Psychological therapies and interventions specification

The Outcomes

Outcomes 1 to 7 below describe the common experiences that you should expect when accessing psychological practice delivered by relevant trained psychological professionals. The outcomes state what should happen to support the delivery of this. This specification and the outcomes will be reviewed regularly and updated as needed.

What this means for me and others needing psychological practice:

Outcome 1 – High Quality Care and Support That Is Right for Me

Everyone accessing psychological practice deserves to receive high-quality treatments, and the right support that they need, all delivered by appropriately trained professionals.

1.1 When I get help, where appropriate, and based on clinical judgement, a psychological formulation will be agreed with me, linked to jointly agreed goals and decision-making. This means psychological theory is used to help describe my problems and needs, how they developed, what is keeping them going, and what can help them improve.

1.2 The psychological practice offered to me will guide and help me to make informed choices about how to access the right services at the right time, based on my needs, the evidence base, and expert advice offered.

1.3 I will have confidence that the professionals seeing me are registered with the relevant professional body and get appropriate supervision so that I know they are trained to offer me the safe treatments that I need.

1.4 Where relevant and helpful, nationally appropriate outcomes measures (clinically designed questionnaires) will be used to measure my progress during treatment so I can see how the psychological practice offered is helping me.

1.5 Access to peer support can be helpful to recovery, and where possible and appropriate I will be supported to connect with others with lived experience if I choose to do so.

1.6 There will be clear guidance about involving my family or friends in my treatment if this is something I want, and this will take into account my capacity to consent. If I cannot provide informed consent, the Adults with Incapacity (Scotland) Act 2000 will be considered along with any other relevant legislation or legal frameworks.

Outcome 2 – I Am Fully Involved in Decisions About My Care

To make sure people are fully involved in their care and care planning; with collaboration between professionals playing a crucial role in this.

2.1 The psychological practice offered should be based on clinical assessment and tailored to my needs and individual circumstances to help me improve the quality of my life.

2.2 I can choose which members of my family or care network can come with me when appropriate.

2.3 A process of shared decision-making will take place with me when receiving psychological practice. This will help to set goals, which will be regularly reviewed.

2.4 The length of the appointment will be recommended to me and will be based on my needs and what feels manageable for me. Appointments are usually around an hour, but they may be shorter or longer depending on my individual circumstances and where I am seen.

2.5 Where appropriate and relevant, if I express a wish to get help, I will be offered:

the choice to have an initial contact appointment with an appropriately trained and supervised professional, ideally within a maximum of 12 weeks,to discuss my needs.

advice from the professional seeing me about what might help me. The type of therapy or intervention offered to me may, or may not, start at this first contact.

where appropriate, the choice to be copied into any letters about me using language I can understand, if I consent to this.

self-help, written materials, and any treatment plans, if they are required and advised by the professional seeing me.

The initial contact with a professional or team will feel helpful and meaningful to me. All advice and treatment offered will be based on the expertise and judgement of the professional or service helping me.

2.6 Any additional appointments or offers of treatment will be offered according to my needs and advice of the professional who saw me. I can choose to engage in these appointments or other offers of help as appropriate (this may include meaningful offers from other services such as third sector agencies, if appropriate).

2.7 I will have started treatment no longer than 18 weeks from referral as stated in the Public Health Scotland national waiting times standard. Once treatment has started, appointments will be on a regular basis, and the frequency of these appointments will be matched to my treatment plan.

2.8 If I have difficulties understanding or consenting to therapies or interventions offered to me (e.g., associated with having learning difficulties or dementia), I will have support from a carer or professional who can help me.

Outcome 3 – High-Quality Interventions and Treatments That Are Right for Me

All psychological practice must be right for those receiving care to make sure the best results are achieved for others and me.

3.1 The Psychological Therapies Matrix will be used to inform delivery of the right psychological practice offered to me. The Matrix is the main guide for the delivery of psychological therapies and interventions in Scotland and this will be used to get the best help I need.

