During surveys of both psychiatric hospitals and behavioral health organizations, issues continue to arise around how the organization is assessing the competence of its clinical staff. We have seen several survey findings for organizations not clearly defining competencies and not having a process for ongoing evaluation of clinical competencies. So, in this article, we are answering some questions we’ve received about competence and providing examples of methods for competence assessment.

What does the term “competence” mean?

Competence has two components. The first component is knowledge and the second component is skill. The difference between the two is that knowledge is the preparation for performance and skill is the demonstration of performance. Knowledge is assumed to exist based on credentials such as academic degrees, licensure/certification, etc. However, skill can only be confirmed by direct observation of an individual’s performance or review of the outcomes of that performance. The key point here is that knowledge does not necessarily result in skill whereas skill is evidence of knowledge. To make sure you are prepared, you need experts in Joint Commission survey preparation.

What kinds of skills are considered competencies?

Competence involves three types of skills: cognitive skills, psychomotor skills, and interpersonal skills:

Cognitive skills (critical thinking skills) include the following:

• Ability to analyze and see the importance of observations and events
• Ability to analyze a situation and anticipate future events
• Ability to be proactive rather than reactive

An example in a BH setting would be the counselor’s ability to interpret that the client’s withdrawal from program activities signals decompensation.

Psychomotor skills include the ability to perform physical tasks learned from didactic training. Examples would be CPR, AIMS testing, restraint, and physical holds.

Interpersonal skills include the ability to work with others. Examples would be interviewing clients and families, conducting group therapy, working with the treatment team, and engaging families in treatment.

Where should competencies be defined?

Clinical competencies must be delineated and put in writing. They can either be incorporated into the job description or they can be listed in a competency checklist that is separate from the job description. Many organizations find that the most efficient approach is to include the competencies in the job description. Other organizations have generic job descriptions that cannot be modified and so they develop separate competency checklists.

What are some examples of competencies for different types of BH practitioners?

Sample competencies for a primary therapist at a residential treatment facility:

• Establish and maintain a therapeutic relationship with the client’s support system (biological family/foster family/significant others)
• Maintain professional relationships with referral agencies
• Advocate for resident’s needs to maximize resident’s daily functioning

Sample competencies for an outpatient therapist:

• Uses active listening skills that are sensitive to individual and cultural communication differences
• Considers special needs (substance abuse, medical, housing) and incorporates them into the treatment planning process
• Discusses treatment plans with clients in a clear and understandable manner

Once the competencies have been defined, the next step is to develop performance standards for these competencies. These performance standards will articulate the specific skills that the individual should be able to demonstrate in order to show their competence. Examples of performance standards for the competency “uses active listening skills” could include the following:

• Seeks clarification of information from clients, families, co-workers
• Paraphrases his/her understanding of the issue
• Demonstrates sensitivity to cultural or disability differences

Examples of performance standards for the competency “considers special needs (substance abuse, medical, housing)” could include the following:

• Can describe how they address special needs in the assessment and treatment planning process
• Assessments and treatment plans reflect consideration of special needs

Once the competencies have been defined, how should the competencies be assessed?

Once the competencies have been defined, the organization needs to determine the methods it will use to assess competence. This includes defining how the skill will be evaluated; by whom; and at what intervals. Some of the common methods used to assess competence include the following:

• Clinical supervision
• Record review
• Peer review
• Observations
• Case presentations
• Self assessment

These competence assessment activities should be documented and the results then fed into the annual performance evaluation or competency checklist review. Keep in mind that the breakdown on surveys often occurs when the surveyor is reviewing one of those annual competency checklists but there is nothing to “back up” the check marks in the boxes.

In response to a TJC survey finding in this area, one of our psychiatric hospital clients developed a competency assessment tool for their therapists. They kindly agreed to share this Therapist Competency Verification tool with our readers.  It can be modified or adapted to suit your setting and services.