Trainees have all undertaken some SHSC induction including conflict resolution/breakaway training. Please tick here to confirm attendance at these sessions this academic year and discuss content with supervisor. Please tick when the following induction procedures have been completed: etc.

Familiarisation with:

Health and Safety procedures

Fire Regulations

Service Induction Pack

Note taking, electronic records and report writing conventions

File management

Introduced to other staff

Revised Oct 2013 1 7.1

UNIVERSITY OF SHEFFIELD

CLINICAL PSYCHOLOGY TRAINING PROGRAMME

ASSESSMENT OF

CLINICAL COMPETENCIES

TRAINEE:…………………………………………………………………………………………..

PLACEMENT: Number:……… Area of Work:…………..……..………………………………

……………………………………………………………………………………………………….

SUPERVISOR:…………………………………………………………..…………………………

Supervisor HCPC Registration Number:……………………………..……..……………………..

NHS TRUST / ORGANISATION:………………………………………….…………………….

Start Date:………………….……..........……. End Date:……………………..………..………...

Date of Initial Placement Meeting:

Attendees:

Location:

Date of Mid-Placement Meeting:

Attendees:

Location:

Date of Internal Exam Board pertinent to this placement:

PLACEMENT INDUCTION AND CONTRACTING

Allocated space and secretarial support

Guidance on home visits

SUPERVISION CONTRACT

Have the following been discussed? (Please detail agreed arrangements)

Time and frequency of supervision:

Formal and informal contact:

Protection of reflective space:

Range of the focus of supervision (casework, emotions, team dynamics, transference,

themes, theories):

Previous ACC form shared with supervisor (from 2nd placement onwards) and broad areas

for development discussed:

SUPERVISION CONTRACT - continued

Methods and degree of feedback:

Support for theory practice links:

Caseload size and range:

Revised Oct 2013 2 7.1

Facilities for organising observation of trainee and supervisor:

Issues of difference and diversity:

Practical issues, e.g. travel, personal needs:

You might also want to consider discussing the expectations of the supervisor, service and trainee regarding the work on placement. Are these expectations understood and shared between supervisor and trainee? How will mutual expectations be met? If differences in expectations or ruptures occur how will they be addressed?

Revised Oct 2013 3 7.1

PLACEMENT AIMS AND OBJECTIVES

SECTION 1: RELATIONSHIP BUILDING

SPECIFIC LEARNING OBJECTIVES:

PLACEMENT PLAN:

MID-PLACEMENT MEETING, review of competency development:

END OF PLACEMENT REPORT BY SUPERVISOR (To include trainee’s strengths and needs for further development on this competency):

Revised Oct 2013 4 7.1

SECTION 2: PSYCHOLOGICAL ASSESSMENT

SPECIFIC LEARNING OBJECTIVES:

PLACEMENT PLAN:

MID-PLACEMENT MEETING, review of competency development:

END OF PLACEMENT REPORT BY SUPERVISOR (To include trainee’s strengths and needs for further development on this competency):

Revised Oct 2013 5 7.1

SECTION 3: PSYCHOLOGICAL FORMULATION

SPECIFIC LEARNING OBJECTIVES:

PLACEMENT PLAN:

MID-PLACEMENT MEETING, review of competency development:

END OF PLACEMENT REPORT BY SUPERVISOR (To include trainee’s strengths and needs for further development on this competency):

Revised Oct 2013 6 7.1

SECTION 4: PSYCHOLOGICAL INTERVENTION

SPECIFIC LEARNING OBJECTIVES:

PLACEMENT PLAN:

MID-PLACEMENT MEETING, review of competency development:

END OF PLACEMENT REPORT BY SUPERVISOR (To include trainee’s strengths and needs for further development on this competency):

Revised Oct 2013 7 7.1

SECTION 5: EVALUATION

SPECIFIC LEARNING OBJECTIVES:

PLACEMENT PLAN:

MID-PLACEMENT MEETING, review of competency development:

END OF PLACEMENT REPORT BY SUPERVISOR (To include trainee’s strengths and needs for further development on this competency):

Revised Oct 2013 8 7.1

SECTION 6: COMMUNICATION

SPECIFIC LEARNING OBJECTIVES:

PLACEMENT PLAN:

MID-PLACEMENT MEETING, review of competency development:

END OF PLACEMENT REPORT BY SUPERVISOR (To include trainee’s strengths and needs for further development on this competency):

Revised Oct 2013 9 7.1

SECTION 7: SERVICE DELIVERY

SPECIFIC LEARNING OBJECTIVES:

PLACEMENT PLAN:

MID-PLACEMENT MEETING, review of competency development:

END OF PLACEMENT REPORT BY SUPERVISOR (To include trainee’s strengths and needs for further development on this competency):

Revised Oct 2013 10 7.1

SECTION 8: TEACHING AND TRAINING

SPECIFIC LEARNING OBJECTIVES:

PLACEMENT PLAN:

MID-PLACEMENT MEETING, review of competency development:

END OF PLACEMENT REPORT BY SUPERVISOR (To include trainee’s strengths and needs for further development on this competency):

Revised Oct 2013 11 7.1

SECTION 9: DIVERSITY

SPECIFIC LEARNING OBJECTIVES:

PLACEMENT PLAN:

MID-PLACEMENT MEETING, review of competency development:

END OF PLACEMENT REPORT BY SUPERVISOR (To include trainee’s strengths and needs for further development on this competency):