3.2 When receiving treatments or interventions, offers of psychological practice should be considered and offered to me as recommended and appropriate. I may be offered short interventions, guided self-help, or more directed support. Psychological practice may be supplemented by additional psychological care approaches recommended by registered professionals from a range of backgrounds (e.g., allied health professionals).

3.3 The psychological practice I receive will be determined and recommended by the professionals I see, the available evidence, the guidance available to services, and will take account of my views and protected characteristics (e.g., intellectual disabilities).

3.4 I can discuss my needs again with a registered health care professional (e.g., GP) if I feel my psychological health deteriorates.

3.5 The appointments offered to me will be shared with me as part of my treatment plan as a guide to help me, so I know what to expect.

Outcome 4 – My Rights Are Acknowledged, Respected and Delivered

When psychological practice is delivered, I will be an equal partner in my care. Values, rights-based, and person-centred approaches will be embedded in all practice.

4.1 Any treatment plans or recommendations about psychological practice offered to me, including a formulation, will be provided in a format I can understand. Where possible, I should develop this jointly with the professionals helping me as this helps me to understand my needs.

4.2 As a person with lived experience, organisations delivering psychological therapies and interventions, will seek my feedback to make sure that psychological practice continues to improve psychological services for all.

Outcome 5 – I Am Fully Involved in Planning and Agreeing My Transitions

Transitions for those accessing direct psychological practice across a variety of delivery partners can often be challenging. Therefore, a smooth transfer of care should be effectively planned, communicated, and implemented in line with the Scottish Government's Transition Care Planning Guidance.

5.1 There will be recognition of the importance of a good therapeutic relationship between me and the psychologically trained professional helping me; once in treatment it will be the same professional that sees me wherever possible.

5.2 Any risks of harm to me or others will be clearly identified and documented in a care plan.

5.3 If needed and appropriate, the flexibility in the timing of any handover of treatment will be considered.

Outcome 6 – We Fully Involve People, Their Families and Carers

Services, teams, and professionals delivering the Psychological Therapies and Interventions Specification will continue to work in partnership with people, their families, and carers to shape aspects of delivery, service design, and review.

6.1 It is recognised that my support network – carers, family, or friends – may help me with my needs and the delivery of my treatments, should I consent to them being involved. I will be informed that when I am seeking psychological practice, I can have someone with me, if I choose to do so and when appropriate.

6.2 When appropriate and available, peer support may be offered to me, or my family as needed.

Outcome 7 – I Have Confidence in the Staff Who Support Me

The variety in the workforce practice types, professional mix, activity of staff, and outcomes are important when delivering high-quality practice. Guidance will be provided for professionals on how to support service delivery and staff wellbeing to make sure workloads are shared, fair and clear where specialist and enhanced practice types of care are offered.

7.1 The roles and qualifications of all professionals delivering direct psychological practice will be clearly described in an accessible format and will be available for me (e.g., leaflets, webpages).

7.2 I can be confident that the professional helping me is appropriately trained and supervised so that they are delivering high-quality practice.

7.3 My views and the views of those who support for me, will be sought, and analysed through regular service audit and research to help improve the psychological practice offered.

7.4 If I need or get help from more than one professional (e.g., a psychologist, a nurse, and a doctor) they should discuss my needs and treatment plan together to make sure I get the best help possible. I will be informed that they are discussing my needs.

What this means for services, teams, and professionals delivering psychological practice:

Outcome 1 – High Quality Care and Support

Everyone accessing psychological practice deserves to receive high-quality treatments, and the right support that they need, all delivered by appropriately trained professionals.

1.7 The individual will be seen within the recommended psychological therapies waiting times standard of 18 weeks referral to treatment.

1.8 Services and teams will have clear referral criteria, including dealing with urgent needs, and individuals seeking help will get information about when they are going to be seen.

