Matrix - Delivering effective psychological therapies and interventions to autistic and otherwise neurodivergent people

Included in Training (Knowledge)

• Understand the factors that support optimal brain and psychological development in infancy, childhood and adolescence

Not Included in Training (Knowledge)

• Understand theories of child development including physical, cognitive and social - emotional development, and how they relate to supporting the child

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Have a good understanding of attachment theory, including its limitations and critiques
• Understand how difficulties in early relationships can impact; - cognitive, emotional, and social skills - parent-child, sibling and peer relationships - Emotional wellbeing - Self-regulation - Mental health Resilience
• Know about the importance of the care-givers’ experiences of attachment relationships and being parented (including the experience of developmental trauma and adverse experiences) and how these can impact parenting capacity and ability to form secure attachments with their own children
• Know about evidence-based interventions that support parent-child attachments and parenting capacity

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Understand how play links with child development and relationships
• Be aware of potential barriers to play
• Understand how to link language to play to support language and communication development

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be aware of the interaction between developmental stage, and the number and nature of transitions at any one time
• Be aware of the potential impact of family transitions, such as a family member moving out of home, retirement, on both child and young person and their family
• Be aware of the impact on children, young and their families of not being able to complete developmental tasks

Included in Training (Knowledge)

• Be aware of how to improve health outcomes for individuals, families and communities to address inequalities and support people’s access to occupational, vocational and leisure opportunities
• Understand that mental health, distress and disorder are viewed through the lens of cultural, religious and social norms, and gender, and that these may impact on the child or young person’s mental health

Not Included in Training (Knowledge)

• Understand theories of family lifecycle across social contexts and cultures to understand the developmental tasks of specific families
• Know the core principles of, and responsibility to uphold, the Human Rights and Equality Acts in their practice, including the PANEL principles (Participation, Accountability, Non-Discrimination and Equality, Empowerment and Legality)

Included in Training (Knowledge)

• Understand how the impact of trauma can present across stages of child and adolescent development
• Be aware that repeated complex developmental trauma can affect neurodevelopment, functioning and development of the self

Not Included in Training (Knowledge)

• Be aware that trauma occurring at critical developmental points, such as in infancy and childhood, has particularly damaging effects due to its potential to disrupt healthy development

Included in Training (Knowledge)

• Be aware of the impact of neurodiversity on attachment, and parental attunement
• Be aware of current research and clinical evidence, in relation to co-occurring mental health and medical conditions, such as, epilepsy, sensory processing and restricted eating
• Understand the links between speech, language and communication needs and social disadvantage: poverty can result in a reduction of opportunities for learning of language
• Be aware that children and young people with language and communication difficulties are at greater risk of developing behavioural, cognitive, emotional and social difficulties
• Be aware of the role of communication in accessing and being able to benefit from a service

Not Included in Training (Knowledge)

Included in Training (Knowledge)

• Have a detailed knowledge about the theories of mental health and mental illness
• Understand social, psychological, family and biological factors associated with the development and maintenance of mental health problems
• Be aware of the role that inequalities play at an individual, community and population level to increase the risk of mental ill health, self-harm and/or suicide
• Be aware of the role of social exclusion, isolation and lack of access to services and support on mental ill health
• Know the relevant national policies and national guidelines relating to your work with children and young people’s mental health including, National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), and National Standard Frameworks

Not Included in Training (Knowledge)

Included in Training (Knowledge)

• Have detailed knowledge about how mental health difficulties may present in children or young people with differences in development, such as neurodiverse children and young people

Not Included in Training (Knowledge)

• Have a detailed knowledge of how mental health difficulties present from infancy to adolescence

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be aware of the importance of trauma-informed approaches to underpin medical procedures

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be aware of the diagnostic criteria for child and adolescent mental health conditions specified in the main classification systems, such as Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD)
• Understand the rationale for using diagnostic systems and how a diagnosis fits within a wider understanding/formulation of presenting difficulties

Included in Training (Knowledge)

• Be aware of the wider environmental influences on health including the availability of good quality housing, green space, employment, education and access to social and cultural opportunities
• Know how to improve health outcomes for individuals, families and communities to address inequalities and support people’s access to occupational, vocational and leisure opportunities

