Example Portfolio Framework

1. The role of the Approved Clinician

1.1 A comprehensive understanding of the role, legal responsibilities and key functions of the approved clinician and the responsible clinician.

How the competency was acquired:

• Existing professional skills, knowledge and experience.

Examples of Evidence for competence:

• Professional qualification
• Evidence of current full registration with the regulatory body
• Up to date Curriculum Vitae (CV) including:
• Evidence of continued professional development (CPD) such as logs/certificate of good professional standing
• Anonymised reports; documentation created in current job eg care plans

How the competency was acquired:

Shadowing AC/RC/Approved Mental Health Practitioner (AMHP), of competency performance Suitable coursework, Seminars, teaching, learning set membership, specific training

Examples of Evidence for competence:

• Certificate of supervision
• Testimony of demonstration of competency performance
• Reflective log/journal
• Certificates of any specific training.
• Certificate of statutory ‘initial training’.
• 360 degree assessment

This is an overarching competence. The AC and RC competencies will build on existing professional competencies. Additional skills, knowledge and experience should be acquired where these are lacking, to demonstrate the full range of AC/RC competencies. Shadowing of the AC/RC in order to demonstrate this overarching competency MUST include clear evidence of the applicant having demonstrated the ability to make ALL THE KEY DECISIONS reserved to the RC.

Where exposure to certain decisions (EG application for CTO is not readily available to applicants in the service where they are currently deployed, they should ensure that they can access such opportunities for observing and participating in such decisions with an RC who can attest to their capability for making such decisions). They should have considered, on more than one occasion, each of the following decisions:

• Renewal of detention,
• Discharge from detention,
• Granting of s17 leave; and
• Application for CTO

Although the applicant cannot actually implement any of their decisions, they must have written confirmation from the RC that they are shadowing that they have demonstrated sound decision-making ability, using appropriate and good clinical judgement and risk assessment skills. That should be undertaken in a sequence of observing, participating in, and being observed to have demonstrated capability for the relevant competency.

Where the applicant is a medical practitioner or nurse prescriber they should also demonstrate on more than one occasion, consideration of the decision/s around consent to treatment specific to section 58 MHA.

2. Values based practice:

2.1 The ability to identify what constitutes least restrictive health and social care for those dealt with or who may be dealt with under the Act.

How the competency was acquired:

Observed Practice of MDT discussions, safeguarding or CTP/117 meetings where options under the MHA were considered.

Examples of Evidence for competence:

• Notes of case discussions in supervision.
• MHRT reports. Care plans. Risk assessments and management plans.
• Minutes of CTP meetings, 117 meetings.
• Reflective Journal for all sub competencies in 2.1.

2.2 Understanding and respect of an individual’s qualities, abilities and diverse backgrounds

How the competency was acquired:

As above

Examples of Evidence for competence:

• Equality and Diversity Training Certificate

2.3 Sensitivity to individuals’ needs in terms of respect to the patient and the patient’s choice, dignity and privacy whilst exercising the role of approved clinician or responsible clinician.

How the competency was acquired:

As 2.1 above

Examples of Evidence for competence:

• As above

2.4 The ability to promote the rights, dignity and self-determination of patients consistent with their own needs and wishes, to enable them to contribute to the decisions made affecting their quality of life and liberty

How the competency was acquired:

As above

Examples of Evidence for competence:

• As above

3. Assessment:

3.1 Able to identify the presence or absence of mental disorder and the severity of the disorder, including whether it is of a kind or degree warranting the use of detention under the Act

How the competency was acquired:

• Existing professional training and experience. 
• And, in addition, see specific AC preparation acquired below.

Examples of Evidence for competence:

• Professional body accreditation of such competencies
• Job Description
• CV
• CPD

How the competency was acquired:

• Shadowing
• Coursework

Examples of Evidence for competence:

• Testimony of competency
• Statutory report and a linked commentary
• CPD Log

Whilst the relative seniority of many applications should ensure a high degree of existing competency in assessment, evidence of shadowing of AC/RC and AMHP is useful and may be necessary to demonstrate RC competencies. It is especially important that the applicant can, in undertaking such assessments, show an applied understanding of the legal criteria for compulsory confinement and the statutory basis for making decisions reserved to them. Shadowing of the AC/RC in order to show evidence of this competency must include clear testimony of the applicant having demonstrated the ability to undertake the relevant assessment in order to make all the key decisions reserved to the RC.

They should have considered, on more than one occasion, assessment of the patient prior to making each of the following decisions:

• Renewal of detention,
• Discharge from detention,
• Granting of s17 leave; and
• Application for CTO

Although the applicant cannot actually implement any of their decisions, which will be based on such assessments, they must have written confirmation from the RC that they are shadowing that they have demonstrated sound skills in undertaking these pre-decision assessments, and have appropriately applied the relevant legal criteria, using appropriate and good clinical judgement and risk assessment skills.

The evidence should also be demonstrated in reflective learning sets/logs/journal.

3.2 Able to undertake a mental health assessment incorporating biological, psychological, cultural and social perspectives.

