ACAT Training Committee Consultation paper agreed on 1st July 2022
Dawn Bennett & Steve Jefferis
A small working group met to review the paper ‘Remote and Hybrid Training Models draft 1’ presented to ACAT Training Committee 4th March 2022. We also reviewed
• HEE Blended Learning Guidance for preregistration training and undergraduate healthcare registration. It reviews psychological therapy training and includes the advice of professional bodies (this document and a summary by Dawn are available on request)
• DClinPsychol Manchester developments and plan for blended learning for implementation Oct 2022: This is essentially that trainers are requested to design their training as 1/3 digital (for theoretical content eg narrated slides, video, online materials) and 2/3 in person (with a skills emphasis)
• Invited views of ACAT Technology Assisted Supervision Therapy and Training (TASTT) group
A proposal for consultation (version 2) was discussed with ACAT Training Committee and Trustees on 1st July 2022 and approved for implementation as below.
Remote and hybrid training models for CAT Training
ACAT training requirements will retain some flexibility with a proportion of online training components to allow trainees to operate within their service requirements and to maximise the opportunity for ACAT trainers to build on their expertise in online training. ACAT Training Committee will continue to review the impact for trainees and trainers to ensure the quality of training delivery and that trainees are able to achieve the CAT competences.
1. Training days
ACAT training aims to return to in person teaching. This is the preferred model for CAT training as we think we can share and demonstrate how we use CAT theory more effectively and it allows for better group and skills work. Training will move to online delivery only if required for safety reasons. This model would be a translation of the days usually delivered in person to online format, very much as we have operated through the pandemic.
ACAT would be in support of those course centres who intend to develop more digital elements and become hybrid courses. These courses may opt to deliver a proportion of their taught part on-line, giving consideration to those concepts / topics best delivered in person or on-line and where these will fall. For these courses ACAT proposes
• The course cohort would usually meet in person at the start of training.
• No more than 50% of teaching content would be delivered on-line and the recommended proportion would usually be 70:30 in-person to on-line content.
• The on-line content could include narrated slides, prepared materials, video, reading, tasks but the recommendation would be for the majority of online content to be contemporaneous presentation (on-line delivery to the whole cohort).
ACAT would wish to support these developments recognising the expertise that trainers and courses have developed and not restricting growth but will not require all courses to commit to a digital component as to do this well trainers need to have skills and confidence in online training and development can be costly, for example reviewing the curriculum to produce / translate materials (although we can of course draw on what we have delivered during the pandemic). Consequently, some CAT training courses will aim to deliver all training in person.
ACAT would not at present and be unlikely to deliver a fully digital online CAT training course in which the whole series of taught days is delivered online. As outlined above an advisory level is 30% on-line and up to a maximum of 50% online days.
ACAT have thought about livestreaming from in person teaching days and our view is that the group would become split so the experience would be poorer for trainees not being part of the whole cohort. Trainers may struggle to design a day for in person teaching which could also be easily translatable for those joining by technology on any particular day. We therefore propose that although livestreaming is possible, it isn’t encouraged. It would be a necessity and if a trainee has no other option. It is also recognised that a trainee’s needs and circumstances may change over time. The course would facilitate trainees joining remotely but would keep this to absolute minimum numbers, agreed by the course director as a proportion of the overall cohort size. There may be some days when the course can’t offer this fully or for parts due to the nature of the day so this can’t always be guaranteed. The recommended guidance for any individual trainee would be as above, 30% of the training days could be attended by livestreaming, up to a maximum of 50% attended by livestreaming. The trainees must have cameras on for the duration of remote attendance.
There may be an exception for applicants who cannot easily access a CAT training course due to disability or other extenuating circumstances. Applicants could apply to any course centre, although a hybrid course would be recommended. The course would decide if it could offer a training plan in which a proportion of the taught in person days can be delivered by livestreaming in addition to any on-line materials. This would be agreed in consultation with the course director and appropriate to the course design/structure. It would usually mean attending the start of the course and end of the course in person and any residential components in person. The recommendation guidance would be as above, 30% of the training days could be attended by livestreaming, up to a maximum of 50% attended by livestreaming.
