How do Clinical Associates in Psychology integrate into services?

Elise Dyer, a Clinical Associate in Psychology (CAP) from our PPN South West CAP Community of Practice, interviewed a CAP supervisor, trainer, and apprentice CAP, to learn more about their experiences of fitting into services, and both the challenges and opportunities that arise as a result.

Naomi Payne, Apprentice CAP,  
Child and Adolescent Mental Health Service (CAMHS), Oxford Health NHS Foundation Trust 

How does the CAP role differ from your previous roles? Are there any challenges?   
I worked as an Assistant Psychologist (AP) before becoming a CAP in a research-based role. Working as an apprentice CAP is different in the sense it provided me with in-depth training. I feel I am equipped with more knowledge and skills to practice as a psychologist, work directly with young people, and hold my own caseload. I feel that I am more autonomous now compared to working as an AP. I grew in confidence as a clinician using formulation and feel more able to contribute to my team as a clinician rather than in a supportive role. I feel that my role is more defined now as an associate psychologist, and I feel like a valued team member. I suppose the challenges are it’s a new profession, but we are now embedded well in our team.    

What has the training been like for you at Plymouth University?   
The depth of the teaching was great and having teachers with expertise in their subject area was very beneficial. The actual quality and the content of the lecture materials were really helpful for our learning. However, the delivery was via Zoom, and four-day slots were sometimes exhausting. I was lucky as I studied my undergrad at Plymouth and was already familiar with various online systems. The advantage of online delivery was that all lectures were recorded, and we could go back to it to re-listen if we wanted or missed a session.    

What are your hopes and aspirations for the future?   
I look forward to working as a qualified CAP and adapting and solidifying the role in my team. We were the first cohort of CAPs at Oxford Health CAMHS service. I want to establish the role and expand my wings to supervising other CAPs and more leadership roles. I am interested in working in children’s services, with asylum seeking children, children in care, and foster carers. An established CAP part in one of these areas would be very interesting.  

Would you recommend this training route to aspiring Clinical Psychologists?  
Yes, I absolutely would recommend this training route. This role has been fantastic for my career progression. I applied for the doctorate initially, and there was a lot of uncertainty regarding the location and work areas. I knew I wanted to work within CAMHS services so when this opportunity came up, I was very excited. It was an excellent progression from Band 4 to initial 5 and Band 6 positions within eighteen months. I feel very happy that I have taken this step. My friends who have completed the doctorate programs said we are getting more in-depth training in our specific area, which I am grateful for as I knew children’s services were my chosen area.    

Would you recommend services to train CAPs?  
I think CAPs are a great asset to teams. CAPs have a range of training modalities such as systemic, CBT, DBT and various models we could offer within services. It is a good investment for services as CAPs bridge the gap between APs and Clinical Psychologists. Additionally, the CAPs are a long-term investment for services as they stay on after training.    

What would be your one top tip for future apprentice CAPs?   
When we started the course, it all seemed scary with all the assignments, especially recordings, so I would recommend just staying with and trusting the process. Once the first one is done, it gets easier. I would also say spending as much time as possible with your team and embedding yourself is hugely beneficial. You learn a lot from your team through just hearing all the clinical discussions in the office.    

Dr Lucy Hubbard, Consultant Clinical Psychologist, Interim Head of Psychological Therapies and Clinical Lead for Clinical Psychology 
Child and Adolescent Mental Health Service (CAMHS), Oxford Health NHS Foundation Trust 

How have the apprentice CAPs impacted the services they work into?   
The apprentice CAPs impacted our service hugely. It has been very positive as they have been super helpful with various projects. They have been able to support their colleagues via joint working (eg in assessments, systemic practice and training/teaching). The fact they have their own caseloads helps a stretched CAMHS Community team and they have access to team support which has been helpful. Their work made our service more accessible and helped reduce our waiting times. The issue has been holding them back as they wanted to be up and running and help with most of the tasks within our service.   

