Assistants employed in a split support worker/psychology assistant post rated the experience of working with people with a learning disability positively and as an opportunity to increase knowledge of clinical psychology theory and its direct application to practice. Drawbacks included role ambiguity

MacDonald, Kirsty

McKenzie, Karen

Wilson, Suzanne

English

Northumbria Research Link

 1 This is the peer reviewed version of the following article:  McKenzie, K., MacDonald, K., & Wilson, S. (2005) Attracting psychologists to learning disability services: starting with assistants. Clinical Psychology Forum, 156, 25-28.The final published version is available via : http://www.bps.org.uk/networks-and-communities/member-networks/division-clinical-psychology   Attracting psychologists to learning disability services: starting with assistants  2 Authors Karen Mckenzie  Kirsty MacDonald  Suzanne Wilson      Key words: Psychology assistants, learning disabilities, support work, evaluation Word count: 1894   3  Abstract Assistants employed in a split support worker/psychology assistant post rated the experience of working with people with a learning disability positively and as an opportunity to increase knowledge of clinical psychology theory and its direct application to practice.  Drawbacks included role ambiguity.  Introduction Despite increases in training numbers for clinical psychologists and a general expansion in the profession (Pilgrim, 2003), there continues to be a shortfall, particularly in some specialties such as learning disabilities. The Division of Clinical Psychology recommended 4 whole time equivalent clinical psychologists, headed by a B grade for learning disability services, per 250000 population (BPS, 2004). Empty posts and recruitment problems means that this target can be difficult to achieve (Knight & Llewelyn, 2001). Clinical psychology training programmes are expected to reflect workforce patterns (CPCT, 2002) and recent guidance in relation to learning disability services argues that courses should encourage trainees to specialise in this area after qualifying (Faculty for Learning Disabilities, 2005).   Research which has looked at predictors of trainee job choice, recruitment and retention has found that the ability to work with a specific client group is a major influencing factor (Lavender, 1993; Thomas & Cook, 1995; Knight & Llewelyn, 2001). Knight and Llewelyn (2001) conclude that, given the importance of client group as a factor, there is a need to address the attractiveness of all specialties.   4 Traditionally, assistant posts offered aspiring clinical psychologists the opportunity to gain early experience in working in a range of specialties. Working as an assistant in learning disability services can help challenge and dispel misconceptions which can prevent this area of work being seen as attractive (Slevin & Sines, 1996). In many cases, however clinical psychology departments may have transferred funding which had previously been used for assistant posts into training posts, resulting in fewer opportunities for graduate psychologists to gain this type of experience. While the Faculty of Learning Disability guidance (2005) identifies lack of exposure to learning disability services as a major factor in terms of recruitment problems, gaining this experience at graduate level appears more and more difficult.   As a result, organisations are looking at alternative means of attracting psychology graduates into learning disability services. The present study focuses on a partnership between clinical psychology and a non-statutory organisation which supports people with a learning disability. Psychology graduates were employed within the dual role of psychology assistant/support worker by the non-statutory organisation. Supervision was provided by a qualified clinical psychologist on a weekly basis. Social care services have traditionally had difficulty recruiting and retaining staff, particularly if supporting clients with challenging behaviour (Bromley & Emerson, 1995). The initiative aimed to achieve the following: to offer psychology graduates experience of working with a clinical psychologist within learning disability services while using the skills and experience of the assistants to provide direct support to client who displayed challenging behaviour.   5 As a new initiative it was important to establish how the assistants viewed their post in terms of the extent to which it increased the attractiveness of learning disabilities as a specialty. The paper reports on the views of the assistants about the benefits and drawbacks of such an initiative.  Method Ten female psychology assistants participated in the study.  One had previous experience as a psychology assistant and six had previous experience as support workers.  