Hcpc Challenging Behaviour Essay

HEALTH & CARE PROFESSIONS COUNCIL

In Unit 1 you studied the BPS' Ethical Guidelines for psychological research. In Unit 2, the focus is on practitioner psychologists - psychologists who are doing a job. In the UK, practitioner psychologists are overseen by the Health & Care Professions Council (HCPC).
In the exam, give the Health & Care Profession Council its full name the first time you mention it, then call it HCPC after that.
A psychologist needs to be registered with the HCPC in order to get a job and needs to re-register every 2 years. Someone in bad standing with the HCPC (perhaps because they didn't meet its standards) will struggle to find employment as a practitioner psychologist. It is a criminal offence to claim to be HCPC registered if you are not.
The HCPC standards consist of guidelines for all practitioner psychologists, then specific guidelines for different types of practitioners: clinical psychologists (with extra guidelines for counselors), educational psychologists, forensic psychologists, health psychologists, occupational psychologists and sport psychologists.

THE HCPC STANDARDS (2015)
15 STANDARDS OF PROFICIENCY

On the right is a summary of the HCPC's 15 Standards of Proficiency:
Other standards practitioner psychologists must follow include:
  • Character: To join the HCPC, trustworthy character references need to be obtained from people who have known you for at least three years. This will also consider criminal convictions or cautions.
  • Health: Regular updates on general health must be sent to the HCPC (this will happen every 2 years when you re-register). If you have any conditions that will impact on your clients, you must stop work immediately.
  • Standards of ethics: There are 10 ethical guidelines that practitioners must conform to, including: maintaining confidentiality of clients and only acting within the limits of your own knowledge and skills (competence) and referring on to others when necessary (collegiality).

CLINICAL PSYCHOLOGISTS

A clinical psychologist will assess the behaviour and needs of their client using a variety of methods.  Clinical psychologists work as part of a multidisciplinary team alongside doctors, nurses, social workers, teachers, psychiatrists and therapists. They devise and monitor treatment programmes, as well as applied research.

There are HCPC Standards that apply specifically to clinical psychologists:
  • Standards for education and training: For clinical psychologists, the minimum qualification required is a Master’s degree with BPS qualification and a doctorate.
  • Standards for prescribing: There are standards for prescribing medication. This includes the knowledge and training to be able to prescribe appropriately and safely.
  • Standards for counselors: Therapists offering counseling must understand the importance of empathy and imagination as well as the philosophy behind psychological therapies
These standards set out safe and effective practice in the professions we regulate. They are the threshold standards we consider necessary to protect members of the public - HCPC
You don't need to know all 15 - just pick a few to learn. I recommend:
  • legal & ethical boundaries
  • impact of culture, equality & discrimination
  • confidentiality
  • safe practice

It's interesting that actually knowing anything about psychology doesn't turn up until  #13

  1. Being able to practice safely and effectively
  2. Being able to practice with the legal and ethical boundaries of the profession
  3. Being able to maintain fitness to practice
  4. Being able to practice in an autonomous way and to use professional judgement
  5. Being aware of the impact of culture, equality and diversity on practice
  6. Being able to practice in a non-discriminatory manner
  7. Understanding the importance of confidentiality
  8. Being able to communicate effectively
  9. Being able to work appropriately with others
  10. Being able to maintain records appropriately
  11. Being able to reflect on and review practice
  12. Being able to assure quality of practice
  13. Understanding the key concepts of the profession’s knowledge base
  14. Drawing on knowledge and skills to inform practice
  15. Understanding the need to establish and maintain safe practice

APPLYING HCPC STANDARDS
AO2

Are the HCPC Standards being applied? A brief trawl of the Internet turns up these lively news stories:
  • 2010: a clinical psychologist struck off the HCPC register for not keeping proper patient records: "such a haphazard approach to case notes must seriously undermine public confidence in the consistency of delivery of health care"
  • 2013: a paramedic struck off the HPCP register for having sex with someone while answering a 999 call: "This was an abuse of trust which violated a professional boundary"
  • 2013: a clinical psychologist struck off the HCPC register for telling an under-age client she was trying to "rescue" to break off relationships with her parents and come and live with her instead: "failing to maintain appropriate boundaries"
  • 2016: a child psychologist suspended from the HCPC register for taking ecstasy in a nightclub with clients: "a significant breach of trust, particularly given the vulnerability of the young people concerned"
  • 2016: a clinical psychologist struck off the HCPC register for making his staff work on his personal website and private business rather than their mental health project: "the abuse of trust; the abuse of resources; the abuse of colleagues"

Being struck off the register means the end of a career. Being suspended means the psychologist could practise again in the future.
These news stories certainly make it sound like the HCPC has got "teeth" and give an impression of the ways in which practitioners can fall short of the HCPC Standards.

