Building capacity in behavioural science and public health using the Stage 2 Health Psychology training route: Ideas for the development of a funded model
Angel Chater1 & Jo Hart2
1University of Bedfordshire; Chair of the Behavioural Science and Public Health Network; firstname.lastname@example.org
2University of Manchester; Chair of the Division of Health Psychology; email@example.com
Building capacity in Health Psychology and Behavioural Science has been recommended as a key objective in the recent Public Health England (PHE)-led national strategy entitled: Improving People’s Health: Applying Behavioural and Social Sciences to Improve Population Health and Wellbeing in England (PHE, 2018). The integration of Health Psychology training to the public health and NHS workforces may be one way to facilitate building capacity in Behavioural Science (Chater, 2017).
Health Psychology in the United Kingdom (UK) has been established since 1986, with Divisional status awarded by the British Psychological Society (BPS) in 1997 (Johnston, Weinman & Chater, 2011). To become a Health Psychologist in the UK, trainees must complete an undergraduate psychology degree (3 years full-time equating to 360 UK credits) which offers Graduate Basis for Chartership (GBC) with the BPS, followed by a 1-year full-time (or part-time equivalent) BPS accredited MSc in Health Psychology (180 UK credits at M level) leading to the Stage 1 Qualification in Health Psychology. Stage 2 Training then continues for a period of 2 years full time (equating to 37.5/40 hours per week for 46 weeks per year or part-time equivalent) doctoral level supervised practice in Health Psychology (McSharry, Chater, Lucanin, Hofer, Paschali & Warner, 2017). Through this time, trainees must reach competencies in the key areas of generic professional practice, research, teaching/training, consultancy and psychological interventions/behaviour change.
Completing Stage 2 allows trainees to apply for full membership of the Division of Health Psychology (DHP) and Chartered Status with the BPS. This training also meets the Standards of Proficiency (SoPs) needed to register with the Health and Care Professions Council (HCPC), a legal requirement to be able to practice and legally use the term ‘Health Psychologist’ in the UK.
There are two routes to achieve Stage 2; the University route (usually via a Doctorate in Health Psychology (DHealthPsych or PhD), and the Independent route (whereby the student would be independently supervised by a suitably qualified Health Psychologist to gain the competencies through a BPS-approved Training Plan). Stage 2 supervisors should be included on the Register of Applied Practice Psychology Supervisors (RAPPS) and trainees can study alongside a PhD. Assessment for Stage 2 is via a portfolio of work and an oral viva. Those undergoing the PhD or Doctorate university route will also receive the Dr status; those through the independent route will not, unless they combine with an independent PhD registration (for more detail see McSharry et al., 2017). The Stage 2 training route in the UK is regulated by the British Psychological Society’s Division of Health Psychology Training Committee.
Developing funded Stage 2 Health Psychology training
Scotland has been facilitating funded Stage 2 Health Psychology training for nearly a decade, with trainees working in various positions within the NHS and public health, and we can learn a great deal from the Scottish model presented by Swanson (2017). Since 2007/2008 NHS Education for Scotland (NES: in collaboration with NHS Health Boards) have funded the 2-year supervised practice of over 35 Stage 2 Health Psychology trainees through the independent route of supervised practice. This model sees Health Boards across Scotland bid for a trainee to support Local Delivery Plans, reflecting Government targets for the enhancement of health and wellbeing. Initially, trainees are recruited to a role at Band 6, supervised by a registered and chartered Health Psychologist. Areas of work include weight management, eating behaviour, physical activity, substance use, sexual health, frailty and dementia, long-term conditions and mental health. Health Psychology trainees have helped to design, deliver and evaluate interventions and produced high quality outputs such as local audits, reports, conference presentations and peer-reviewed articles (Swanson, 2017).
Creating a similar approach in England and throughout the UK could help build the health psychology workforce, widening access to jobs while also sharing the expertise that comes from a health psychology qualification, creating a beneficial knowledge exchange. This is especially important given the current interest in behavioural science (PHE, 2018). Those working within Public Health England, local authorities and those with commissioning power such as CCGs, alongside industry partners, have shown interest in creating a similar national approach in England, which could then be extended to the rest of the UK (and potentially beyond via the European Health Psychology Society). There is mutual benefit to linking those with commissioning ability who wish to develop, deliver or evaluate services, with those able to co-ordinate and supervise Stage 2 training and the trainees themselves, yet there is no current mechanism to do so.
