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Frequently asked questions These Q&As are regularly updated with authentic questions that have recently been asked of the Lead Advisor, BACP and the FHCP Core Group Before NHS Employment: I am a student on a diploma course and would like an NHS placement is there anything that I should know? For many students, healthcare settings will provide a conducive learning environment if the appropriate support, mentorship and supervision is offered. A 'student counsellor' is an individual undertaking an initial generic training course in counselling. A Trainee is a counsellor who has already gained their counselling diploma but if they are not employed as a counsellor may need a placement to keep up their skills. Placement coordinators should ensure that the students and trainees who are accepted for a counselling placement have professional membership and private indemnity cover prior to the commencement of their placement. This ensures they work within a professional ethical framework for good practice. You can find advice on seeking a placement in the BACP information sheet (Guidance on Trainee Placements). Mentoring and supervision of counselling placements Prior to commencing their placements, students and trainees should be inducted into the policies and procedures of the service and relevant staff. To maintain accountability of practice it is essential to have a process for mentorship and supervision. This is particularly important for students not yet competent to practise as a counsellor. Employers need to be aware that mentoring is a distinctly different activity to that of supervision and should be provided by different/separate professionals. There should be clear differentiation between the role of mentor and supervisor, with clarity of responsibilities. Mentorship The mentor should be a Band 6 or above NHS counsellor or equivalent, e.g. clinical counselling psychologist, who will offer direct guidance and support to the student and trainee counsellor and will therefore be working within, or be attached to, the student's placement. The role of the mentor will include management of the student/trainee counsellor and their clients and should include client assessments. Those in placements should not exceed more than three clients per week, although those deemed competent by their supervisor may increase to a maximum of six clients per week. The mentor should ensure that policies, procedures and protocols for counselling practice are appropriately carried out and encourage the student counsellor to work collaboratively within the team. The mentor may be required to provide verification of the number of clinical hours achieved during the placement. There should be a well-established link between the placement and the organisation providing the training. Supervision Student counsellors should receive regular counselling supervision of their caseload during their placement. It is essential to assess the level of supervision required by a student counsellor when allocating them to a supervisor. It is expected that student counsellors will be at different levels of competence, ranging from novice through to masters level, depending on their previous knowledge and experience. Most courses require a supervision report of the student counsellor's progress in relation to their counselling competence and this should be undertaken in negotiation and agreement with the student/trainee and the agency. Although BACP recommends a minimum of one and a half hours of individual supervision per month, or the equivalent in group supervision, the frequency of supervision should reflect the amount and complexity of clinical caseload undertaken and the level of experience and competence of the student/trainee counsellor. As new skills are developing, a student counsellor may require supervision weekly, regardless of their client caseload. A Band 6/7 NHS counsellor, with specific training and qualified in counselling supervision, could provide (instead of undertake) supervision for (not of) student counsellors in healthcare settings. The professional experience and knowledge base of the supervisor must equip them for the specialist area of supervising those working in healthcare settings. Supervisors should have experience in both long-term and time-limited counselling. Counselling supervision ensures that the needs of the student counsellor and their clients continue to be addressed. Supervision is necessary for monitoring, developing and supporting the student counsellors in their counselling role and enables them to mature as professional practitioners and preserve their own well-being. At present there are historical inconsistencies in relation to supervision fees and responsibility for funding. Most students plan (not arrange) and fund their own supervisory arrangements during placements, although they may be provided with an 'in-house' qualified supervisor to ensure accountability of clinical practice. Most teaching trusts are happy to facilitate counselling training placements, despite this being a time-consuming exercise. Students and trainees can inform and update established counsellors on new practices and developments in counselling and this helps enhance the quality of service delivery. Provision of placements also helps the recruitment and retention process for counselling in healthcare settings.It is to be noted that some training establishments will not allow students to go on placements where they have to work in a brief way because they do not feel they have this competency. Is counselling supervision offered by an NHS colleague who is not trained in