Not Included in Training (Knowledge)

• Be aware of the key areas where there is strong evidence for action such as poverty, unemployment, childhood adversity, low income, social isolation, and problem debt

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be aware of the importance of obtaining a history of parental mental health difficulties and neurodevelopmental conditions during assessment and formulation of the child and young person’s strengths and difficulties

Included in Training (Knowledge)

• Be aware that stigma exists at several levels including public, societal, systems, structures and individual levels
• Know how self-stigma may impact a child or young person’s ability to access support and services
• Know how stigma can be multifactorial, and people may experience multiple stigmas in relation to mental health, and wider equality issues

Not Included in Training (Knowledge)

• Be aware that there may be a lack of understanding of mental health issues by family, friends, and others
• Understand how bullying, physical violence or harassment may influence the development of distress and mental ill-health and impede helpseeking behaviour
• Be aware of societal discrimination issues such as structural racism

Included in Training (Knowledge)

• Understand what makes an effective therapeutic alliance including unconditional positive regard and the importance of therapeutic boundaries
• Be aware of the types of things that can negatively impact a therapeutic alliance including being distant, distracted, overly rigid or critical or making inappropriate self-disclosure

Not Included in Training (Knowledge)

Included in Training (Knowledge)

• Maintain a good therapeutic relationship within a protocoldriven intervention, such as cognitive behaviour therapy informed approaches
• Be able to recognise and address threats to the therapeutic alliance including being able to manage rupture and repair
• Take steps to reduce the power imbalance where possible
• Consider ways that access to and use of services could be facilitated to allow for engagement for example, home visiting, flexible working, linking families with community resources
• Empower children, young people and their families by using collaborative working practice
• Be able to conduct assessments and therapy sessions via interpreters or advocates when this will aid engagement and communication with a child or young person and their family

Not Included in Training (Knowledge)

• Be able to make sense of and use process issues in therapy, for example transference and countertransference

Included in Training (Knowledge)

• Understand theories of emotional containment, including how these are applied within intervention approaches and programmes

Not Included in Training (Knowledge)

• Understand models of supervision and use supervision for managing the emotional impact of work on the self
• Know that emotional containment within the context of therapeutic relationships can make a significant contribution to managing clinical risk

Included in Training (Knowledge)

• Elicit emotions that facilitate change and provide containment of strong emotions which interfere with effective change
• Be able to get alongside the child or young person’s experience and convey your felt understanding of that experience so making strong emotions more tolerable
• Be able to help parents and other adults to support the child or young person’s capacity to express emotion appropriately

Not Included in Training (Knowledge)

Included in Training (Knowledge)

• Understand the impact of child development and neurodiversity on the child and family’s understanding of, and participation in, clinical work

Not Included in Training (Knowledge)

• Be aware of the importance of ensuring all children, young people and their families can fully participate in assessments and interventions

Included in Training (Knowledge)

• Be able to support parents to modify and adapt their language and communication to take account of their child’s needs
• Be able to adapt an assessment to match the strengths and abilities of a child or young person which may include use of questionnaires with visuals or at different language levels depending on need
• Engage families with physical and sensory impairment or poor physical health (for example by offering them a choice in assessment venue, or altering the pace and content of the session)

Not Included in Training (Knowledge)

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be aware of the Mental Health Act and the different levels of restrictions within the act and the least restrictive alternative
• Be aware of the young person’s and named person’s legal rights within the Mental Health Act
• Be aware of advocacy available to ensure young people have access to an independent representative

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be able to assess a child or young person’s capacity to consent to information sharing using adaptations to ensure understanding if necessary
• Seek legal advice about specific circumstances when consent can be accepted from a person who has care or control of the child, but who does not have parental rights or responsibilities

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be aware that the initial assessment generates working hypotheses which may need to be updated or corrected in response to obtaining further information during the course of contact with the family
• Be aware that the assessment process can, in itself, be helpful as it provides an opportunity for new understanding

