Support workforce toolkit

The competencies from the RCSLT support worker framework are available below as Word documents for you to download and use.

Core competencies

These are based on generic NHS England, previously known as Health Education England (HEE), HEE’s Allied Health Professions’ Support Worker Competency, Education, and Career Development Framework and adapted for use in speech and language therapy as foundation for role.

• Download the blank core competencies document (Word)

Clinical competencies

Clinical competencies from the RCSLT support worker framework relate specifically to knowledge and skills in speech and language therapy and are relevant across specialist areas. Please note, the term clinical has been used but this tool includes competencies relating to work in educational and universal services.

The clinical competencies can be adapted for specific jobs. Support worker roles are evolving, and it is recognised there are considerable differences in the skillsets required. The message is for services to ensure there is evaluation of a support worker competencies and planned development in role.

• Download the blank clinical competencies (Word)

Competencies completion/sign-off sheet

A tool for services to use which recognise achievement and record the completion of a competency profile.

• Download the completion/sign-off sheet (Word)

Competencies recognition confirmation (manager)

A tool for a manager to recognise and record that an experienced support worker has achieved equivalency in competencies to the core or clinical competencies i.e. there is no requirement for a support worker to work through these competencies as the standard is already reached.

• Download the recognition confirmation (Word)

Individual profile development plan

A tool for recording competencies which are a support worker’s current goals. The actual competency profiles could also be used for this purpose. Many services have their own paperwork for recording goals.

This type of document can also be used for planning with those support workers who are working above the level of the core and clinical competencies.

• Download the individual profile development plan (Word)

 Tracking competencies (example and template)

This is an example of best practice from Hertfordshire NHS Trust Children’s Service relating to a Band 3 post. This service uses an individual competencies profile which links with Knowledge and Skills Framework, NHS Agenda for Change.

• Download the tracking example and template (PDF)

The following information will support you to record your continuing professional development (CPD).

Using the RCSLT CPD diary

• Support workers who are RCSLT members can choose to use the RCSLT CPD diary as a tool to record their CPD activities.
• The goal function in the diary can be used to create individual goals and add activities, by clicking in the diary on CPD Goal.
• For goals recorded in the online CPD diary there is no need for a supervisor to approve goals.
• A support worker from the framework project group describes using the RCSLT diary for recording CPD (PDF).

Alternative approaches

Alternative approaches for logging learning and development, e.g. taking a portfolio-based approach, include using a:

• NHS portfolio approach
• Skills passport – this concept is taken from HEE’s AHP Support Worker Competency, Education and Career Development Framework. If developed at systems or network level, passports can be applied across organisations and boundaries, supporting transferability and reducing transaction costs.
  • Read about skills passports in the AHPSW framework (PDF)
  • See an example of a Skills Passport for London midwives (PDF)
  • Support worker skills passport

Support workers will receive in house and mandatory training as part of the role. These will differ between trusts and across the UK. These may include:

• Training on specific clinical areas and speech, communication, eating, drinking and swallowing difficulties
• Safeguarding
• First aid
• Leadership
• Equality, diversity and inclusion

Please note: the training options below were shared by support workers. They are provided for informational purposes only. No endorsement is expressed or implied.

Support workers may also complete other external training. These may include:

• CAUK
• Dysphagia
• Elklan
• The National Nursery Examination Board (NNEB)
• Colourful Semantics
• Portage
• Talking Mats
• Care Certificate
• Makaton
• Augmentative and Alternative Communication training
• NFSE CACHE education and training
• NIPA and NAPA
• Signalong
• Picture Exchange Communication System (PECS)
• Intensive Interaction Reflective Practitioner training
• Communication partner training
• Stroke Training and Awareness Resources (STARs)
• Curiosity Programme
• Attention Autism
• Gestalt training
• Shape coding
• Sensory Lexiconary

The RCSLT has extensive, accessible and evidenced delegation guidance to support members delegate within their practice.

This guidance is for students, the support workforce, newly qualified practitioners (NQPs), experienced practitioners and managers.

The delegation pages include guidance, case studies, scenarios and references which aim to reflect the diversity of work situations and employment status of the speech and language therapy workforce employed across the four nations of the UK.

Delegation learning 

To support delegation skills, see: 

• RCSLT guidance on developing delegation skills 
• A senior SLT’s reflections on managing a team of support workers (PDF) 
• All Wales guidelines for delegation (PDF)

Supervision

The RCSLT supervision guidance (2017) provides the broad framework of supervision for support workers, e.g. the frequency and benefits of supervision.