1.9 Taking account of where people live (e. g., remote and rural areas), services, professionals, and teams who deliver psychological practice will aim to reduce unnecessary delays and limit unequal waits across Scotland as far as possible.

1.10 Leadership should provide clear governance and enable professionals to deliver high-quality practice, so people know that services and teams are providing safe, efficient, and effective service delivery.

1.11 Information technology and data systems that support psychological practice should align with ongoing developments in systems across Health and Social Care to provide improved functionality and connectivity. These should provide meaningful information about quality as well as quantity of care provided. (See Public Health Scotland (PHS) Guidance for more details and the Health and social care data strategy)

1.12 All clinical recording systems used by the workforce should be fit for purpose and minimise impact on professional's time. They should be used in a way that supports confidentially, increases consistency of data reporting across Scotland, and does not hinder the quality of practice provided.

1.13 Professionals will work together to reduce barriers to accessing psychological practice and reduce waiting times so there is timely and appropriate access to the relevant psychologically trained professionals that can help.

1.14 Services will routinely use outcome measures and analyse these to help them know that they are offering quality treatments and interventions. This will help services to make improvements.

1.15 Services and teams should consider peer support workers as roles that can aid recovery for others, and those with lived experience should be considered as valuable members of the community who can help shape services and systems.

Outcome 2 – People are Fully Involved in Decisions

To make sure people are fully involved in their care and care planning; and collaboration between professionals is crucial.

2.9 When the individual needs psychological practice from an appropriately trained psychological professional, they will be offered the choice to:

actively engage in the offers of treatment recommended to them which is based on evidence and best practice.

where possible, and based on clinical recommendations, be supported to get access to the local options for therapy or interventions that are available and accessible to them (e.g., digital, group work, or in person). This should take account of the person's ability to access the type of help recommended.

2.10 If for any reason the individual has not started treatment within the national waiting times standard of 18 weeks, the service or team will be in touch with the individual within a maximum of 12 weeks. This is to let them know how long their wait is and a chance for the individual to:

update about any change in their circumstances.

confirm if they still wish or need to be seen.

discuss other avenues of support if this may be available to them.

get any information that could help them while they wait.

2.11 If the individual has complex, or urgent care needs, or is seen in a ward or forensic setting (e.g., those detained under the Mental Health Act, individuals presenting to 'out of hours' care, people in prison, those with acute physical health needs), there may be a different pathway for them to access psychological practice.

Outcome 3 – High Quality Interventions and Treatments

All psychological practice must be right to make sure the best results are achieved.

3.6 Psychological practice should be delivered within an integrated care system, to limit the number of times people have to keep telling their story. There will be good professional relationships and joint working between professionals to ensure that transitions are as seamless as possible.

3.7 The Psychological Therapies Matrix should guide all clinical delivery. Professionals may exercise clinical judgement about using psychological interventions and treatments that are not listed in the Matrix if they have sought advice from a senior practitioner psychologist and considered any associated risks and governance.

3.8 Professionals should use their training, clinical judgement, job planning, national guidance, and supervision to decide how many sessions might best help the individual seeking support.

3.9 If the individual does not attend an appointment, their case should not be closed due to non-attendance without establishing contact with them, or the person that referred them. This is to make sure they are not at risk and have the help they need.

3.10 The PHS trajectory modelling tool (CAMHS and PT trajectory tool - Public Health Scotland) should be used as a guide so that managers and leaders can advise staff at different grades on recommended activity levels. Line management should also be used to support workload management for appropriately trained psychological professionals so that staff wellbeing is also considered.

Outcome 4 – Rights Are Acknowledged, Respected and Delivered

When psychological practice is delivered, people seeking help will be an equal partner in their care. Values, rights-based, and person-centred approaches will be embedded in all practice.

4.3 Services and teams will aim to reduce the risk of harms by helping individuals seeking support to engage in appropriate treatments or interventions that help to improve the individual's psychological and physical health.

