This supplementary guidance does not replace the generic guidance but is additional. CPRs should all conform to the generic guidance and the supplementary guidance adds to it. If you have any queries about this, please ask your Academic Tutor.

Guidance for CPRs focusing on Consultancy, leadership or strategic work

  1. Referral/Establishing the Contract: A clear statement should be made about the reasons for undertaking the piece of work. This could be a statement about referral (if a referral was made) or identified service needs and how you learnt of these.  In consultancy, this would involve identifying the client and roles and responsibilities of the consultant.
  2. Assessment Phase: A description should be provided of methods of gathering information and sources of information eg. discussion with service manager, staff team, observation etc.  Consent issues should be discussed.
  3. Formulation of Problem/Service need: If possible, use theory of consultation/adult learning/leadership or appropriate psychological model to structure formulation.  Alternatively, describe the use relevant published work guiding your undertaking.  Demonstrate how the problem is conceptualised following the assessment phase.  This may lead on to a further gathering of information.
  4. Action Plan: A plan of intervention should follow logically from the assessment and formulation. This should cover aims and objectives for the work being undertaken and an outline of the relevant plan.  In a consultation you may wish to discuss issues of legitimacy and resources.
  5. Intervention/Implementation phase: Provide a description of what you have done and the methods used, related to any relevant models/evidence
  6. Outcome: Describe what was achieved in relation to the original aims and objectives.  With consultation there should be an exploration of how the ending was agreed and what evaluation, implementation plan or follow-up has been arranged.  Feedback from the consultation and closure of the contract should be discussed.
  7. Review: Discuss strengths and weaknesses of the work and any ethical professional issues, along with any lessons learned and alternative options for interventions.

Guidance for CPRs involving group work

  1. There should be a clear and focused discussion of the rationale for the use of group intervention and the research and evidence base for the approach.
  2. Key principles used in selection of members should be outlined. This may include a summary of the inclusion and exclusion criteria, or outline of staff team/home needs.
  3. Details of assessment should be given of prospective members (if appropriate) including any psychometric assessment or baseline measures.
  4. Brief details should be provided of all members involved. This may include a formulation of the difficulties of individual members, or more likely, a summary of the nature of the problem faced by group members.
  5. Ethical issues, including the process for ensuring informed consent has been obtained should be discussed.
  6. A clear outline should be given of the intended aim of the intervention for group members. If a standard intervention is used an outline should be provided of the intended benefits, both to the group members and wider system.
  7. Details should be given of the main components or techniques used.
  8. Group leadership issues should be considered (including use of co-therapists).
  9. The content of group sessions may be described although not in excessive detail.
  10. Evaluation should be made of the group in terms of group processes, dependent on the approach used, individual participants and the context.
  11. If appropriate, results of any measures should be included, together with participant feedback.
  12. There should be a review of the group, including the strengths and weaknesses of the clinical work.

 

Guidance for the structure of a psychometric assessment

Referral - A brief statement of how and/or why the problem came to the candidate or their supervisor, who referred (agency, profession), for what presenting problem or to answer what questions. An CPR should contain a clear statement of the purpose of the assessment;


Pre assessment thinking – This information may be partly available from the referral and should be generated by the trainee in his or her thinking about the referral. It should indicate the broad classes or types of likely or possible causes of the problem for which the client has been referred for assessment. 

For example:

  • Physical illness (e.g. tumour, infection)
  • Iatrogenic (caused by treatment)
  • Developmental delay (e.g. autism, Down’s syndrome)
  • Organic (e.g. degenerative condition or conditions)

 Malingering (i.e. the individual may benefit from claiming or exaggerating deficits, either deliberately or without awareness)

  • Psychogenic (e.g. due to depression, grief or anxiety)
  • Multiple (a combination of the above)

Alternatively, if the client is being referred for assessment for rehabilitation or management, it may include your pre-assessment thinking about the likely cognitive and emotional impact of the disorder and how you may go about assessing these. It might also include your thinking about ethical issues, the reason for the referral and what you will need to find out in order to be able to respond to it.