But is the HCPC too aggressive in policing these Standards?

The HCPC also regulates social workers and is criticised for "setting itself up as a moral police force". Social workers who are suspended or struck off for their private lives or struggling to manage caseloads claim their human rights are being ignored by the HCPC - particularly Article 8 of the European Declaration of Human Rights, the "right to a private life".

The HCPC argues it's part of its job to make sure its members' private lives are respectable.
Our standards of conduct, performance and ethics are clear that you must keep high standards of personal conduct, as well as professional conduct - HCPC
A problem with the HCPC's verdicts is that they cannot be appealed without going to the High Court. This is a very expensive legal challenge that lower-paid jobs like social workers cannot afford.
But the HCPC only has authority over its registered members.
In 2016, there were 21, 613 practitioner psychologists registered with the HCPC. The British Psychological Society (BPS) has over 50,000 members.

This is because only specialist psychologists need to be registered with the HCPC - such as workers employed by the NHS - but anyone can set themselves up as a "psychologist" so long as they don't claim to be a "registered psychologist". This means over half of the UK's psychologists are unregulated.

EVALUATING HCPC STANDARDS
AO3

Credibility

The 15 Standards set out by the HCPC are a credible framework. They are SMART targets:
Objections

No one objects to the existence of standards or the expectation that people who work in healthcare should meet high standards. The question is whether the HCPC's Standards are appropriate.
  • SPECIFIC: Just where do "legal and ethical boundaries" lie when it comes to clinical psychology? The psychologist struck off for forming a close friendship with an under-age client argued she was trying to offer help to a young person in a desperate situation. The HCPC disagreed, but the boundary wasn't clear at the time.
  • MEASURABLE: The psychologist who took ecstasy in the company of her young clients was not engaging in "safe practice" but no actual harm was done to them. She was suspended rather than struck off. Should she have faced a worse or a lesser punishment?
  • ATTAINABLE: The accusation that the HCPC acts like a "moral police force" would mean that its Standards are unattainable for ordinary people with difficult private lives - or not enough money to fund expensive appeals.
  • RELEVANT: Are all the Standards equally relevant? The psychologist struck off for bad record-keeping doesn't seem to have done something as awful as the one who diverted staff time and funds into his private business.
  • TIME-BASED: Is 2 years often enough for re-registration? Or too often? The HCPC takes a fee when you re-register, so is this just money-making? Or perhaps, given the pace of change in healthcare, practitioners should re-register every year.
Applications

The AO2 section (above) describes a number of cases of the HCPC investigating breaches of its Standards and suspending or striking off members.

On the one hand, it's important that a body like the HCPC should have "teeth" so that vulnerable people (especially children and people with mental disorders) aren't abused, exploited or carelessly treated by their therapists and clinicians.

There are "grey areas" in practitioner-client relationships. Should your client also be your friend? How should you behave if you meet your clients when socialising? How far are you supposed to go to "rescue" a client in a difficult situation?

By setting out Standards and enforcing them, the HCPC provides guidelines for all its other members about where the boundaries are.

On the other hand, if the HCPC goes to far and becomes a "moral police force", it starts to infringe on its members' right to a private life. If it becomes meddlesome and intrusive, it adds to the stress of healthwork. If it suspends or strikes off members for petty reasons, it is robbing the health sector of skilled psychologists whose work could help a lot of people.
  • SPECIFIC: The Standards refer to well-defined achievements that can be understood by anyone with a psychological background
  • MEASURABLE: It's obvious when someone meets the Standard or falls beneath it
  • ATTAINABLE: The Standards aren't impossible to meet; most practitioner psychologists meet them
  • RELEVANT: The Standards have specific expectations for clinical psychologists and other types of psychologists
  • TIME-BOUND: Members have to re-register every 2 years and show that they still meet the Standards

EXEMPLAR ESSAY
How to write a 8-mark answer

Assess the importance of the HCPC guidelines for clinical practitioners. (8 marks)
  • A 8-mark “evaluate” question awards 4 marks for describing the guidelines (AO1) and 4 marks for evaluation (AO2). You need a conclusion to get a mark in the top band (7-8 marks).