4.4 Services and teams offering psychological practice should regularly monitor and evaluate the services they provide. This process should be easy to understand and should help improve services and practice offered.

4.5 There will be ongoing, quality improvement at the heart of offers of psychological practice. Listening to the voices of those accessing services, carers, and those delivering psychological practice, will be clear and meaningful to make sure that services continue to improve care for all.

Outcome 5 – People are fully involved in planning and agreeing transitions

Transitions for those accessing direct psychological practice across a variety of delivery partners can often be challenging. Therefore, a smooth transfer of care should be effectively planned, communicated, and implemented in line with the Scottish Government's Transition Care Planning Guidance. (Transitions from Children's Services to Adult's Services are specified in the National Transition Principles and the CAMHS and ND National Specifications).

5.4 There will be clear and regular communication between professionals if there is any transition of psychological practice. Where possible, the professional who knows the individual best will support their transition.

5.5 Services and teams that provide psychological treatments and interventions will use referral systems that are clear, accessible, and efficient. Where appropriate, self-referral options can be offered, for those needing less complex types of interventions (e.g., accessing a self-help digital intervention).

Outcome 6 – We Fully Involve People, Their Families and Carers

Services, teams, and professionals delivering the Psychological Therapies and Interventions Specification will continue to work in partnership with people, their families, and carers to shape aspects of delivery, service design, and review.

6.3 If wanted, carers should be signposted to support and resources that are available, as they often need help too.

6.4 True meaningful and valued feedback and involvement from those with lived experience, and their families, should be a core part of all psychological service delivery. This should be integrated into service delivery as part of regular service planning.

Outcome 7 – Confidence in The Staff delivering services

The variety in the workforce practice types, professional mix, activity of staff, and outcomes are important when delivering high-quality practice. Guidance will be provided for professionals on how to support service delivery and staff wellbeing to make sure workloads are shared, fair and clear where specialist and enhanced practice types of care are offered.

What this means for services, teams or professionals delivering psychological practice:

7.5 Leadership should be clear and enable staff to deliver high-quality practice, so people know that services and teams are providing safe, efficient, and effective service delivery (see Psychological Therapies Matrix).

7.6 Consideration should be given to ensure protected time for joint working between professionals (e.g., a nurse in a dementia team having time to speak to the psychologist about a treatment plan). This is to make sure they work well together and provide the help needed.

7.7 All NHS Boards across Scotland will have clear leadership and oversight from a Director of Psychology. Where appropriate, the Director of Psychology will also provide advice and guidance about whole system planning by working with senior leaders in Health and Social Care to provide direction for psychological care and practice to make sure that people get the equitable high-quality help that they need.

7.8 There will be sufficient investment in psychological services and teams so that there is an adequately staffed psychological workforce to meet local demand. Directors of Psychology can help plan and provide guidance on how the psychologically trained professionals might be best placed to ensure services are responsive. They can also advise on psychological care as appropriate and needed.

7.9 Staffing activity should be based on the PHS trajectory modelling tool, and take into account specific clinical services, population need, and local circumstance so people receive the level of support needed (CAMHS and PT trajectory tool - Public Health Scotland). This tool can also be used as appropriate for wider delivery of psychological practice.

7.10 In all area-wide Boards there will be a Psychological Therapies and Interventions Governance Group (See Annex F for an example) that will be led by the Professional Lead for Psychology/Director of Psychology, or their delegated senior clinician. All professionals delivering psychological practice will be represented so that treatments offered are safe and based on evidence.

7.11 Investment in the workforce needs regular consideration so that staff are trained to deliver interventions and therapies that improve access and quality. All professionals providing psychological practice will be supported to access relevant learning materials and will keep their training updated as part of routine continuous personal development.

7.12 Regular consideration will be given to resources required for the delivery of effective psychological practice inclusive of staff requirements, rooms, digital infrastructure, and administrative support available for professionals.

Details on how service delivery can be improved can be seen in Annex G.