-and-schizophrenia
Egan, G., & Reese, R. J. (2021). The skilled helper: A client-centred approach (Third Edition). Cengage Learning EMEA.
Farrand, P., Perry, J., & Linsley, S. (2010). Enhancing self-practice/self-reflection (SP/SR) approach to cognitive behaviour training through the use of reflective blogs. Behavioural and Cognitive Psychotherapy, 38(4), 473–477. https://doi.org/10.1017/s1352465810000238
Goldberg, D. and Huxley, P. (1992). Common Mental Health Disorders: A Biosocial Model. London: Routledge.
Layard, R., & Clark, D. M. (2014). Thrive: The power of evidence-based psychological therapies. London: Penguin Group.
Leamy, M., Bird, V., Boutillier, C. L., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. The British Journal of Psychiatry, 199(6), 445–452. https://doi.org/10.1192/bjp.bp.110.083733
Mansell, W., Jones, S., Lobban, F., Cooke, A., Hemmingfield, J., Kinderman, P., Schwannauer, M., Palmer, A., Van der Gucht, E., Wright, K., & Hanna, J. (2010). Understanding bipolar disorder: Why some people experience extreme mood states and what can help. The British Psychological Society. https://doi.org/10.53841/bpsrep.2010.rep151
Michie, S., van Stralen M.M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42
Myles, P. and Rushforth, D. (2007). Complete Guide to Primary Care Mental Health. London: Robinson.
NHS. (N.D.). Mental health and wellbeing practitioner. Healthcareers.nhs.uk. https://www.healthcareers.nhs.uk/explore-roles/psychological-therapies/roles-psychological-therapies/mental-health-and-wellbeing-practitioner
NHS England. (2024). Safeguarding adults: A guide for health care staff. https://www.england.nhs.uk/long-read/safeguarding
Richards, D., & Whyte, M. (2011). Reach out (Third edition). Rethink Mental Illness.
Silverman, J., Kurtz, S. and Draper, J. (2005). Skills for communicating with patients. Radcliffe.
Sweeney, A. & Taggart, D. (2018) (Mis)understanding trauma-informed approaches in mental health. Journal of Mental Health, 27(5), 383-387, DOI: 10.1080/09638237.2018.1520973
The British Psychological Society. (2017). Careers and professional development, Professional Practice BPS Practice Guidelines. The British Psychological Society. https://doi.org/10.53841/bpsrep.2017.inf115
The British Psychological Society (2021) Family interventions in psychosis: Guidelines for psychologists and practitioners supporting families and social networks
Thwaites, R., Bennett?Levy, J., Cairns, L., Lowrie, R., Robinson, A. J., Haarhoff, B., Lockhart, L., & Perry, H. (2017). Self-practice/self-reflection (SP/SR) as a training strategy to enhance therapeutic empathy in low intensity CBT practitioners. New Zealand Journal of Psychology, 46(2), 63. https://psycnet.apa.org/record/2017-36131-008
University of Manchester. (2018). The assessment of clinical risk in mental health services. https://sites.manchester.ac.uk/ncish/reports/the-assessment-of-clinical-risk-in-mental-health-services/
University of Sheffield. (N.D.). Resources Available to Download. https://www.reqol.org.uk/p/essential-reqol-resources-to-download.html
Unknown (N.D.). Example Mental Health and Wellbeing Practitioner Job Description. https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.hee.nhs.uk%2Fsites%2Fdefault%2Ffiles%2Fdocuments%2FBand%25205%2520Example%2520JD%2520MHWP%2520v2.0.doc&wdOrigin=BROWSELINK
Whittington, A., & Grey, N. (Eds.). (2014). How to become a More Effective CBT Therapist: Mastering Metacompetence in Clinical practice. http://ci.nii.ac.jp/ncid/BB16729649
Worthington, A., Rooney, P., & Hannan, R. (2013). The triangle of care: Carers included: A guide to best practice in mental health Care in England. Carers Trust.

Indicative learning resources - Web based and electronic resources

• ELE – https://vle.exeter.ac.uk/

Indicative learning resources - Other resources

NHS England. Reducing health inequalities resources:
- LGBT Health
- Advanced Mental Health Equality
- NHS Resources

Key words search

Mental Health Wellbeing Practitioners, MHWP, low intensity, cognitive behavioural therapy, common mental health problems, secondary care, evidence based psychological therapies, clinical competency

Credit value	20
Module ECTS	10
Module pre-requisites	None
Module co-requisites	PYC3032 Care planning in partnership and PYC3033 Wellbeing-focused psychologically informed interventions for severe mental health problems
NQF level (module)	6
Available as distance learning?	No
Origin date	17/02/2022
Last revision date	22/08/2024