counselling/psychotherapy OK? A counselling supervisor for an NHS-employed counsellor should have professional experience and a knowledge base that equips them to work in this specialist field. Ideally, they should have experience of working as a counsellor in the NHS and hold a qualification in counselling supervision from a reputable institution, or be accredited as a supervisor by BACP. It may be the case that a counselling psychologist also has sufficient training to be a supervisor of counsellors. It is important that an employer of NHS counsellors understands the nature and significance of counselling supervision and the difference between it and line management. Explicit lines of accountability, in both employment and professional terms, should be clearly established. Supervision is a contractual arrangement between a counsellor and a supervisor and is usually offered on a one-to-one or group basis. It is seen as a safe place where counsellors can take client material. For this reason the supervisor should not be in any managerial relationship with the supervisee. Information disclosed in supervision is confidential to the supervisor and the counsellor and, as such, is not divulged by the supervisor to a third party unless there are concerns regarding professional or ethical practice. In this instance, the supervisee should be informed prior to any sharing of information about them or their practice with a third party. I would like to work as a counsellor/psychotherapists in the NHS how do I go about it? Speak to counsellors in your area who are already employed within the NHS. They will know the likelihood of their being vacancies for counselling posts in your locality. You could also look in the local and national press for advertisements. Advertised posts for NHS counsellors usually request that the applicant is BACP Accredited or equivalent. If you would like to work in a healthcare setting it would also be beneficial to seek additional, and more specialised, counselling training and a placement in an NHS setting (see BACP information sheet (Guidance on Trainee Placements)). A trainee counsellor has already gained a recognised qualification in counselling at diploma level. They may be seeking a placement in healthcare, either to enhance and develop their professional counselling role, or to accumulate more clinical hours to achieve their BACP individual counsellor accreditation (minimum 450 hours of supervised practice required). The trainee receives no payment for their work, although some assistance towards funding professional membership fees, indemnity cover and supervision fees may be offered. Counsellors seeking employment within the NHS need to include in their CPD plan:
In line with Clinical Governance initiatives, NHS employers will now support CPD, both financially and in allowing time for further training. As the postgraduate training requirements are very specific, it is far more cost effective for services to develop 'in-house' research, education and continuing development programmes, or to buy in a qualified trainer to deliver a programme for the whole team, than to send individuals on day courses. Employers may therefore offer a variety of options in furthering the professional development of counsellors. The minimum qualification recommended for counsellors working in the NHS is a diploma in counselling from a recognised training institute. Once this programme of generic counselling training is complete, the counsellor has a personal responsibility to continue their professional development (Sharman, 2001)1. This may be achieved by undertaking further training in order to develop specialist approaches to counselling, which would enhance practice in a healthcare setting, or by attending seminars, workshops, study days and conferences. It is recommended that, post qualification, counsellors undertake a minimum of 30 hours of CPD a year. Most employers would support this, both financially and in time, in relation to Clinical Governance initiatives. Counsellors are expected to achieve their BACP individual counsellor accreditation within five years of qualifying. Professional development should be assessed annually through appraisals and monitored on Professional Development Plans (PDPs). It is recommended that all NHS organisations should have these systems in place. Questions that have arisen from NHS Counsellors: Private Practice and NHS Employment I have been working as a counsellor in primary care and my client would like some extra sessions. Can I see them in my private practice? Check with your Trust, but our advice would be that it is not advisable for NHS counsellors to continue to see patients in their own private practice. This would not be in accordance with the Clinical Governance requirements of the NHS. It would also contravene most NHS protocols concerning confidential material going outside the NHS. It would not be ethical for NHS counsellors to be seen to be profiting from their NHS employment. NHS counsellors need to be very clear as to the limits in numbers of sessions that they can offer to clients in their initial contracting. It is also advisable to have available a directory of local counselling services that may be available to counselling clients to enable clients to investigate and then to choose an appropriate service if they wish to have additional counselling. As an NHS counsellor how much counselling supervision should I have? Counselling supervision is essential for effective counselling practice. It is a formal professional arrangement for counsellors to discuss their work on a regular basis with someone experienced in counselling supervision. The aim is for the