Clinical Associates in Psychology: a new role with new challenges and opportunities

The Clinical Associate in Psychology (CAP) is a new role recently introduced in England. The role is designed to provide greater access to psychologically informed services, filling the gap between assistant psychologists and registered practitioner psychologists.

Some CAPs from the PPN South West CAP Community of Practice have conducted interviews with apprentice CAPs, a CAP supervisor, and a CAP program director to give a taste of what the role entails, the challenges and opportunities associated with it, and the potential future of the role.

Apprentice CAP Katie Slender
Gloucestershire, Adult Inpatient Service

What is it like working as an apprentice CAP?
It is good and feels like a step-up from an Assistant Psychologist role I have previously done. As an apprentice CAP, I have more grounding in different models that I gained from the teachings, giving me confidence. As a CAP, I rely on my supervisor less to make decisions. I like the service I work for, a female ward. I can apply the theories I learned in the course to my practice.

How does it differ from other roles you have held?
I have worked as an Assistant Psychologist (AP) for quite a few years, but I did not have much grounding in theories and models and their clinical applications. Hence, it felt like I relied on my supervisor to guide me. Learning various models in the CAP course gave me a base to work from. I enjoy working more independently and confidently making clinical decisions under supervision. I can identify pieces of work on the ward, and additionally, I will be supervising a student on the ward which would have not happened as an AP.

What resources have been beneficial to support you?
My supervisor has been helpful throughout my training. The university staff, my clinical tutor, the apprenticeship team, check-in sessions, reflective sessions, and the library have been beneficial. The lecturers and the teaching staff were helpful when I had queries or needed help.

What are the challenges of working as an apprentice CAP?
What is an apprentice staff, and what does that mean to the multidisciplinary team, or the clients not knowing the limitations of my work has been challenging. Balancing the academic and clinical work has been challenging. I never been in an apprenticeship program before and juggling personal life, academic and clinical demands can be challenging.

What has the training been like for you?
It has been good. It has been helpful to have an overview of various models. It was teaching heavy to start with and it took some getting used to.

What are your hopes or aspirations for the future of CAPs?
I hope there is a development opportunity for CAPs. I would like to see CAPs working in various settings and services. Top-up to a doctoral level of training (life span training) would be great. This development would improve access for professionals.

Apprentice CAP Victoria Partington Smith
Community Mental Health Team, Plymouth

What is it like working as an apprentice CAP?
I have experience working as an AP. Working as an apprentice CAP is enjoyable, it is new and exciting.  My role as an apprentice CAP is protected, I know what I am doing, my role is clearly defined. It is nice to have a set of boundaries. 

How does it differ from other roles you have held?
The Apprentice CAP role is more respected compared to my previous AP role. I have a clear role definition and professional identity. The CAP role has its own set of standards. I can easily define the CAP role. I feel more confident in my abilities as a mental health clinician. My knowledge of models and theories is grounded, and I feel confident drawing upon a range of models when I work clinically. I also noticed that working as a CAP enabled me to work more reflectively, and I am happy to sit in silence in my sessions whereas before I was not able to do this. I used to feel lost in sessions as an assistant psychologist, but I am a more confident and comfortable clinician now working as an apprentice CAP.

What resources have been beneficial to support you?
The Plymouth University CAP handbook has been helpful, reflective practice sessions, having lecture slides on the Digital Learning Environment and having access to the recorded lectures are incredibly helpful. I can listen to missed lectures afterwards. The university has listened to what worked well, and what did not work, and our feedback was well valued.

What are the challenges of working as an apprentice CAP?
One of the challenges for me personally has been navigating various systems. For instance, I had to learn to use Plymouth University internal systems to help apprentices log their clinical hours and reflections, and what goes where has been challenging. Trying to juggle the academic side and clinical side has been challenging. The course is intense, and trying to keep on top of all assignments, deadlines, and clinical requirements can be challenging.

What has the training been like for you?
The training has been enjoyable. The training was academically loaded initially, with four days of learning, and one day of clinical placement. It would have been better if the teaching had been delivered systemically in line with the required assignments.

What are your hopes or aspirations for the future of CAPs?
This has been an excellent developmental opportunity for me personally. I have completed quite a few lower band jobs, and I am excited to be training at the Band-5 level and moving up to the Band-6 role upon graduation. I remember having a Psychology degree and working in a pastry shop feeling ‘lost’.
I feel thrilled now I am training as a CAP with a clear developmental opportunity. The role is integrated into the workplace and allows us to stay in services, progress internally, and bring psychological thinking into services. Overall, the future of the role seems bright, and I am excited.

Clinical Psychologist Supervisor Dr Beth Taylor
Gloucestershire, Adult Inpatient Service

What is it like supervising an apprentice CAP?
It has been really good, it feels like supervising a trainee Clinical Psychologist. I do not have to do basic teachings of ‘how to talk to people’ etc. The academic training really helps shape up apprentices.