Initial assessment – This must set the scene of the problem, and should describe the client’s and family’s concerns. Ideally, it should contain a sense of the client’s own speech or the client’s own thoughts about the problem, and should stress the multiplicity of concerns expressed by the client. For example, the client complains that they ‘feel embarrassed when going to the pub’. When this is unpicked through interview the following symptoms are elicited: a) he can’t remember the order, b) he can’t name the drinks, and/or c) he can’t calculate the cost of the round. All of these problems (memory, expressive language and calculation deficits) lead him to avoid the pub because he is afraid he will embarrass himself or his friends (social anxiety).

An initial assessment might include information from interviews, clinical case notes, meetings, telephone calls, observations or daily diaries, past medical history, previous assessments, screening measures conducted during the initial assessment or by other colleagues. Make sure you note previous diagnoses or major treatment (such as inpatient psychiatric hospitalisation). Include placements (e.g. group home or day activity) if relevant for the assessment. Such assessment should form the basis for subsequent action including assessment of outcome.


Background information on the client

Date of birth, age, gender, and handedness. For children and young people with suspected learning disabilities: family, parents’ age, social and educational history, job functioning, marital history, health, siblings age, school performance, family history, medical or developmental history (for children this may include pregnancy, birth, perinatal incidents, hospitalisations-overnight), neurological history (blows to the head, seizures), milestones (first unsupported steps, first words other than mum/dad, toileting), current treatment/medication, school (academic progress – reading, writing and numeracy, socialising with peers, compliance withroutines).

For adults and older adults: family history, age and cause of parents’ deaths, social and educational history, job functioning, hobbies or interests, marital history, health, siblings age and health status, medical history, neurological history (blows to the head, seizures, stroke etc), current treatment/medication.


Presenting Complaint

Be behavioural and descriptive. How long has there been a problem, how severe is it, when did it start, what is the frequency/duration of the difficulties, does it vary, have there been previous attempts at intervention and how successful were they.


Clinical impression

Observe and comment briefly on grooming and clothes appearance, language and social presentation, affect, response to you, response to testing (is it therefore valid or representative of their actual abilities?).


The CPR should contain a clear statement of what the client was like and how much assessment was possible;


Initial formulation - An initial formulation consists of a statement about how the problem was understood after the Initial Assessment. Such an initial formulation could turn out to be wrong but should lead coherently to the Action Plan.

If the clinical practice work is a complex one, then the initial formulation might be a mixture of the causes outlined in (ii) or some other factors may be at play. This section should describe the overall formulation of the presenting problem/s, but then may focus on some areas in more detail. This will allow generation of an action plan that leads coherently to the assessments used;


Action plan - following logically from the initial assessment and formulation of the problem. This action plan should specify what assessments you have decided to use and how you decided on them. For example, your assessment may be part of a multidisciplinary assessment which included: neuroradiological scans, laboratory analyses (bloods), observations, diary records, further interview and psychometric testing.

If so, and the trainee is focussing on only one aspect, the action plan needs to provide an overview of the assessments that are indicated by the initial formulation. The focus should then be placed on the trainee’s own planned assessment.

Where relevant it should refer to the professional and ethical issues raised;


Further assessment - A description of how the assessment was implemented. Although not a verbatim account, this should provide enough detail and/or examples to enable the assessors to have a clear picture of which procedures were adopted. It is important to demonstrate the link between theory and practice in this section and relate procedures to established research findings:


Assessment process – briefly describe the assessment process, how you clarified the aims of assessment with the client and explicitly gained consent for assessment. If a child or an individuals who is not capable of giving informed consent is involved, described how you handled this issue (e.g. seeking assent from relative in the clinical practice work of an older adult with suspected dementia, or consent from the parent of a child);


