Core and Specific Work

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Core and Specific Work

• Ann York and Steve Kingsbury

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Core vs specialist work in job plan

• Core work
• Tends to be of standard duration- on average 7
  sessions
• Uses threshold level extended skills (ABCDS)
• Specialist work
• specialist level skill used to complement the
  core work e.g specific assessment or intervention
• May be shorter (e.g. Specialist assessments) or
  longer duration (e.g. high intensity
  interventions)
• But how much do you need?

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Specialist work protected in job plan

• You decide as a team what you need to protect.
• Examples could be...
• Shorter duration
• ASD assessment
• WISC
• Longer duration
• psychodynamic psychotherapy
• EMDR
• Specialist level/high intensity CBT

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Why have seperate core and specialist work?

• Many can be helped by threshold level work
• Extended core skills reduces bottlenecks to
  specialised work
• Extended core skills increases clinical
  flexibility (fewer queues into specilised
  streams)
• Allows us to identify AND PROTECT specific team
  / individual capacity for specific specialist
  work
• Segments and so helps flow

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Why not all core or all specialist work?

• All core
• Some families need more intensive/specilised
  skills
• Some need longer term interventions
• Specialist time may eaten into by core work

• All specialist
• Many familes are helped by core threshold level
  work
• queues to each specialist leads to bottlenecks
• Lots of handoffs
• Waits to each step/specialist varies
• Poor client experience

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How do we job plan core and specialist work?

• Need to identify
• Core work- using extended skills
• Specialist work- using specialist level skills
• Using
• Competencies ideas
• Threshold and specialist level Alphabet skills
• And information on
• Flow rates
• shorter term vs longer term durations

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CBT core vs specialist

• Core CBT
• Core/basic work- explain model, structure
  sessions, using homework, reviewing homework
• Specialist CBT
• All the above PLUS
• Socratic questioning/guided discovery
• Automatic thoughts/assumptions/beliefs
• Problem specific competencies eg in ERP for OCD
• Could you manage a bottleneck to CBT by extending
  clincal skills to increase capacity at
  threshold/core level?
• Ref The competencies required to deliver
  effective cognitive and behavioural therapy for
  people with depression and with anxiety
  disorders. Dept of Heatlh 2007.

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So what does a core clinician look like?

• Range of extended clinical skills
• Able to work flexibly between these skills
• What are the skills?

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Alphabet skills our ideas

• ABCDS Skills Clinicians alphabet skills
• Clinicians who have extended their skills to
  include the competencies of
• Assessment
• Behavioural
• Cognitive
• Dynamic.
• Systemic

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Specialist skills pattern
Skill level
Specialist
Core
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Extended skills
Skill level
Specialist
Threshold
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Team skill issues

• Question
• How does the distribution of these skills affect
  the team?

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A Possible Pattern Effects?
Specialist
Core
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A Possible Pattern Effects?
Specialist
Core
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A Possible Pattern Effects?
Specialist
Core
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Issues

• Specialist skills in core time
• Long term core work
• Anorexia
• Case example

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Segmentation

• Fast, medium and slow lanes