All responses were anonymous and participation was voluntary. The psychology assistants were employed by a non-statutory organisation which supported people with a learning disability. All were employed in services where the clients had behaviours that challenged. The assistants spent one day a week receiving training and supervision from a consultant clinical psychologist which directly related to the clients they supported for 4 days a week as support workers.     Information was collected about assistant views about the job at the beginning of their employment and after six months in post. A questionnaire asked about the benefits and drawbacks of the job, what the assistants hoped to gain from the post and how they felt the reality of the post had compared with their expectations.        Results and discussion Benefits of the post Knowledge of clinical psychology theory and practice All of the assistants identified the main benefits of the post as obtaining increased knowledge and experience of the application of clinical psychology theory and  6 practice. Interestingly, some of the comments related to the satisfaction of contributing to behavioural change in clients who had long-standing difficulties with behaviours which challenged. A lack of knowledge about how to respond to challenging behaviour has been found to be a contributing factor to staff burn-out and turn-over in learning disability services (Bromley & Emerson, 1995). Prior to the introduction of the assistants, many of the services in question had high staff turn-over rates, which were greatly reduced following the introduction of the assistants. The ability to directly apply psychological theory and practice to the needs of the service user they supported is likely to have been an important factor in this.    Research In addition, all of the assistants agreed that a benefit of the post was that it afforded the opportunity to carry out research. This appeared to be linked to an awareness that, as well as being intrinsically of interest and important to the role of psychologist as scientist-practitioner, experience of carrying out research is often seen as relevant to gaining a place on clinical psychology training courses. In terms of this, all except one assistant explicitly stated that a benefit of the post was that they felt it would increase their chances of gaining entry onto the professional doctorate course.    The above would suggest that the assistants saw the post in terms of the personal benefit to them i.e. as an opportunity to obtain  relevant clinical and research experience which would enhance their chances of gaining a place on a clinical psychology training course.   Working with people with a learning disability  7 The evaluation also offered some hope in terms of attracting psychologists to the learning disability specialty. The Faculty of Learning Disability guidance (2005) argues that it can be difficult to recruit to learning disability services because psychologists lack exposure. Six out of the ten assistants found the direct, practical experience of supporting people with a learning disability and exposure to challenging behaviour as a positive factor. In addition, two cited the variety of the job as an attraction, with two others specifically mentioning the peer support and the chance to learn about team dynamics.  This finding suggests that the structure of having a split post was successful in both giving the assistants psychological knowledge and skills via training and supervision from a clinical psychologist, but also the direct clinical support work which allowed this to be applied in a direct and practical way. As the assistants were supporting a group of clients who can often be perceived as unrewarding to work with (Emerson et al., 2000) this indicates that the initiative was achieving the aim of providing positive experiences of working in learning disability services for the majority of assistants, thereby enhancing the attractiveness of this speciality.   Drawbacks of the post Organisational factors The post was not, however, without its drawbacks. All of the assistants agreed that organisational factors such as shift work and only having one day with the clinical psychologist were aspects of the post they disliked. Such factors could potentially contribute to complaints relating to the limitations of support work. For example, boredom and frustration with the support worker role was reported by half the  8 assistants. This could indirectly reflect the disproportionate amount of time spent performing this particular aspect of the job.   Role ambiguity Seven out of the 10 assistants identified role ambiguity as a drawback of the post, particularly at the start of their employment.  These assistants identified a lack of understanding and clarity on the part of the non-statutory organisation about their role and subsequently experienced an over-estimation of their abilities. This confusion also manifested as initial resistance from some support workers to implementing the advice from the clinical psychologist, as this was seen as coming from people who were perceived either as ‘student psychologists’ or simply support workers like themselves.  