Description
The Health & Care Professions Council (HCPC) published its new guidelines in 2015. These set out the 15 Standards expected of practitioner psychologists.
The Standards include respecting legal and ethical boundaries with clients, understanding the importance of confidentiality and safe practice.
Clinical psychologists must register with the HPCP and show that they meet its Standards, including references and health checks. They must re-register every 2 years.
The HCPC can suspend or strike off psychologists who don't meet its Standards. For example, one psychologist was struck off for an inappropriate relationship with a client.

Evaluation
The HCPC Standards are SMART targets because they are Specific, Measurable, Attainable, Relevant and Time-Based.
For example, the idea of boundaries and safe practice is clearly understood by psychologists and this is a Standard most of them attain in their work.
However, critics would say that the Standards are too vague. The psychologist who was struck off was trying to "rescue" her client and didn't think the relationship crossed a boundary.
Some critics say the HCPC acts as a "moral police force" and intrudes into its members private lives.

Conclusion
It's important that there are standards for clinical psychologists and that the HCPC has "teeth" to remove members who don't meet the standards. This ensures patients with mental disorders are not abused or neglected.

  • Notice that for a 8-mark answer you don’t have to include everything about the HCPC. You will notice I haven't mentioned ethical standards or the 30,000+ psychologists who aren't HCPC-registered. But it is a balanced answer - one half description and one half evaluation.

Lou was encouraged to aim high. Photo: OJO/Rex (posed by models)

Last week, after more than twenty years of university teaching, I handed in my notice and resigned from my post as senior lecturer in social work and course lead of a Masters in Advanced Practice.

I don’t have another job to go to and will, undoubtedly, miss the regular income and relative safety of a full-time, permanent post.

However, I won’t miss the twelve hour days, the working every weekend and the on-going battle with university managers to uphold and maintain the academic and professional standards required and expected on a social work degree programme.

In the end, it was this that finally did it for me, with one case of plagiarism in particular that tipped me over the edge.

This year at graduation, one of the final year students will be qualifying as a social worker having been found to have plagiarised on two separate occasions – once in a second year essay, and once in her final year dissertation.

One plagiarism case too many

While the university regulations are very clear about the punishment imposed for such a serious proven offence for the second time around (students should automatically ‘fail the assessment and fail the unit, with no right to re-sit’), this student has managed to successfully appeal on the grounds that such a penalty is unfairly harsh.

Joining her on the platform at the graduation ceremony will be two of her peers who have ‘only’ been subjected to a single academic misconduct panel having been found to have plagiarised just the once.

Standing behind them will be a further three students whose work was returned to me by the investigating officer and not subjected to the panel’s scrutiny, as their essays contained less than 20% of copied and pasted material from unattributed online sources.

If you’re a practitioner, this is the quality and calibre of the current crop of social work graduates coming to join a team or agency near you.

If you’re a service user, these are the sorts of individuals who might be acting as your care manager or key worker in the very near future.

How has it come to pass that on a course where values and ethics are embedded in the curriculum and the importance of openness and honesty are taught from day one, we have six out of forty-two final year students behaving like this?

How is it, on a University programme that has recently been approved by the HCPC and endorsed by TCSW, we are only able to initiate suitability procedures when misconduct relates to practice? (In the cases outlined above, proven plagiarism was judged to be an academic misdemeanour and therefore outside the reach of the professional suitability procedures).

Changing landscape

The problems, in my opinion, relate to the changing landscape and political context in which social work education has been taking place.

When I first began teaching in 1993, the social work programme was ‘full’ when the course had recruited thirty candidates. Seminars had no more than fifteen students in a class to maximise discussion and debate. Personal tutors had one group of between eight and ten tutees to support on placement, so that visits for the practice learning contract and interim reviews were manageable, given the likely travelling distances.

Since then, student numbers have increased dramatically while the numbers of full-time, permanent teaching staff have remained static. For example, in the department I have just left, we enrolled over eighty first-year undergraduates during last September’s induction programme with the same number of full-time, permanent staff (six) that we have had since the new degree began in 2003.

