A Competency Based Curriculum for Specialist Training in Psychiatry Specialists in Child and Adolescent Psychiatry Royal College of Psychiatrists Approved 14 May 2013 (update approved 2 October 2014, revised February 2015) © Royal College of Psychiatrists 2013 1 Child and Adolescent Psychiatry Curriculum 2013 Table of Contents Introduction ............................................................................................................................................................. 10 1. Development of the Curriculum ............................................................................................................................ 10 2. Purpose of ST4-6 Curriculum for Child & Adolescent Psychiatry ................................................................................. 11 3. Core trainees (CT1-3) .......................................................................................................................................... 12 4. Higher Trainees (ST4-6) ....................................................................................................................................... 13 Mandatory ILO (H)s for Higher Training .................................................................................................................. 14 Selective ILO (H) s ............................................................................................................................................... 14 1. Induction ..................................................................................................................................................... 15 2. Placements ................................................................................................................................................... 15 3. Academic Learning Experiences for Higher Training (ST4-6) ................................................................................ 16 4. Research for Higher Trainees .......................................................................................................................... 16 5. Supervision .................................................................................................................................................. 17 6. Caseload and Experience ................................................................................................................................ 18 7. Concerns from Trainees .................................................................................................................................. 19 8. Mapping the Curriculum into the Scheme .......................................................................................................... 19 9. Involvement of carers and patients in workplace-based assessments .................................................................... 21 2 10. Acting Up ................................................................................................................................................... 21 11. Accreditation of Transferable Competences Framework (ATCF) .......................................................................... 21 Higher Intended Learning Objectives – ILO (H) .............................................................................................................. 23 ILO (H) 1: Professionalism for Child and Adolescent Psychiatrist (Mandatory) ................................................................. 23 1.1 Practices Child & Adolescent Psychiatry in a professional and ethical manner ......................................................... 23 1.2 Child and Family centred practice: The needs of the child are central to the child psychiatrist’s practice, taking into account and balancing their views and those of their carers ...................................................................................... 26 1.3 Understands the impact of stigma and other barriers to accessing mental health services ....................................... 28 1.4 The child and adolescent Psychiatrist works with colleagues in the multidisciplinary team and between agencies to achieve the best outcome possible for their patients ................................................................................................ 29 ILO (H) 2: Establishing and maintaining therapeutic relationships with children, adolescents and families (Mandatory) ...... 33 2.1 Builds trust and respect .................................................................................................................................. 33 2.2 Advise on young people’s confidentiality, competence (capacity) to make treatment decisions, and consent and refuse treatment ........................................................................................................................................................... 35 ILO (H) 3: Safeguarding Children (Mandatory) .......................................................................................................... 37 3.1 Detects alterations in children’s development that might suggest the child has been maltreated or neglected ............ 37 3.2 Works with the family and professional network to clarify and manage safeguarding .............................................. 39 3.3 Contributes to the assessment and treatment of children/young people who have been abused and/or neglected ...... 40 ILO (H) 4: Undertake clinical assessment of children and young people with mental health problems across the age range (Mandatory) ........................................................................................................................................................... 42 3 4.1 History taking and interviewing using developmental approach ............................................................................ 43 4.2 Physical examination of children across the age range ........................................................................................ 44 4.3 Use of appropriate rating scales / questionnaires/ instruments ............................................................................ 45 4.4 Seeking information from available outside sources ............................................................................................ 46 4.5 Diagnosis formulation and feedback of assessment and management plan to parents and child or young person ....... 47 4.6 Note-keeping and clinical correspondence ......................................................................................................... 49 ILO (H) 5: Main Clinical Conditions (including Axis I diagnoses) in Childhood and Adolescence (Mandatory) ....................... 51 5.1 Assesses and manage the main clinical conditions presenting in the under 5s ........................................................ 51 5.2 Assesses and manage the main clinical diagnoses presenting in the preadolescent, school aged child or continuing from under 5s ............................................................................................................................................................. 51 5.3 Assesses and manage the commencing in adolescence or continuing from childhood – includes transition to adult mental health ...................................................................................................................................................... 51 Examples ............................................................................................................................................................ 