Early psychosis workforce: development of core competencies for mental health professionals working in the early psychosis field

Abstract

Background: Evidence for early intervention in psychosis has steadily grown over the last 20 years leading to increasing investment in early psychosis service development and a rapidly expanding workforce. Although training of staff has been identified as critical to early psychosis model fidelity and the effective delivery of early psychosis services, to date there has been limited peer-reviewed research in this area. The development and use of competency standards has been identified as useful in supporting health professionals’ education and training, and in health workforce development. Currently the most common approach to competency standards development in healthcare is expert consensus. The overall aim of this thesis was to identify the core competencies required of mental health professionals working in the early psychosis field, which could function as an evidence-based tool to support the early psychosis workforce, strengthen early psychosis model fidelity and in turn assist early psychosis service implementation. The Delphi method was used to establish expert consensus on the core competencies

Method: A two-stage Delphi method was used to establish expert consensus on the core competencies. In the first stage, a systematic literature search was conducted to generate competency items. A Delphi Reference Group consisting of 5 clinicians and researchers further reviewed these competency statements for overlap and redundancy. In the second stage, an expert panel consisting of expert early psychosis clinicians from around the world was formed. Panel members then rated each of the competency items on how essential they are to the clinical practice of all early psychosis clinicians. A comparison group of experts in adult severe mental illness was also formed. Data from the comparison group was not included in the primary study. Post-hoc comparisons were made to determine whether there were any differences or similarities in response patterns between the two different panels.

Results: In total, 1023 pieces of literature, including textbooks, journal articles and grey literature were reviewed, from which 4667 competency statements were extracted for potential inclusion in the study. After review by the Delphi Reference Group, a final 542 competency statements were identified for inclusion in the questionnaire. 63 early psychosis experts participated in three questionnaire rating rounds. The overall retention rate was 93.6% across all three rating rounds. Of the 542 competency items, 242 competency statements were rated as ‘Essential’ or ‘Important’ by 90% or more of the expert panel and are thus identified as the required core competencies of an early psychosis clinician. Twenty-nine of these competency statements were endorsed by 62 or more of the 63 early psychosis experts. Due to the very high level of consensus achieved, these highest-rated competency statements may be considered the foundational competencies for early psychosis practice. A comparison group of 15 experts in adult severe mental illness participated in one rating round. There were few notable differences between the two expert groups. However the differences identified indicate that there may be important philosophical differences between mainstream mental health services and an early intervention approach to early psychosis care.

Conclusion: The study generated a set of core competencies required of clinicians working in the early psychosis field. The core competencies provide a common language for early psychosis clinicians across professional disciplines and regardless of country of practice. The findings thus provide a useful resource to support early psychosis workforce development and early psychosis service reform.