How the competency was acquired:

• Professional training and experience

Examples of Evidence for competence:

• Professional body accreditation
• CV
• CPD
• Job Description

How the competency was acquired:

• Shadowing AC/RC/AMHP 

Examples of Evidence for competence:

• Testimonial; reflective log/journal
• Evidence of MHA assessment involvement
• Case reports and commentaries

All the above evidence should be relevant to the patient/group/s the applicant is likely to be making decisions about.

There should be confirmatory evidence from shadowing testimony that the applicant has demonstrated sound decision-making and assessment skills from a range of perspectives.

3.3 Able to assess all levels of clinical risk, and the safety of the patient and others within an evidence based framework for risk assessment and management

How the competency was acquired:

• Professional Training and experience 

Examples of Evidence for competence:

• Professional body accreditation
• CV
• CPD
• Job Description

How the competency was acquired:

• Training in relevant risk assessment and management tools and processes

Examples of Evidence for competence:

• Certificate
• Anonymised reports and commentaries; care plans Learning set logs Application of formal risk management tools (eg HCR-20)

3.4 Demonstrate a high level of skill in determining whether a patient has capacity to consent to treatment

How the competency was acquired:

• Professional training and experience

Examples of Evidence for competence:

• Capacity Assessment, MDT/CTP reports (refer to 2.1)

4. Care Planning

Ability to manage and develop care plans which combine health (including measures related to physical and psychological health and medication), social services (including housing and employment), and other resources, within the context of The Mental Health (Wales) Measure 2010.

4.1 Possesses the skills and knowledge necessary to undertake safe, effective and efficient care planning, being able to:

• (a) involve patients and (where appropriate) their families and carers in care planning;
• (b) assess patients’ needs;
• (c) formulate individual care plans to meet identified needs;
• (d) ensure that care plans are implemented as agreed;
• (e) review and evaluate care plans (and revise as necessary).

How the competency was acquired:

• Observed Practice

Examples of Evidence for competence:

• Completed care plans and reviews. Service user and carer feedback

5. Treatment

5.1 Has the skills and knowledge necessary to harness the specialist treatment expertise of the multidisciplinary team, for the benefit of the patient.

Specifically, must be able to understand the roles and specialist competencies of the various members of a multidisciplinary team, in relation to specific treatments and therapies.

How the competency was acquired:

• As below

Examples of Evidence for competence:

• As below
• Reports and commentaries; care plans
• Testimonies of understanding across a range of applicable treatment approaches. Minutes of MDT/117 reports where you have taken the lead. Testimonies of other professionals.
• Reflective log

5.2 Broad understanding of all mental health related treatments, ie physical, psychological and social interventions

How the competency was acquired:

• Professional Training and experience 

Examples of Evidence for competence:

• Professional body accreditation
• CV
• CPD
• Job Description

How the competency was acquired:

• Commissioned didactic/seminar courses in areas of identified required knowledge/need (eg psychopharmacology; ECT; psycho-surgery

Examples of Evidence for competence:

• Certificate of attendance
• CPD Log
• Case reports and commentaries

The CPD and specific training will be pertinent to professions, for example, nurse applicants may have undertaken prescribing courses and specific modules to support prescribing practice, for example psychopharmacology.

6. Leadership and Multi-Disciplinary Team Working:

6.1 Possesses the skills and knowledge necessary to:

• (a) lead effectively a multi-disciplinary team in the delivery of co-ordinated programmes of care, in order to meet the needs of patients for whom he or she is responsible;
• (b) take into account the views and opinions of patients and (where appropriate) their families and carers when developing programmes of care involving the team;
• (c) consider objectively the professional opinions of other colleagues within the team when formulating programmes of care, so as to ensure that care and treatment decisions are multi-disciplinary and based on sound evidence

How the competency was acquired:

• Professional training and experience

Examples of Evidence for competence:

• CV
• Job Description
• CPD
• MDT Minutes
• Anonymised care plans to show evidence of leadership role.
• 360 degree appraisal.

6.2 An advanced level of skills in making and taking responsibility for complex judgements and decisions, without referring to supervision in each individual case.

How the competency was acquired:

• Professional training and experience

Examples of Evidence for competence:

• CV
• Job Description
• CPD
• Anonymised care plans 
• 360 degree appraisal.

7. Equality and Cultural Diversity

7.1 Demonstrates an up-to-date knowledge of race equality legislation and other equality issues, including disability, sexual orientation and gender.

How the competency was acquired:

• Knowledge of policy and legislation 

Examples of Evidence for competence:

• Attendance at appropriate courses (including mandatory)
• Manager’s training
• Commissioned (law school)

7.2 Has a broad grasp of issues of social exclusion

How the competency was acquired:

• Experience/supervision
• Attendance at relevant training.

Examples of Evidence for competence:

• Supervision notes, reflection on any relevant training attended. Completed assessments and Care Plans demonstrating an awareness of the effects of social exclusion.

7.3 Understand the need to promote equality and diversity.

7.4 Aware of how cultural factors and personal values can affect practitioners’ judgements and decisions in the application of mental health legislation.

7.5 Ability to identify, challenge, and where possible redress discrimination and inequality in all its forms in relation to approved clinician practice.