Revised Oct 2013 12 7.1

SECTION 10: PERSONAL AND PROFESSIONAL DEVELOPMENT

SPECIFIC LEARNING OBJECTIVES:

PLACEMENT PLAN:

MID-PLACEMENT MEETING, review of competency development:

END OF PLACEMENT REPORT BY SUPERVISOR (To include trainee’s strengths and needs for further development on this competency):

Revised Oct 2013 13 7.1

SECTION 11: SUPERVISION

SPECIFIC LEARNING OBJECTIVES:

PLACEMENT PLAN:

MID-PLACEMENT MEETING, review of competency development:

END OF PLACEMENT REPORT BY SUPERVISOR (To include trainee’s strengths and needs for further development on this competency):

Revised Oct 2013 14 7.1

SECTION 12: RESEARCH

SPECIFIC LEARNING OBJECTIVES:

PLACEMENT PLAN:

MID-PLACEMENT MEETING, review of competency development:

END OF PLACEMENT REPORT BY SUPERVISOR (To include trainee’s strengths and needs for further development on this competency):

Revised Oct 2013 15 7.1

OVERALL ASSESSMENT BY SUPERVISOR OF TRAINEE SO FAR

OVERALL ASSESSMENT BY TRAINEE CLINICAL PSYCHOLOGIST OF THE PLACEMENT SO FAR

SUMMARY OF RECOMMENDATIONS FROM MPM (CLINICAL TUTOR)

Did the MPV take place with at least 8 weeks of the placement remaining? YES/NO

Are there any significant reservations about the placement being passed? If so, what needs to be addressed?

Revised Oct 2013 16 7.1

SUMMARY AT MID-PLACEMENT

SUMMARY OF COMPETENCY DEVELOPMENT

TRAINEE NAME:…………………………………………………………………………..

SUPERVISOR NAME:……………………………………………………………………..

Competency Achieved Partially Achieved Not Achieved

Deferred to Next

Placement

1. Relationship Building

2. Psychological Assessment

3. Psychological Formulation

4. Psychological Intervention

5. Evaluation

6. Communication

7. Service Delivery

8. Teaching & Training

9. Diversity

10. Personal & Professional Development

11. Supervision

12. Research

OVERALL RATING: (Please tick one box)

PASS FAIL DEFERRED

SIGNED: .................................................................. DATED: ...........................................................

Revised Oct 2013 17 7.1

SUMMARY AT END OF PLACEMENT

OVERALL ASSESSMENT BY SUPERVISOR OF TRAINEE

Recommendations for Further Experience Needed (please indicate whether essential or desirable)

1.

2.

3.

Recommendations for Further Development of Competencies Needed (please indicate whether essential or desirable)

1.

2.

3.

Revised Oct 2013 18 7.1

SUMMARY OF RECOMMENDATIONS FOR FURTHER DEVELOPMENT AT END OF PLACEMENT (To be completed on every placement and sent to next supervisor)

TRAINEE CLINICAL PSYCHOLOGIST:

PLACEMENT SPECIALTY:

SUPERVISOR:

Record of Placement Activity: Direct and Indirect Clinical WorkC

lient

initi

als o

r id

entif

ying

num

ber

Presenting problems:

No

of S

essi

ons

Age

Gen

der

Work with:

IndividualsCouplesFamiliesGroupsIndirect work with staff or servicesJoint workConsultancyTeam workLeadershipTeachingOther (please specify)

Type of Service provided:

Primary careEnduring mental healthOlder AdultLearning DisabilityChild & FamilyPhysical HealthNeuro-psychologyAssertiveOutreachOther

Diversity issues discussed with client and/or in supervision:

EthnicityCulturePowerReligionSexualityRacial heritageLanguageIntellectual/ cognitive abilitySocialEducationOther

Public and Patient Involvement:

Awareness of power imbalanceCollaborative approach takenShared formulationService user feedback soughtContact with service user groupsVisits to voluntary/non-NHS servicesService evaluationOther

Assessment:

History making (clinical interview)Cognitive assessment* WAIS* WISC* Memory

assessmentRisk assessmentFunctional analysisStandardised measuresOther

Psychological model/approach used:

Cognitive-BehaviouralSystemicCATPsychodynamicPerson-centredNarrativeSolution-focusedACTOther

Revised Sept 2013 19 7.1

Record of Placement Activity: Direct and Indirect Clinical WorkC

lient

initi

als o

r id

entif

ying

num

ber

Presenting problems:

No

of S

essi

ons/

hour

s

Age

Gen

der

Work with:

IndividualsCouplesFamiliesGroupsIndirect work with staff or servicesJoint workConsultancyTeam workLeadershipTeachingOther (please specify)

Type of Service provided:

Primary careEnduring mental healthOlder AdultLearning DisabilityChild & FamilyPhysical HealthNeuro-psychologyAssertiveOutreachOther

Diversity issues discussed with client and/or in supervision:

EthnicityCulturePowerReligionSexualityRacial heritageLanguageIntellectual/ cognitive abilitySocialEducationOther

Public and Patient Involvement:

Awareness of power imbalanceCollaborative approach takenShared formulationService user feedback soughtContact with service user groupsVisits to voluntary/non-NHS servicesService evaluationOther

Assessment:

History making (clinical interview)Cognitive assessment* WAIS* WISC* Memory

assessmentRisk assessmentFunctional analysisStandardised measuresOther

Psychological model/approach used:

Cognitive-BehaviouralSystemicCATPsychodynamicPerson-centredNarrativeSolution-focusedACTOther

Revised Sept 2013 20 7.1