60 ILO (H) 5 Example: Sleep problems in a child under 5 ............................................................................................ 60 ILO (H) 5.2 – Assess and manage a child with Hyperkinetic Disorder ........................................................................ 61 ILO (H) 5.3 – Assesses and manages eating disorders in adolescence ...................................................................... 63 ILO (H) 6: Managing Emergencies (Mandatory).......................................................................................................... 65 6.1 Assessment and management of psychiatric emergencies ................................................................................... 65 ILO (H) 7: Paediatric Psychopharmacology (Mandatory) .............................................................................................. 71 4 7.1 To recognise the indications for drug treatment in children and young people ........................................................ 71 7.2 Able to explain the risks and benefits and develop treatment decisions collaboratively ............................................ 72 7.3 Able to prescribe safely ................................................................................................................................... 74 ILO (H) 8: Psychological Therapies in Child and Adolescent Psychiatry (Mandatory) ........................................................ 75 8.1 Ability to assess suitability of children, adolescents and families for psychological therapy ...................................... 75 8.2 Ability to refer appropriately and monitor progress of child and adolescent patients in therapy ................................ 78 8.3 Ability to deliver therapy to child and adolescent patients and families .................................................................. 79 ILO (H) 9: Inpatient and day-patient Child and Adolescent Psychiatry (Mandatory) ......................................................... 81 9.1 Manages children/young people with severe/complex mental health problems in inpatient or day-patient setting ....... 81 9.2 Provides day to day medical leadership for an inpatient or day-patient multi- disciplinary team ............................... 83 9.3 Understands the legal frameworks in use in an inpatient or day- patient setting..................................................... 85 9.4 Manages the physical well-being of children/ young people in an inpatient or day patient setting ............................. 87 ILO (H) 10: Management ILO for all ST4-6 CAP trainees (Mandatory) ........................................................................... 89 10.1 Managing risk .............................................................................................................................................. 89 10.2 Evidence based Practice ................................................................................................................................ 91 10.3 Applying good practice standards ................................................................................................................... 93 10.4 Involving service users .................................................................................................................................. 94 10.5 Audit........................................................................................................................................................... 95 ILO (H) 11: Teaching, Supervision & lifelong learning skills (Mandatory) ...................................................................... 97 5 11.1 Is able to organise and deliver teaching sessions in a variety of formats ............................................................. 97 11.2 Can complete a structured assessment of another’s performance and deliver constructive feedback ....................... 98 11.3 Can supervise another’s clinical work .............................................................................................................. 99 ILO (H) 12: Research and scholarship ..................................................................................................................... 100 12.1 Able to find and analyse research carried out by others ................................................................................... 100 12.2 Can generate original research ..................................................................................................................... 102 12.3 To disseminate findings ............................................................................................................................... 104 ILO (H) 13: Assessment and Treatment in Child and Adolescent Neuropsychiatry (Selective) ......................................... 105 13.1 To be able to assess and treat the psychiatric and behavioural consequences, associations, and learning complications of acquired brain injury and progressive neurological disorder ................................................................................. 105 13.2 To be able to diagnose and treat neuropsychiatric disorders such as ADHD, Tic Disorders, Tourette Syndrome, and OCD ................................................................................................................................................................. 106 13.3 To be able to carry out an assessment of an individual with autism spectrum disorder ........................................ 108 13.4 To be able to contribute to the management plan of an individual with autism spectrum disorder including use of psychotherapeutic and psychopharmacological interventions ................................................................................... 109 13.5 To be able to contribute to the management of neuroepileptic conditions .......................................................... 110 ILO (H) 14: Psychiatric management of children and adolescents with learning disabilities (Selective) ............................. 111 14.1 To be able to undertake a developmental assessment of child to make a diagnosis of learning disability and assess associated comorbid conditions ........................................................................................................................... 111 14.2 To be able to take part in a multidisciplinary assessment of a child with learning disability and associated mental health disorder and to formulate, implement and coordinate a multidisciplinary assessment and treatment plan ........... 112 6 14.3 To be able to liaise with colleagues and other child health professionals in associated agencies to provide advice about assessment, diagnosis and management of children with learning disability and associated mental health problems ...... 114 14.4 To be able to advise the courts/legal process in relation to children with learning disability .................................. 115 ILO (H) 15: Intended Learning Objective: Paediatric Liaison (Selective) ...................................................................... 117 15.1 To be able to advise on the presentation of psychiatric disorder in the context of physical illness ......................... 117 15.2 To be able to assess and manage cases of self-harm, delirium and other psychiatric emergencies that present in the A&E department or on the ward .......................................................................................................................... 