More students, same number of staff

Running in parallel is a thriving post-graduate / Masters pathway as well as a foundation degree in Health and Social Care:  both these new extensions to the portfolio have been designed, developed and delivered with little in the way of additional staff or extra resources.

What we’ve seen is a student to staff ratio that has steadily risen so that a seminar group of thirty students becomes, by necessity, more of a workshop. Personal tutor groups have doubled in size to at least twenty, so that supporting and visiting your personal tutees, when they are out on placement, is twice the work that visiting ten used to be.

If you are allocated two (or more) tutor groups, then it is a moot point just how ‘personal’ this important relationship can actually be (and just how many tutees you can logistically visit in the time that you have available).

Knock-on effect

The knock-on effect of this intense expansion has had a significant impact on weary academics. Lecturing to a large cohort requires a very specific set of skills and abilities, and holding the interest and attention of such a big group of diverse learners is no small task.

While the time taken to plan and prepare a lecture is broadly equivalent regardless of the size of the audience, the same cannot be said for the associated marking of students’ assessed work: it takes a lot longer to read, mark and write feedback on eighty essays than it ever did for thirty.

Increasing the number of people accessing higher education and implementing strategies to widen participation has changed the academic profile of the student body with a steep rise in applications coinciding with the introduction of the social work bursary.

While numbers may have recently settled, we can (and do) frequently accept candidates with much less than the minimum 240 UCAS points  (3 C grades at A-level) making the first year of study at university a challenge for many students who require specialist input and support from study skills and Student Services.

Mass market in education

But curiously, this does not seem to have a subsequent impact on the class of degree a student might hope to get, with eleven people on last year’s social work course receiving a first, thirty nine receiving a 2.1, eleven receiving a 2.2 and only one person getting a third.

In lots of ways it could be argued that what I am describing is just a sign of the times and reflects a wider pattern currently found in many teams, agencies and organisations where staff are being exhorted to ‘do more with less’.

However, the opening up of a mass market in education and the introduction of tuition fees has led to additional and competing organisational demands being placed on HEIs and academics.

Universities are prioritising customer service and student satisfaction rather than upholding professional standards and providing a rigorous but exacting education.

Many students, for their part, see themselves primarily as consumers rather than learners and have a profound sense of entitlement that if they have paid good money then they deserve a good degree.

The combination of these two forces – a demanding and vociferous student body who are quick to complain and litigate, and a squeamish management team who are more concerned about student numbers, generating income and ‘enhancing the student experience’ – make universities an uncomfortable environment for people like me to be working in.

Social work educators, desperately trying to raise the capacity and capability of the workforce with no support or understanding from university managers, are buckling under the pressure of maintaining ethical, practice and academic standards whilst simultaneously absorbing extra work.

Research output dwindling

It is no longer feasible – if indeed, it ever was – for social work academics to ‘do a little bit of everything’. Colleagues who have been research active in the past have seen their output dwindle; colleagues who traditionally have been more focused on teaching and supporting practice learning have seen their workloads doubled.

Partners in practice (on hourly-paid, fixed term contracts) previously contributing to the teaching programme perhaps by facilitating a seminar or two, are being asked to front up ‘open days’, take on additional marking and are given the ‘opportunity’ of delivering core units and heavy admin roles like induction.

Something has to give and, sadly in my case, I have come to the conclusion that I can no longer be part of an organisation that both ignores and forgives plagiarism, actively supports the inflation of degrees and changes their own rules and regulations to enhance the overall pass rate.

Wipe the slate clean

This summer for example, a student who fails a final year unit can effectively wipe the slate clean, re-take all their units – even the ones they have successfully passed – and start again as if for the first time. In other words, if an individual has the funds and/or is prepared to extend their student loan, the university is more than happy for them to buy an additional year of study.

I don’t think for a moment that my ‘naked resignation’ will make much of an impression on the organisation I have left behind and certainly won’t stop the students graduating who I have concerns about qualifying as social workers.

However, there is some small comfort in knowing that I am no longer contributing to the further erosion of professional and academic standards or colluding in a system that does not understand the importance of gate-keeping the profession.

I also realise that, ironically, my decision to leave is compounding the problem further…

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