How does it differ from supervising other professions?
It is like supervising a trainee Clinical Psychologist. As apprentice CAPs are permanent members of the team, I am inclined to think long-term and am more invested in their development and progress. I spend more time in their career development. It is a more invested relationship.

What resources have been beneficial to support you?
It was helpful to have the first meeting about ‘how to supervise Caps' that was run by the university. It’s been helpful to get help with understanding the ‘apprenticeship’ side of the program and learning about the assessments of the course. I did not need a substantial number of resources; our service is well set-up. It’s been fairly straightforward.

What are the challenges of supervising apprentice CAPs?
We are lucky that the set-up of our service is good, it is straightforward, and it is working well. There are no significant challenges apart from the typical ‘supervision’ challenges.
There are a few challenges, but I suppose the main challenge is making sure the CAP is happy, and the team is comfortable, and everyone knows what the role is. As it is a new role within the service and the expectations, and the remits of the role might not be clear.  As it is a new role within the service, expectations might not be apparent to some of the team members.

How has the apprentice CAP impacted the services they work into.
Our apprentice CAP is based on the inpatient ward, able to see a lot more people, the apprentice CAP is present, and visible which is increasing accessibility to ‘Psychology’. There are opportunities for engagement, and one-off sessions, or the team members brainstorming with our apprentice CAP on the ground.
I want the role to move into a bit more is bridging the gap between inpatient and community. For instance, an apprentice CAP could follow a patient into their supported accommodation and support staff by teaching them some grounding techniques. The role is really evolving and addressing the gap in inpatient services.

What are your aspirations, and hopes for the future of CAPs?
I would like CAPs to do a range of things that are normally available on the ward, such as groups like problem-solving, and a set of interventions that are readily available. I would like CAPs to carry out more leadership, reflective practice, and consultation roles.

Program Director for the MSc CAP Apprenticeship Program Dr Mike Hodgkinson
University of Exeter

What are CAPS, and how were they developed?
CAPs are Psychology graduates, who have also got some prior experience of client-facing roles in the health service or social care, or third sector. CAPs train within the NHS service and receive training at the university. They are trained in psychological assessment, formulation, intervention and evaluation, and research.

Why did you create CAPs?
In practice, CAPs were developed to fill the gap in the Psychology workforce between assistant psychologists and Clinical Psychologists. We noticed that there were many Psychology graduates who could not get onto Doctorate in Clinical Psychology programs and there was a clear potential for utilizing their skills, particularly in the secondary services. The program was developed to fill the real workforce gaps that were not filled with existing roles. Additionally, the role provided an opportunity for people who wanted to work in the applied psychology field.

What do CAPs do?
CAPs are psychological professionals who can apply psychological principles to a broad range of services. We train people to provide assessment, formulation, interventions, and evaluation. However, the advantage of a CAP professional is CAP’s flexibility to work in a range of services. The most exciting thing about the CAP role is that their role is defined by the service they join. For instance, CAPs could be working in a CAMHS (Child and Adolescence Mental Health Service) service or LD (Learning Difficulties) service, and their day-to-day work would be shaped by the service and the team they work in. The value of the CAP role is its flexibility. The unique CAP training provides the core component for an ‘Applied Psychologist’, which can be applied in various settings and services. The value of the CAP role is that they can use their skills in a broad range of settings which makes the role more appealing for numerous services including secondary mental health services.

What aspects of the program excite you the most?
I find that diversity of people and the skillset of people who join services as CAPs are extremely exciting. People can use their pre-existing skills, we start to see the whole breadth of knowledge and skillset within the CAP role, and we also see that the CAPs are bringing people into mental health services who probably would not have arrived before. There are nearly fifteen- thousand people who graduate from ‘Psychology’ courses each year. Only seven hundred and fifty of these graduates are accepted to the Doctor of Clinical Psychology programs. The CAP programs are now offering an opportunity to Psychology graduates to work in the applied psychology field and offer mental health services to an additional psychological workforce.

What are the challenges of running the CAP program?
One of the challenges is that CAPs are still not well-known professionals. Helping services to understand the potential benefits of having CAPs in their services. Additionally, getting services to understand CAPs' training needs, how services could support CAPs during and beyond their training could be challenging.

What are your hopes and aspirations for the future of CAPs?
We’ve already started seeing the fame of CAPs beginning to spread, and more programs are running nationally. What is incredibly positive is that the program began as a trailblazer and is now offered as an apprenticeship. It is rapidly growing. My aspiration for the profession is for CAPs to become a nationally recognized group of professionals. After three years of qualification, the first cohort of CAPs in Cornwall is branching out. We see CAPs going into education, or specialist therapy roles and beginning to develop within their role. I reckon there is a diverse and exciting range of possibilities in terms of career development for CAPs.