How the competency was acquired:

• Value-based practice of legal knowledge

Examples of Evidence for competence:

• Job Description
• Annual job appraisal process
• 360 degree appraisal
• Practice supervision records
• Anonymised correspondence and
• Reports/plans

Reflective learning set activities should reflect this area. Evidence of policies and models drawn on should be specific to patient group (eg Valuing People, normalisation with Learning Disability).

The anonymised care plans and reports should also reflect evidence that the applicant has considered and assessed the specific needs of their cases with regard to any protected characteristics as well as any cultural matters.

8. Mental Health Legislation and Policy:

8.1 Up to date working knowledge of;

• (a) the Mental Health Act

How the competency was acquired:

• Existing knowledge

Examples of Evidence for competence:

• CV
• CPD log

How the competency was acquired:

• Training by appropriate provider (law school, accredited body)

Examples of Evidence for competence:

• Certificate

How the competency was acquired:

• Shadowing AC/RC/AMHP

Examples of Evidence for competence:

Anonymised statutory reports/commentaries based on supervision practice/shadowing

(b) relevant NICE Guidelines

How the competency was acquired:

• Applied knowledge of relevant* guidance issued by the NICE/Matrix Cymru (see note below);

Evidence for competence:

• Reflective log
• MDT Minutes
• CPD
• Learning set work
• Evidence/knowledge of,
• Professional guidelines, NICE, National Service Frameworks, policies

How the competency was acquired:

• Knowledge of evidence based practice relevant to likely patient group (AMH, LD, CAMHS, Autism, PD, OP) about whom decisions will be made

Evidence for competence:

• See above

In the above paragraph* ‘relevant’ means relevant to the decisions likely to be taken by an AC or RC. Where national or professional guidance is not available, the applicant should use other evidence-based sources relevant to the patient group likely to be subject to their decisions.

Because this competency relates to applied legal knowledge, the anonymised statutory reports are an essential primary source of this evidence.

The applied component should be underpinned by shadowing AC/RC and, if practicable, AMHPs and by evidenced reflective practice in learning set.

(C) relevant parts of other related legislation: (including the Mental Capacity Act 2005, the Mental Health (Wales) Measure 2010, the Mental Health Review Tribunal (Wales) Practice Direction, the Human Rights Act 1998 and Children Acts;

How the competency was acquired:

• Refer to (a) above

Evidence for competence:

• As 8.1(a) above

(d) All other relevant codes of practice, national policies and protocols related to mental health;

How the competency was acquired:

• Observed discussions in MDT or CTP's regarding relevant legislation

Examples of Evidence for competence:

• Reflection on appropriate training.
• Supervision

(e) Case law relevant to the practice of approved clinicians and responsible clinicians

How the competency was acquired:

• As above

Examples of Evidence for competence:

• An example of where a judgment has influenced your practice

9. Communication

9.1 Ability to communicate effectively with professions, service users, carers and others, particularly in relation to decisions taken and the underlying reasons for these

How the competency was acquired:

• Professional training and experience

Examples of Evidence for competence:

• Job Description
• CPD log

9.2 Consideration of the needs of individuals for whom Welsh is their language of choice

How the competency was acquired:

• Discussion in supervision to demonstrate understanding of the needs of people whose first language is Welsh.
• Awareness of legislation relating to this area and the services which might be available

Examples of Evidence for competence:

• Supervision notes.
• Employing organisation's Welsh Language Policy, explaining how you would put the policy into practice.
• Anonymised Case Discussion.
• 360 degree appraisal.

9.3 Able to demonstrate appropriate record keeping and an awareness of the legal requirements with respect to record keeping

How the competency was acquired:

• Knowledge of law and policy

Examples of Evidence for competence:

• Anonymised case notes

Anonymised example reports for Mental Health Review Tribunals (Wales) and Hospital Managers’ Reviews of detention; example completed anonymised CO2 Forms (where relevant), anonymised completed example H5 Forms, anonymised completed example internal s17 leave forms and anonymised example completed CTO Forms, should be available in the portfolio.

9.4 Ability to compile and complete statutory documentation and to provide written reports as required of an approved clinician

How the competency was acquired:

• Professional experience
• Formal AC training
• Shadowing AC/RC/AMHP

Examples of Evidence for competence:

• Anonymised reports
• Certificate
• Testimonial/log

9.5 Ability with regard to effective report writing

How the competency was acquired:

• Experience

Evidence for competence:

• Example of MHRT Wales report

9.6 Ability to competently present evidence both ver and tribunals.

How the competency was acquired:

• Professional experience

Examples of Evidence for competence:

• CV
• Anonymised reports

How the competency was acquired:

• Specialist course attendance.
• (FTTs; court work).
• Shadowing and actual presenting of evidence (under supervision) at relevant hearings

Examples of Evidence for competence:

• Certificate.
• Testimonial/log.
• Anonymised transcripts of Managers' Hearings and Tribunals where the applicant's evidence has been accepted

The reports to Tribunals and Hospital Managers’ reviews above will evidence elements of this competency. Apart from 9.4 and 9.5, the seniority of most eligible applicants should ensure competency.