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be able to co-ordinate a multidimensional assessment using multiple methods (observations, interviews, measures), sources (child, family, school) and levels (physical, emotional, cognitive, social, cultural)
• Acknowledge and evaluate the different views of the difficulties and aims for intervention (child, family, school)
• Be able to focus assessment, such as develop initial hypotheses and get more information from partner agencies in advance
• Be able to engage all family members in mental health assessment in an empathic, respectful and evenhanded way
• Make explicit and value the unique perspective of each individual on the functioning of the family

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Knowledge of the use, and interpretation of structured assessments

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Observe, describe and interpret a child/young person’s behaviour and interactions in the context of relevant theories
• Be able to use play as a therapeutic method including to assess the quality and nature of relationships between children and their parents
• Be able to conduct and interpret structured mental health, cognitive, functional, and developmental assessments and any neurodevelopmental assessments as appropriate
• Be able to take a history of the child’s strengths and difficulties, development, family, school and medical history, within the family’s social and cultural context
• Be able to ask about topics such as early family relationships in a sensitive non-blaming manner
• Explore with families their own understanding and beliefs about parenting, childhood, adolescence and the meaning of family
• Be able to draw on knowledge, theory and research about child and family development and mental health, to focus on topics which appear to be problematic or of particular significance for the child, such as taking a more detailed developmental history if there are indicators of developmental delays

Included in Training (Knowledge)

• Know national and local policies, standards, procedures and legislation

Not Included in Training (Knowledge)

• Be aware that the assessment of risk may need to be an ongoing process due to the dynamic nature of some risk factors
• Know about assessment and management processes
• Have knowledge of risk assessment measures and their limitations
• Be aware of the cumulative and interactive nature of different types of risk, such as parental risk factors limiting the ability to support and protect a child or young person at risk of self-harm

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be able to carry out a comprehensive risk assessment which combines information from multiple sources including such as clinical interviews, measures, observations, other family members and other agencies
• Be able to conduct a risk formulation which identifies factors which are likely to increase the risk of harm, and factors which are likely to decrease the risk of harm
• Be able to conduct risk management planning in collaboration with children, young people and families and inter-agency colleagues
• Be able to escalate concerns (within own or other agencies) when the implementation of the risk management plan is problematic and where necessary, express a concern or position that is different from the views of others and do so during (rather than subsequent to) any meeting
• Be able to highlight when information is missing, contradictory or unclear
• Record and report on interventions/ any part of the plan that the clinician is responsible for
• Be able to refer to, and work with, more specialised agencies, such as inpatient units or forensic services, in line with local referral protocols
• Work with others to enact Mental Health Act legislation if required

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Know theories of supervision regarding how best to provide support for workers including supporting critical thinking and self-awareness for self and others

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Provide support and guidance for others working with children and young people at risk of harm

Included in Training (Knowledge)

• Understand that the formulation may include an embedded mental health or neurodevelopmental diagnosis

Not Included in Training (Knowledge)

• Knowledge of generic formulations including, predisposing, precipitating, maintaining and protective factors
• Knowledge of one relevant theoretical model

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Within a coaching relationship, be able to identify and formulate mild to moderate mental health difficulties, within protocol driven programmes
• Integrate information from various sources and contexts
• Assess and respond to children, young people and families’ understanding and beliefs regarding mental health
• Apply theoretical models, such as, psychodynamic, cognitive behaviour therapy, systemic therapy, to collaboratively develop, communicate formulations to guide intervention
• Be able to contribute to a diagnostic assessment of neurodevelopmental and mental health difficulties, and consult with colleagues around whether diagnostic criteria are met
• Identify and describe a child’s developmental needs, acknowledging gaps which may have occurred in developmental experiences and skill acquisition, for example, as a result of trauma and adversity
• Be able to discuss the use of diagnosis with a child or young person and their family
• Be able to consider the reasons for any different perspectives amongst the child, young person and their family, and all working with them, related to the formulation
• Able to adapt the pace and amount of information and level of complexity to the family’s level of understanding and emotional readiness to accept the information
• Able to seek the views of the child and family throughout the feedback process