Those who have the funds to commission services, could benefit from a Stage 2 Health Psychology trainee situated in their organisation, to develop, deliver and evaluate services, benefiting both from a highly educated individual, already at least trained to masters level, while also being supported by their co-ordinating supervisor, who would be a Chartered and Registered Health Psychologist. The trainee will benefit from having a funded post to further develop the core skills required to be a Health Psychologist in the areas of consultancy, psychological intervention, behaviour change, research, teaching and training, while the commissioning body will benefit from the knowledge transfer that this partnership provides, and the outcomes that it produces. There has been success with funding this type of relationship to integrate health psychology with public health and the NHS in some areas of England such as Staffordshire, Bristol, Coventry, Hertfordshire and within Public Health England, but not a national nor standardised approach.
Since its inception, the Health Psychology in Public Health Network, which later became the Behavioural Science and Public Health Network has benefited from the relationships created by Health Psychologists and Health Psychology trainees working closely with or within public health. Working closely with the Division of Health Psychology, the vision to create funded Stage 2 places within England has been discussed at various levels and we would now like to widen this to plan how we can realise this dream. This would not just be in the realm of public health, but also has the potential to span out to the NHS, health education and industry.
Moving this agenda forward
The BSPHN and DHP will be facilitating a series of meetings to discuss how this vision can be realised. These meetings will aim to address the following questions:
- How can we create a Stage 2 funded pathway in England?
- What would it look like on a week-to-week basis?
- Where are trainees best placed?
- What would their ‘role’ be? Potentially a new role i.e. ‘Behavioural Science Champion’?
o that could be comparable to a Health Living Champion (based in pharmacies, Royal Society for Public Health level 2 trained) or a Psychological Wellbeing Practitioner (PWP: based in IAPT services, British Psychological Society accredited).
- How could this be linked to:
o the apprenticeship levy?
o F2 public health rotations?
o Improving Access to Psychological Therapies (IAPT) for long-term conditions?
- What are the cost implications? (Fees, stipend, supervisor costs, time allocation)
- How does this fit with current training routes, and do we need to negotiate new models?
- Who are the key stakeholders?
There are a number of practicalities that need to be addressed to turn the vision of funded Stage 2 Health Psychology places and routes to build capacity in Behavioural Science, (a desired outcome from the Public Health England strategy document; PHE, 2018) into a reality in England and beyond. However, the Scottish approach has provided a successful framework from which we can draw on. The first of the scheduled meetings to discuss this further is set to occur in April 2019 with a small invited set of individuals who are currently involved in Stage 2 Health Psychology training at a senior/strategic level. This will be followed by a meeting with those in a similar position in public health, the NHS, IAPT, health education and areas where trainees could be based. To ensure we are able to support this process in the most informed way possible, we encourage anyone who is interested in being part of this debate, who would be willing to act on a wider advisory level, to get in touch with us and share any thoughts you have on moving this agenda forward.
Chater, A. (2017). Building capacity in the workforce: How can we best use education and training to benefit public health? Health Psychology and Public Health. 1, (2), 2-3
Johnston, M., Weinman, J. & Chater, A. (2011). A quarter century of health psychology. The Psychologist, 24, (12), 890-902.
Public Health England. (2018). Improving People’s Health: Applying Behavioural and Social Sciences to Improve Population Health and Wellbeing in England. London: PHE http://www.bsphn.org.uk/352/Foreword
McSharry, J., Chater, A., Lucanin, J. D., Hofer, S., Paschali, A. & Warner, L. M. (2017). Health Psychology education and training in countries represented by the EHPS. The European Health Psychologist. 19, (6), 375-380.
Swanson, V. (2017). Adding value to health in Scotland: Big contributions from a small training programme for health psychologists. Health Psychology in Public Health. 1, (2), 3-4.