Deciding what is Core and what is Specific

What skills are needed for Core work?

In the absence of other guidance we have come up with the idea of Alphabet skills helpful in our teams. These are the ABCD’S skills each core clinician ideally has. These Alphabet skills include the competencies of:

You can decide as a team what you feel the key skills should be. In New Zealand, for instance, cultural competence is included under ‘C’.

A traditional Specialist skills pattern might look like this…

Traditional Skills

Traditional Specialist Skill Set

This staff member has Specialist level skills in assessment (say autism assessment using a structured tool such as the ADI and ADOS) and in systemic therapy (probably a senior systemic therapist). They could be used in family therapy teams (obviously!), to do autism assessments and in core work using their systemic skills. However, they could not be used in a broader way in Core work (for example to do some behavioural work or CBT) and so would be a less flexible member of the workforce.








Traditional Skills

Extended Core Skills

Here the same member of staff has received core/threshold level training in behavioural, cognitive and dynamic approaches and in now very capable of working with all children and families in Core work. A highly useful, flexible worker!

However, not everyone needs (nor wants) training in everything! If so, you just need to make sure your CAMHS team has sufficient well-trained, extended skills clinicians to offer all Core work.

What is the difference between threshold and specialist Alphabet skills?

At the time of writing, there are no national definitions in the UK for these therapeutic modalities so for the moment it is up to us all to decide them. The nearest example is the concept of low intensity and high intensity workers in adult Increasing Access to Psychological Therapies (IAPT) CBT. Low intensity (Core CBT in CAPA language) includes the ability to explain model, structure sessions, use homework and review homework. High Intensity (Specialist) CBT uses all those skills but also Socratic questioning/guided discovery, identification of automatic thoughts/assumptions/beliefs and problem specific competencies e.g. in Exposure and Response Prevention for OCD (Dept of Health, 2007b). We encourage you to think about what are threshold and specialist skills competences in your own team.

The Richmond team came up with these on an away day: East Herts consider it in this way:

Can you do specialist level work in Core time?

Yes, you can of course, use your specialist level skills but the methodology may be less pure and intense and the content more eclectic and probably shorter duration. For example, you may do a screening for autism in Core work. Detailed structured assessment using the ADI or DISCO would be part of Specific work.

How much do you need of each specific skill?

This depends on your demand and capacity balance. If you only have one child psychotherapist you may need them to do lots of Specific child psychotherapy and little or no Core work BUT if you have 5, you might use them significantly in Core Partnership work.

Two dimensions

We find that teams often find the concept of Core and Specific work the most challenging to grasp. To recap there are two key concepts:

In other words we separate into these two types of clinical work as it helps us deploy the work thinking about the competencies and skills we need and this structure smooths the clinical work streams . This flow management approach increases our efficiency without raising the workload.