counsellor and supervisor to develop the efficacy of the counsellor/client relationship and ensure the personal well-being of the counsellor. Counselling supervision is concerned with monitoring, developing and supporting individuals in their counselling role to ensure that the needs of the client are being addressed. It is different from personal therapy or line management. Counsellors are required to have ongoing supervision or consultation throughout their career in order to practise effectively. BACP requires a minimum of one and a half hours of individual supervision per month. The frequency of supervision should reflect the amount and complexity of the client caseload and the level of experience and competence of the counsellor. For example, a counsellor with three clients per week requires one and a half hours of individual supervision every month. A counsellor with 18 clients per week may require an hour of individual supervision per week and to attend a regular supervision group. Group supervision allows counsellors to share their ideas, air concerns and hopefully stimulate new ways of working, which makes for a better counselling service. It is recommended that time for supervision is part of the terms and conditions of all counsellors employed in the NHS and should therefore be funded by employers. Counselling supervision plays an essential role in maintaining clinical competence. Confidentiality and Notes I am concerned about confidentiality and note-keeping within the NHS have you any advice? Firstly, ensure that you know what your Trust protocols on confidentiality are. The need to respect client confidentiality is a core principle of counselling and it is therefore important to be fully aware of the wide range of external agencies or individuals that can gain access to personal information disclosed and explored in therapy. Counselling relationships are built upon trust. Using warmth, genuineness, empathy, congruence and unconditional positive regard encourages self disclosure in order to enable the client to engage in resolving their problems. Disclosure may be impeded if the client feels insecure or suspicious of what happens to the material offered during a counselling session. It is essential that issues of confidentiality be clearly and openly discussed with your NHS employer and the client before engaging in counselling. It is important that clients understand the limitations of confidentiality within the client-counsellor relationship and are clear under what circumstances exceptions in confidentiality may occur. It is essential that there is clear contracting before engaging in the counselling process. Certain circumstances can require confidentiality to be breached, for example:
Other situations may arise where the professional sharing of information is considered necessary, for example, case conferences, team briefs and supervision. This should always be in the interest of the client and should not compromise the counselling relationship. Prior and explicit agreement should be obtained from the client and not merely be assumed. Record keeping Clarity is essential where record keeping is concerned. It is important for each employment agency within the healthcare setting to develop precise protocols in relation to the legal systems and with reference to the Data Protection Act, 1998. It is considered good practice for counsellors to maintain notes of counselling appointments, but those working in the NHS may be obliged to make counselling entries onto the patient's medical records, or in a case file. In these circumstances, the client's records may be accessible to all authorised personnel within the healthcare setting and may assist in the development of collaborative care programme plans. Counsellors may find that they have to enter records on computers that are accessible to other NHS personnel. If there is any cause for concern with any issues concerning confidentiality then it is wise to discuss the matter with your manager and your employer's Caldicott Guardian. Set out below are the Caldicott Principles. All NHS staff, including counsellors, are legally obliged to keep all forms of patient information confidential, in accordance with the Caldicott Principles. These are outlined by the NHS Executive as follows:
To ensure that these principles are adhered to, all NHS organisations are required to appoint Caldicott Guardians of patient information, as recommended by the Caldicott Committee report. The main aim is to protect the information collected in confidence from patients by healthcare professionals, in compliance with Information Governance (IG). IG aims to improve outcomes by raising standards and ensuring that information processing is subject to continuous evaluation based on five broad aspects known as HORUS:
IG requires that this work be clearly understood, effectively recorded and constructively managed by Caldicott Guardians. This results in more informed patients who are aware of their privacy rights. Counsellors requiring information on issues of confidentiality can approach their local Caldicott Guardian or the BACP Information Helpdesk for advice and support. What about NHS counsellors and confidentiality in connection with counselling children and young people? Some counsellors may be employed to offer counselling to children and young people and in this case, the counsellor's role in relation to consent and confidentiality can be complex. In this situation the Guidance and Regulations of the Children Act 1989 apply. The Act brought a new beginning to philosophy and practice in the childcare system and provides guidelines on consent and entitlement to confidentiality of