Perhaps in relation to this, half of the assistants identified a major drawback as the barriers, such as communication between team members, which prevented psychological approaches being put into practice.  This difficulty lessened the longer the assistants were in post and as the staff team and others had more direct experience of the way the post operated. This identified the importance, however, of clearly establishing the role and remit of the assistants as early as possible to ensure that advice and suggestions were implemented.  Psychology Assistant Expectations All of the assistants reported that their initial expectations differed from the reality of the post. This was mainly in relation to expecting and wanting more direct time in clinical psychology (five out of  ten), while one assistant felt that there were more barriers to implementing psychology than she had expected.    9  Conclusion The present study examined the views of psychology assistants about a split assistant/support worker post after six months in post.  In summary, the split post appeared to offer benefits to all of the parties involved. The assistants found the combination of working with a clinical psychologist and carrying out direct clinical support work a beneficial experience, which was also seen as relevant to their application for further professional training. The non-statutory organisation benefited from a more stable staff team and a reduction in client challenging behaviour. The learning disability specialty will hopefully reap the longer term benefit of providing aspiring clinical psychologists with a positive and realistic experience of working with people with a learning disability which will encourage them to enter the speciality following qualification (Knight and Llewelyn, 2001).  Acknowledgements The authors would like to acknowledge the assistance of Gillian Penson, assistant psychologist, Helen Rae, trainee clinical psychologist and the staff at ELCAP.  10  References Bromley, J. & Emerson, E. (1995) Beliefs and emotional reactions of care staff working with people with challenging behaviour. Journal of Intellectual Disability Research, 39, 341-352.   Committee on Training in Clinical Psychology (2002) Criteria for the Accreditation of Postgraduate Training Programmes in Clinical Psychology. Membership and Qualifications Board: British Psychological Society: Leicester  British Psychological Society: Division of Clinical Psychology (2004) Guidance on Clinical Psychology Workforce Planning: DCP Information Leaflet no. 6. British Psychological Society: Leicester.  Emerson, E., Robertson, J., Gregory, N., Hatton, C., Kessissoglou, S., Hallam, A. & Hillary, J. (2000) Treatment and management of challenging behaviours in residential settings. Journal of Applied Research in Intellectual Disabilities, 13, 197-215.   Faculty for Learning Disabilities (2005) Good Practice Guidelines for UK Clinical Psychology Training Providers for the Training and Consolidation of Clinical Practice in Relation to People with Learning Disabilities: Division of Clinical Psychology, British Psychological Society: Leicester.  Knight, P. & Llewelyn, S. (2001) Recruitment and Retention in Clinical Psychology. Clinical Psychology, 5, 32-35.  11  Lavender, A. (1993) Factors determining trainees’ choice of job. Clinical Psychology Forum, 60, 26-30.  Pilgrim, D. (2003) Six threats to the sustainability of clinical psychology. Clinical Psychology, 28, 6-8.  Slevin, E. & Sines, D.  (1996) Attitudes of nurses in a general hospital towards people with learning disabilities: influences of contact, undergraduate-non-graduate status: a comparative study. Journal of Advanced Nursing 24(12) 1116-1126.  Thomas, C. & Cook, F. (1995) An investigation into the factors determining the choice of specialism in clinical psychology. Clinical Psychology Forum, 31, 6-7.  

An investigation into the factors determining the choice of specialism in clinical psychology.

Attitudes of nurses in a general hospital towards people with learning disabilities: influences of contact, undergraduate-non-graduate status: a comparative study.

Beliefs and emotional reactions of care staff working with people with challenging behaviour.

Criteria for the Accreditation of Postgraduate Training Programmes in Clinical Psychology. Membership and Qualifications Board:

Factors determining trainees’ choice of job.

Good Practice Guidelines for UK Clinical Psychology Training Providers for the Training and Consolidation of Clinical Practice in Relation to People with Learning Disabilities: Division of Clinical Psychology,

Recruitment and Retention in Clinical Psychology.

Six threats to the sustainability of clinical psychology.

Treatment and management of challenging behaviours in residential settings.

Attracting psychologists to learning disability services: starting with assistants

Attracting psychologists to learning disability services: starting with assistants

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