119 15.3 To be able to assess and manage somatising disorders including impairing functional or unexplained medical symptoms ......................................................................................................................................................... 121 15.4 To be able to provide a liaison/consultation service to the paediatric team ........................................................ 122 ILO (H) 16: Medico-Legal Aspect of Child & Adolescent Psychiatry (Selective) .............................................................. 123 16.1 Prepare reports for the family courts ............................................................................................................ 123 16.2 Preparing reports for the criminal courts in child and adolescent mental health cases ......................................... 124 16.3 Attend court and present evidence ............................................................................................................... 125 ILO (H) 17: Substance misuse (Selective) ............................................................................................................... 126 17.1 Carries out screening for drug/alcohol misuse in young people presenting with other difficulties .......................... 126 17.2 Deploys a range of techniques explicitly directed at securing engagement in young people with substance use disorders. ......................................................................................................................................................... 128 17.3 Carries out detailed, developmentall y-sensitive assessments of drug/alcohol use in young people to determine the presence or absence of substance misuse, and to assess its impact, and contributory factors ..................................... 130 17.4 Takes part in multidisciplinary/ multi-agency assessments of children/adolesce nts with comorbidity (co- occurring 7 substance misuse and a psychiatric disorder) in order to formulate, implement and coordinate a multi-agency intervention plan ................................................................................................................................................................. 132 17.5 Delivers integrated interventions for young people and their families with substance abuse or dependence to meet the young person’s multiple needs ............................................................................................................................ 134 17.6 Contributes to the development of specialist psychiatric substance misuse services for children/adolescents ......... 136 ILO (H) 18: Transition to Adult Mental Health Care (Selective) ................................................................................... 138 18.1 To assist young people with enduring mental health problems engage with adult mental health services ............... 138 ILO (H) 19: Public Mental Health (Selective) ............................................................................................................ 140 19.1 Knowledge of the findings of epidemiological research studies ......................................................................... 140 19.2 Understanding of the interaction between wider social determinants and mental well-being ................................. 141 19.3 An awareness of the use of population screening ............................................................................................ 142 19.4 Promotes mental well- being and prevention of mental illness, including liaison with media ................................. 143 19.5 Understanding of the impact of stigma and other barriers to accessing mental health services ............................. 144 19.6 Understanding of the link between good emotional health and quality of life ...................................................... 145 19.7 Understands early intervention and economic evaluations ............................................................................... 145 ILO (H) 20: Advanced Management and Leadership (Selective) .................................................................................. 147 20.1 Business and Finance .................................................................................................................................. 147 20.2 Handling complaints .................................................................................................................................... 148 20.3 Analysing and Monitoring Outcomes ............................................................................................................. 150 8 20.4 Clinical Leadership within an organisation ...................................................................................................... 151 Appendix I The ILOs abbreviated ............................................................................................................................... 154 Appendix II – Mapping the curriculum onto the GMC Good Medical Practice ..................................................................... 156 Appendix III - Assessment of Learning Outcomes for Child & Adolescent Psychiatry .......................................................... 158 Appendix IV Sample vignettes to show that WPBA can be used to explore many areas of curriculum depending on need and stage of trainee ....................................................................................................................................................... 172 Appendix V The Assessment system for core psychiatry training..................................................................................... 180 Appendix VI - Guide for ARCP panels in Child and Adolescent Psychiatry (CAP) ST4-6 training ............................................ 184 Appendix VII Curriculum Learning Outcome Progress & Completion Tool ......................................................................... 212 Appendix VIII Trainees’ Guide to the Curriculum .......................................................................................................... 253 9 Introduction 1. Development of the Curriculum In preparing this curriculum we are indebted to the CAPSAC Advisory Papers (1999) and the curriculum developed from those papers. We have written for a generation of trainees and trainers who have grown up with a 'high definition' curriculum. It is a curriculum based on intended learning objectives with a clear indication of the threshold of being ready for consultant practice; it strives towards excellence. We have learned from the first curriculum drawn up in 2007/8. We surveyed the implementation of that curriculum with trainees, trainers and TPDs in 2010 and repeated that survey in 2012 with some additional questions. We have discussed the implementation of the curriculum with the training programme directors and representative trainees at biennial conferences in 2010 and in 2012 in the light of the results of the two surveys. The Child and Adolescent Faculty Education and Curriculum Committee (essentially the Specialist Advisory Committee for this specialty) began the current revision at the end of 2011. We have been joined by three trainee representatives, young service users and a representative of Young Minds. They focussed on aspects of the curriculum that would particularly affect service users’ experience of service and that of their families, such as professionalism; they contributed to all aspects of this revision for which we are grateful. 10