children and young people in medical and psychiatric examination and assessments. The Guidance specifically states that children should have sufficient understanding to make informed decisions about their care and treatment. The Children Act itself gives no guidance on how to determine a child's capacity for understanding and it is accepted that the principles used in ascertaining Gillick Competence will apply. The Gillick Principle originated in the House of Lords in 1985 and concerns the rights of children under 16. The courts agreed that once a child has a sufficient level of understanding and intelligence, they are deemed capable of making up their own minds on matters requiring a decision. A young person meeting these criteria is referred to as a 'Gillick competent child'. To assess Gillick Competence counsellors need to give careful consideration to the following:
Although the Gillick ruling requires that children and young people should be persuaded to allow their parents to be consulted, counsellors who assess children and young people as being 'Gillick competent' are not under any duty to consult with parents before, during or after counselling, unless they perceive their client to be in immediate danger or a high suicidal risk. Young people under the age of 16, assessed as Gillick competent, may receive completely confidential counselling without parents needing to be informed, or giving their consent. The health professional must ascertain Gillick competence in each case. The Guidance warns: 'directions by a court will not absolve a doctor, or other health personnel conducting the assessment, from his responsibilities to satisfy himself that the child is of sufficient age and understanding to consent'. It is imperative that counsellors responsible for undertaking Gillick assessments are appropriately trained and qualified in this procedure. Where young people may not be Gillick competent, there is likely to be considerable sharing of information and liaison with parents. Issues of confidentiality should be clear for all those who work within healthcare teams and who have direct contact with clients/potential clients. Counsellors involved with young people should feel confident and competent in Gillick assessment. Counsellors also need to know the policy and procedures in their own healthcare setting and understand how these integrate with the law. Other NHS colleagues would like me to tell them what is happening with a client's counselling. Do I tell them? NHS counselling/psychotherapy is always part of a coordinated approach to patient care. This being the case any NHS counsellor needs to clarify for themselves how they fit into a collaborative care approach. You need to know exactly who your colleagues are within your NHS setting, their role and their function. You need to assure yourself that they also understand the nature of your work. There needs to be a common understanding about the way that information is shared between colleagues concerning patients/clients. If there is any cause for concern then first discuss this with your colleague to clarify any misunderstanding, share it with your manager and if there is still concern bring the matter to the attention of your Caldicott Guardian (see the above notes on confidentiality and record keeping.) Working Conditions What would you consider to be the appropriate room in which to offer counselling? Is there anything that you would consider to be essential in a counsellor's room? The following are desirable for best practice:
As with other NHS health professionals, such as doctors and nurses, a counsellor needs good facilities principally for the benefit of NHS clients/patients Employment Issues concerning Pay I am having difficulty with my Knowledge and Skills Framework (KSF). Where do I go for advice? The KSF and Developmental Review process, to give it its' proper title is part of the Agenda for Change (A4C) and as such all Trusts must provide individual staff members with training in what the KSF is, and how it will affect them. Trusts either invite managers and other staff to attend special training days or, where a team or department is large enough, the Trust may send trainers to the department. The trainers should represent both management and staff and their task is to explain the KSF and how it fits with the A4C particularly the 'role outline' and 'the review process'. Any KSF (job) role outline should be constructed on a partnership basis, between manager/s and staff. Therefore any questions should in the first instance be directed to your manager, if this fails to get a satisfactory answer you can approach the A4C team, one member of whom will we a KSF lead. Failing this you can approach UNISON who has learning reps or see our website with the link to UNISON. I believe that the post I occupy has not been awarded the appropriate Pay Banding in Agenda for Change (A4C) what must I do? If you wish to appeal against your A4C job matching and pay banding you should do so as soon as possible after you receive the written notification. Having made known your decision to appeal you then have 13 weeks to submit, in full, your written complaints to the A4C team. For each area within the 16 Factors, where you disagree with the matching panel's decision, you must supply evidence supporting your claim that a review is needed. It would be helpful to have a copy of the Job Evaluation Handbook (available from your Trust or manager) to refer to when writing your appeal. Make sure that your job description and your appeal match. If you cannot find the question that you wish answered here then consider:
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