How do CAPs fit into your service? Have there been any challenges with it as a new professional identity? 
There were challenges at the beginning, and we are slowly overcoming these challenges. The biggest challenge was people needing to learn about this new profession and trying to understand the role. We encouraged people to ask Laura (supervisor) or me (psychology professional lead) about it and we worked hard to link with the university and colleagues. A big challenge is clarifying the difference between a Band 7 Clinical psychologist and a Band 6 Senior Mental Health Practitioner. However, the team managers have all been very positive, understanding and willing to ensure we are keeping to the role and not asking too much of them. This will be much easier going forward as the role will be more established and known. This would have been harder if we hadn’t had a supervisor with the amount of time ours had. Laura has been able to meet team managers and others to be clear about what is suitable work/requests. 

Why should services consider training CAPs? What would your top tips be for services that are considering training them?    
Services should consider training CAPs, as they are a real asset to the workforce. The CAPs filled the gap for the Band 5 and 6 roles in our service which is the hardest to recruit for. With CAPs we are clear about what they can offer and their working remits which helps services with case allocations and staffing. You can tailor the workforce to suit service needs with CAPs as workforce.   
My top tip for services considering training apprentices would be to provide sufficient supervision for the apprentice CAPs. In order to meet apprentice’s training needs they would need a supervisor working with them closely. I reckon once qualified CAPs can branch out to more specialised services but getting the foundation core skills are crucial.   

What are some of the benefits and challenges of training at Plymouth University? 
Plymouth University was incredibly supportive and helpful at the beginning as we did not know what we are doing. We met with university leads to clarify and answer all of our questions which helped us to set the scene in our service.  
One challenge has been to get our heads around various new university systems. Another challenge for our apprentices was front-loaded teaching, at the beginning of the program, which exhausted them by the end of the week. They have also reported feeling isolated and wanting to be on campus with other CAPs to get a sense of professional identity. 

Dr Laura Pettigrew, Clinical Psychologist and Clinical Lead for Apprentice Clinical Associates in Psychology 
Child and Adolescent Mental Health Service (CAMHS), Oxford Health NHS Foundation Trust 

How have the apprentice CAPs impacted the services they work in?    
They have had an incredibly positive impact. We receive frequent positive feedback from staff members and managers. The apprentice CAP’s enthusiasm, openness to learning, and growing knowledge and skills have been recognised and valued within teams. The apprentice CAPs have welcomed all opportunities to develop their skills. There is a lot of mutual respect and support. The apprentice CAPs are now providing direct work with families and children, production of resources, training and supporting staff, amongst other roles.       

How do CAPs fit into your service? Have there been any challenges with it as a new professional identity? 
Apprentice CAPs fit well in our service; they have been an excellent addition to our workforce. The role within our teams was set up with a lot of thought, consideration and planning. We met University Staff, Service Managers, and Clinical Psychology colleagues to explore and discuss this role, all aspects of this training, and how we would support apprentice CAPs, which helped hugely. Additionally, we received a presentation from Plymouth University about the CAP role and the training, which was helpful. These meetings paid off, and clear communication and planning have been vital.     

Why should services consider training CAPs? What would your top tips be for services that are considering training them?    
The CAPs are a fantastic psychological resource. They are bright psychology graduates with a lot to bring to services from clinical, volunteer and research roles. The advantage of CAPs is that their post-graduate training can be matched to service needs. The position, in that sense, is very flexible. The apprenticeship training provides a foundation of knowledge and clinical skills. I would say ‘go for it’ to any trust as it is a fantastic development, and services could benefit from having CAPs hugely.     
My top tips for any trust considering employing CAPs is to plan it well and think carefully about what they may need. In my service, we decided that one Clinical Lead supervisor would oversee all our 5 CAPs. Discussing and exploring ideas for new apprentice CAPs and putting in a good support structure would be helpful for services. It will benefit their learning experience and the clinical impact they can have within a service.      

What are some of the benefits and challenges of training at Plymouth University?  
I always talk about Cocreation. It has been a very positive experience. We always felt involved and included. I could email any staff member and always get a response. The course felt very responsive and collaborative.     
The virtual delivery of the program has been positive. Teaching and meetings have worked well without having to commute. However, the flipside to this has been that we never met in person, and the CAPS do not always feel part of the University community.     

What are your hopes and future aspirations for CAPs?    
I hope CAPs complete the program successfully and become confident, happy and settled clinicians.   

In the long run, seeing CAPs as a core profession with a clear career progression would be good. I would support our CAPs in whichever way they would like to steer their career in future and upon qualification. We want them to stay with us and are already planning for and investing in their future with the Trust.