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Know about protocol driven programmes for mild to moderate mental health difficulties: individual or group delivery
• Keep up to date with evidence-base and draw upon knowledge of therapeutic models appropriate to work setting (such as, behavioural, cognitive behavioural therapy, systemic therapies, psychodynamic, interventions based on social learning theory)
• Know the range of psychological interventions that may be indicated when a young person may be at risk of self-harm or suicide
• Knowledge of the range of interventions offered by your service and by other services
• Know about the range of social care options that may improve the quality and length of life for children and young people living with mental ill health, including access to self-directed support
• Know theory and models underpinning group intervention

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Support parent’s emotional regulation, attunement and confidence to understand and meet their child’s needs
• Support parents to understand and meet their child’s needs at an appropriate developmental level
• Explain the value of play to parents and support them if necessary
• Support others to deliver universal/ preventative intervention in social and emotional learning
• Deliver targeted approaches for mild to moderate mental health difficulties, such as cognitive behaviour therapy informed programmes
• Be able to deliver effective, evidence-based interventions to support attachment and optimal child development
• Apply knowledge of therapeutic models and evidence-based practice to inform decision-making about the range of interventions employed
• Be able to plan and deliver group interventions

Included in Training (Knowledge)

• Be able to share knowledge on the impact on developmental difference on mental health difficulties

Not Included in Training (Knowledge)

• Be able to share knowledge about how mental health presents across the age range
• Help parents to understand the impact of trauma on attachment, and develop strategies to manage this and help the child feel safe
• Be able to explain concepts in mental health in helpful, easy to understand, and non-stigmatising ways

Not Included in Training (Knowledge)

• Understand the process of beginning, middle and end of therapy
• Be aware of how to respond to unplanned endings, including local procedures in response to ‘failure to attend’ appointments
• Be aware of local services that can continue to support children and young people that can continue to support at the end of contact with service

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be able to incorporate understanding of transitions into wider understanding of a child or young person
• Be able to work with planned endings: preparation; risk; exploration of feelings in connection with ending; opportunity for reflection on the process of intervention; preparation for transition to another service where appropriate
• Be able to work with premature or unplanned endings

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be aware of systemic factors that support and challenge multidisciplinary and multi-agency working

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Develop multi-disciplinary and multi-agency holistic support and intervention plans/pathways with clearly stated responsibilities for delivery
• Co-ordinate multi professional/ multi agency assessments and interventions

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be aware of commonly used measures including their purpose and application such as, outcome measures and goal-based outcomes

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be able to use outcome measures and goal setting as part of protocol driven intervention
• Be able to explain the use of measures to people being asked to complete them
• Develop mechanisms for monitoring clinical outcomes which focus on positive outcomes that are important to the individual and link to the formulation and intervention plan
• Seek information from multiple sources, including children and young people, on change and integrate feedback into intervention planning

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be aware of the role of medication in the treatment of children and young people with mental health problems, including in conjunction with psychological intervention

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be able to identify when medication may be helpful and seek specialist opinion
• Be able to monitor medication efficacy and side effect and report to prescriber
• Be aware of when urgent action / assistance is required due to side effects of medication, such as oculogyric crisis

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Know the purpose and theoretical models of supervision and learning and how supervision of clinical practice enhances the quality of the interventions delivered

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be able to work collaboratively with supervisor; use self-appraisal and reflection; engage in active learning; use supervision to reflect on developing personal and professional roles; reflect on supervision quality.
• Be able to determine the appropriateness to target interventions according to need and deliver interventions under coaching or refer on for more specialist support
• Discuss clinical work with supervisor as an active and engaged participant, without becoming passive or avoidant, or defensive or aggressive
• When supervising colleagues, take reasonable steps to ensure that they recognise the limits of their competence and do not attempt to practice beyond them

Included in Training (Knowledge)

Not Included in Training (Knowledge)

• Be clear that the aim of any intervention is not to try to cure neurodiversity, but to understand needs and access support, strategies, and medication where appropriate.
• Be able to use guidelines about ways to respond so that needs are met, such as National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN)
• Consider sensory processing issues in the development of any support or intervention plan
• Design support and interventions plans that address medium to longer term needs, such as plans for future transitions
• Apply knowledge of environmental factors to deliver effective interventions for complex needs
• Consider the impact on the child young person and family in relation to complex and co-occurring conditions