Sessions – briefly describe how many sessions were required, how long they were (e.g. the client was seen for assessment at home on three occasions. Each testing session took an hour). Depending on the clinical practice work you may wish to describe what you did at each session and why, although this is not always necessary (e.g. session 2 was curtailed due to fatigue/anxiety);


Assessment results – summarise the assessment results, giving the reader a clear structure for interpreting and assimilating information, e.g. group together information on similar functions or aspects of the client’s presentation (for example, general intellectual function, attention, executive function, motor function, verbal abilities, visuo-spatial and visuo-constructive abilities, memory, affect/personality) rather than going through results test by test without a framework. Give test results in a table. This table should include: the test name (maximum score), raw scores, scaled scores, and percentile ranks. Where necessary, describe the client=s performance in test terminology not using impressionistic labels. Many manuals provide a verbal description of performance such as ‘borderline normal’, use these as well;


Observations – describe the client’s reactions to assessment and their performance during assessment, including any problems noted during testing (e.g. lack of insight, expressive difficulties, poor motivation, difficulty sustaining attention, tearful, self-derogatory, etc.);


Interpretation – summarise the strengths and weaknesses identified and the likely brain regions or cognitive modules/operations which may be compromised. Good interpretations contain opinions based on objective evidence not subjective impressions (objective evidence includes clinical opinion based on observation, however). Provide a source of normative data if a test is not widely used or there could be doubt about its interpretation. Explain statistics if necessary;


Re-formulation of the problem - This should initially focus on the trainee’s own input, and should then lead to an overall reformulation. Synthesise all the information you have gathered about the client’s presenting problems. The re-formulation may be the same as the initial formulation but with more detail and more evidence, or it may be different as a result of the information gathered during further assessment. Summarise details about the client, the cognitive difficulties, the effect on his or her life, mood etc.

Re-formulations can be seen as the summary section of a clinical report. That is they should finish by making a statement about what the presenting problems suggest in terms of the likely causes outlined in (ii), e.g. “the cognitive difficulties Mr S is experiencing were consistent with the injury sustained and these difficulties are addressed in the recommendations outlined below”.

Reformulations should contain your opinion.

The reformulation may also contain detail about recommended or planned rehabilitation;


Intervention/Recommendations section - Some psychometric assessments lead to rehabilitation interventions, some lead to recommendations or feedback to the client, the client’s family and/or the referring agent, some lead to both.

If you undertook rehabilitation with the client, you should provide enough detail and/or examples to enable the assessors to have a clear picture of which procedures were adopted. It is important to demonstrate the link between theory and practice in this section and relate procedures to established research findings.

If the clinical practice work resulted in advice or care planning, please describe plans, advice, or recommendations made on the basis of your assessment (e.g. rehab planning and sessions carried out, need for support, competence, follow-up services, need for re-evaluation). Describe how the information was shared with the client, their family (if relevant) and the referring agent. Describe the impact of this information on the individuals/systems concerned. Describe how this information was used as a collaborative working tool with the client and/or family;


Outcome - A description of what was achieved. This might include accounts and/or measures of change in neuropsychological, social, behavioural or occupational functioning, skills, settings, management practice, and so on.

Follow-up details should be described in this section. If the clinical case is a complex one, or if others were involved in taking forward clinical care then the focus should be on the trainee’s own input, but could also include a brief update on overall progress, if appropriate / available;


Critical review - This should focus on the strengths and weaknesses of the trainee’s assessment. If the CPR reports a complex case, the critical review should show an awareness of the strengths and weaknesses of the assessment as a whole. This might include the trainee’s view on the adequacy of the assessment, the tests used, whether additional assessments might have been helpful, which ones and why, the length of assessment, the degree to which the client engaged with the assessment, the degree to which the initial formulation needed reworking and what the trainee learned from that, the degree to which recommendations from the assessment were adhered to by others, or the pragmatic constraints of the service. It might also include ideas about what clinical issues need addressing next for this client.