The structure of the Digital Learning Map

Practice Levels within the Digital Learning Map

The Knowledge and Skills Framework was structured using four Practice Levels (Informed, Skilled, Enhanced and Specialist) but only the first three of these are used in this Digital Learning Map because the Specialist Level is covered elsewhere, for example, in NICE and SIGN Clinical Practice guidelines.

These Practice Levels do not describe the child or young person’s level of need because this is captured in GIRFEC.

Children and young people might receive mental health care and wellbeing supports from workers at different practice levels depending on the care or support that worker can deliver to meet their needs.

Rather than being hierarchical, the Practice Levels reflect the level of responsibility the worker has to respond to children and young people who experience psychological distress and to deliver supports and interventions. This will vary across schools and other organisations that look after children and young people such as social work services, hospitals, voluntary organisations and so on, and it will also vary by job role.

Each Practice Level defines the responsibility a worker carries, but this does not necessarily correspond to the worker’s seniority within the organisation or profession. Practice Levels also broadly correspond to the levels of intervention set out in both the CAMHS and the Neurodevelopmental Service Specifications are also described within the Community Mental Health and Wellbeing Supports and Services Framework.

The Informed Practice Level describes the baseline knowledge and skills required by everyone who works with children and young people in the Scottish workforce (Support for All)
The Skilled Practice Level describes the knowledge and skills required by all workers who have direct and/or substantial contact with children and young people who may be experiencing mental health challenges (Early Support)
The Enhanced Practice Level details the knowledge and skills required by workers who have more regular and intense contact with children and young people who are known to have difficulties with their mental health, and who provide specific supports or interventions and/or who direct or manage services. This level is likely to be relevant to the range of services and organisations that deliver psychological care, under clinical supervision, applying theory to their practice and working to the evidence-base (Additional Support)
The Specialist Practice Level details the knowledge and skills required by staff who, by virtue of their pre-registration specialist training, job role and practice setting, play a specialist role in directly providing specialist neurodevelopmental assessments, mental state examinations or interventions, including medical interventions, and evidence-based psychological interventions or therapies to children and young people. Staff at the specialist level can also offer consultation, coaching and supervision to inform the care and treatment of those affected by mental health difficulties and/or in managing services and/or lead in the development of services and/or co-ordinate multi-agency, service-level responses to mental health provision for children and young people (Specialist Support)

The knowledge and skills at each Practice Level are incremental meaning that, for example, staff operating at the Enhanced Practice Level would also be expected to possess the knowledge and skills described at the Informed and Skilled Practice Level.

Please note, The Framework does not aim to specify which staff roles correspond to which Practice Levels. The expectation instead is that workers and their employers will take responsibility for ensuring that they relevantly interpret and apply the content and aspirations of the Framework. Staff are encouraged to discuss which Practice Level best suits their role with their line manager.

Specialist skills relating to prescribing medication are not detailed in The Framework; these have been specified by the Royal College of Psychiatrists as part of the training curriculum for psychiatrists (Royal College of Psychiatrists, 2013-18). Specialist skills relating to the delivery of specific psychological therapies are not set out in this framework because they are outlined in detail within the CAMHS Competence Framework.

Skills and knowledge that relate to Child Protection, the activity that is undertaken to protect specific children and young people who are suffering or likely to suffer significant harm, are woven through the Framework rather than having a separate dimension, on the basis that Child Protection permeates every aspect of mental health and wellbeing activity and is central to GIRFEC.

Dimensions within the Digital Learning Map

The Digital Learning Map also contains five Knowledge and Skills Dimensions as follows. Dimensions 1 and 2 are knowledge dimensions, whereas Dimensions 3, 4, and 5 describe both knowledge and skills. Each dimension is structured into smaller sub-dimensions, that contain more detailed knowledge and skills. These dimensions and subdimensions span across the Practice Levels. Within each sub-dimension, the fine detail of the knowledge and skills required is unique to each Practice Level:

1. Child Development and Attachment

Child development

Parent-child relationships (attachment)

Importance of play

Developmental tasks and transitions

Children and young people viewed in context

Impact of Trauma and Adversity on Attachments and Development

Neurodevelopmental diversity and/or Additional Support Needs

2. Mental Health in Children, Young People, and their Families

Overview of mental health

Interaction between mental health and development

Relationship between physical and mental health

Diagnostic criteria

Promotion of wellbeing and prevention of mental health difficulties

Parental mental health

Stigma and mental health

3. Engagement, Containment and Communication

Relationship-based practice

Emotional containment

Adapting communication

Confidentiality, consent, and capacity

4. Identification and Understanding of Need

Identification of need

Able to use different methods to obtain information

Risk of harm

Impact on staff of work with children and young people at risk of harm

Reaching a shared understanding or formulation of difficulties

5. Supports and Interventions

Methods and models of intervention

Psychoeducation

Endings and transitions

Working with and across agencies

Noticing and measuring change (routine outcome measures and psychometrics)

Psychopharmacology

Coaching, supervision, and reflective practice

Neurodevelopmental complexity and additional support needs

Case Study describing how the Practice Levels and Dimensions work in practice:

Lawrie is 13 years old. He struggles with friendships, and he gets anxious about transitions and change. He has not coped well with the move to secondary school. Lawrie has no contact with his dad, and his mum struggles to manage his behaviour at home. Lawrie potentially receives mental health and wellbeing support from a range of professionals in his life, e.g., his English teacher (who considers themselves to be at the ‘Informed’ level) is someone that Lawrie trusts and can confide in. They supply important relationship-based positive experiences for Lawrie by listening to him and empathising with his emotional experience. Lawrie’s Pastoral Care teacher (Skilled Level, who is his named person/key point of contact within the GIRFEC framework), has sign-posted Lawrie’s mum to a local positive parenting group. Lawrie has time with the School Nurse who delivers anxiety management sessions (the Enhanced Level) with coaching from a member of the local specialist CAMHS (Child & Adolescent Mental Health Service) team. Lawrie is on the waiting list for a neurodevelopmental assessment with a specialist level service because he may have Autism. All these professionals, who are helping Lawrie, need distinct levels of knowledge and skill to deliver these supports and these are captured in the Knowledge and Skills Framework, including issues around appropriate information sharing among Lawrie and his mum/the professionals who provide support.