NB. NHS HEE informed us that CBT training is returning to in person teaching. This is likely to have an influence on other psychological therapy training models
2. Delivering seminars as part of the academic programme
Through the pandemic we have noted advantages of on-line groups allowing a mix of trainees who would not usually have the opportunity to work together if the groups met as home/local groups, greater flexibility in meeting arrangements and wider access to facilitators and reduced costs and time. With the return to in person training days the trainees will all have met in person which satisfies our general guidance that any online component follows in person meeting.
ACAT therefore proposes that where courses have seminar/peer learning groups separate from the taught days these can be in person or on-line. This is course and trainee choice. For courses where the groups are integrated into the taught days the models in point 1 will apply
3. Clinical practice
Trainees may be limited by their service as to the proportion of CAT therapies they can deliver in person or online that would make up their training cases. Trainees will also need to consider patient preference/need, for example, those who can’t work virtually.
ACAT proposes a minimum of 50% clinical hours in person but will be flexible and consider difficulties trainees may have meeting this. This recommendation should allow accommodation of the patient’s voice.
NB see section 7 below: Training to include knowledge and skills in the delivery of CAT online. ACAT to develop an appendix to the professionals document in the current competences framework
4. Supervision of clinical practice
The preference is for in person supervision because CAT is a relational and tool based therapy, we use supervision to teach the skills of how to do CAT in person, e.g. developing and sharing reformulation diagrams. However, CAT is now also delivered on line allowing for modelling in the supervision group. In agreeing the proportion of in person vs online supervision consideration will be given to the medium of supervision paralleling that of the therapy and on evidence where possible of the effectiveness and experience of online supervision. Online supervision would increase access to CAT training to those who may not be able to access supervision by an accredited supervisor within a reasonable distance.
ACAT proposes in person supervision as the preferred model of training supervision but supervision can be conducted on-line if all members of the group agree. Groups that meet remotely would benefit from meeting in person occasionally and this would be usual. There may be exceptions. There would be reflection on the medium in the clinical appraisal form
5. Training therapy
The central principle is that CAT is a relational therapy and the aim is for in person training therapy. However, CAT is now offered remotely and trainees have the experience of delivering this. Trainees can therefore experience the same form of CAT therapy that they are delivering and remote training therapy is accepted.
6. Written assignments
We will continue to accept the submission of course work for therapies conducted online and review the writing and marking guidelines for these, especially against any developments in the curriculum for best practice in delivering CAT online
7. CAT Competencies Framework
• Are there areas of the framework that require or are best delivered through in person training?
• Monitor the impact of online training on the development of CAT competences
• Extension of the competence framework to include knowledge and skills in the delivery of CAT online, identifying relevant sections e.g use of CAT tools; working with emotion
• Formation of a professional document as an extension of UCL listing to cover these competences. Initially this can be in the form of an appendix to the professionals’ document.
8. Documentation review in light of competence framework and remote working
• Supervisor appraisals
• Essay titles
• Writing and Marking guidance
• New competences appendix
Models of CAT training with a proportion of the training conducted online can enhance access to individuals who may otherwise not be able to train in CAT. It is this that allowed CAT to develop internationally. This needs to balance with evidence for the quality of training and skills acquisition. Monitor enquiries for distance learning and ability of ACAT courses to meet this need.
EDI working group may propose additional areas to broaden access to CAT training
• Course reports, Vice Chair and Admin reports to Training Committee to comment on enquiries for distance learning and livestreaming.
• Standing item on Training Committee agenda to monitor the impact of and need for online training and hybrid models across ACAT trainings.
• Moderators group and reports to highlight the impact of and need for online and hybrid models.
• End of course feedback to also address trainees’ experiences of the model of training.
Dr Dawn Bennett & Dr Steve Jefferis ACAT Training Committee 1st July 2022
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