These resources focus on professional/clinical supervision in relation to support workers:

• Clinical supervision for support workers: additional pointers (PDF)
• Supervision log template (Word)
• Supervision record sheet template (PDF)
• Best practice in a children’s service (PDF) –an approach to providing clinical supervision for support workers
• Reflections on supervision from a support worker (PDF)
• Reflection on clinical supervision (PDF) – from an SLT manager working in a children’s service

Although examples of a supervision log and record sheet are provided, many NHS and independent services will have their own specific paperwork in relation to supervision.

The RCSLT has detailed and evidenced guidance on managing risk to help members consider, record and mitigate risk at the national, service and practitioner level. These guidance pages contain useful advice and information for support workers, those who manage them, and their services.

Risks and mitigators at national, service and practitioner level

Risks

The risks associated with the current structure of support worker roles can be broken down into 3 levels.

National level

• Lack of professional guidance generally around scope of practice and training and development.
• Availability of training is inconsistent.
• Risk of speech and language therapy being out of step with other professions who have compiled guidance about the role of the support worker.
• Lack of initial training programmes which are accredited and transferable to other NHS roles.
• Wide variation across services in both initial training and continuing development.
• SLTs may receive little training or guidance on how to delegate and provide supervision (management and professional) for support workers.
• Lack of research, including practitioner level action research around the role and involvement of support workers.

Service level

• Possibility of the support worker undertaking clinical roles with no evidence of training.
• Lack of documentation around the scope of practice e.g., in a care pathway or policy.
• Lack of planned training and development with robust recording e.g., portfolio of evidence.
• Possibility of support workers being underused due to risk aversion instead of extending the role through a programme of learning and development.
• Reported lack of robust clinical/professional supervision. Case based support tends to be in place, which can be directive for less experienced support workers and ‘arm’s length’ for an established support worker. However, there is less access to wider professional/clinical supervision. Professional supervision (RCSLT guidelines) for all support workers needs to cover wider case working issues e.g. the dilemmas and difficulties of daily practice and workload management.

Practitioner level

• Roles can change at short notice. This may not be in relation to something like an updated care pathway. In these instances, the support worker felt that their previous job role and contribution was not valued.
• Not all services conduct a thorough risk assessment around the role and scope of practice of this unregistered role.
• Clinical risk in services where there is no clear training/development /CPD/supervision in place.
• Lack of routes to career progression. For many support workers this role is their career. Many choose to stay in this role and acquire a high level of knowledge and skills over several years.
• Where training and access to CPD is not in place then support workers feel undervalued.

Identified mitigators

National level

• Use national more general AHP Frameworks to assure basic competencies are achieved.
• Use the RCSLT toolkit to recognise a level of achievement for established support workers (accreditation of prior learning).
• Adapt profession specific clinical competency frameworks for local use.

The RCSLT has:

• Ensured there are national networks, resources, and support for the support worker.
• Worked to ensure wider availability and access to short courses and formal courses, championing work-based learning and the logging of learning.
• Facilitated giving support workers a voice within the professional body and providing a toolkit for support workers and their managers/supervisors.

Service level

• Each team or service should ensure that the RCSLT risk assessment matrix is completed for the support worker, evaluating the consequence, impact, and probability of potential risks linked to their role and having mitigators in place. This will ensure safe practice.
• Use the RCSLT support worker framework to identify key competencies and guide professional development.
• Use the AHP framework for a ‘grow your own’ approach to training and development. This allows for diversity in approach to training and development with learning being tracked in a robust way.

We also suggest the following:

• Clearly identify and document scope of practice by grade.
• Include the role of support workers within clinical care pathways.
• Ensure initial training is planned, tracked and competency based.
• Access ongoing professional training and development e.g., ensuring work-based learning is clearly identified with reflective learning opportunities.
• Assign a therapist mentor, clinical supervisor to support newly appointed support worker in their basic and clinical competency development.
• Plan support worker development through attendance at CENs, short courses and access to coaching and mentoring.
• Facilitate a culture of work-based learning with reflective support workers logging their learning.
• Ensure that all therapists work consistently with support workers, knowing and respecting their scope of practice.
• Provide professional/clinical supervision which goes beyond directive case specific direction and includes the restorative, supportive functions of supervision.
• Devise individual clinical competency profiles where appropriate for early career support workers or established support workers who are working in a new clinical area.
• Regularly evaluate the difference between roles and scope of practice and competencies for new support workers.
• Sign off the competencies and prior learning of support workers.

Support Worker level

• Use the RCSLT support worker framework and other nation specific competency frameworks which are relevant to their stage of career development.
• Take ownership of learning and development.
• Be aware of the national picture and network with colleagues when opportunity arises to widen professional horizons.
• Keep in touch with opportunities for career progression and how learning supports this.
• SLTs to be aware of how to delegate and motivate colleagues and ensure appropriate supervision.

The risk matrix

The risks above are not a definitive list and will vary from service to service.

The risk matrix within the toolkit allows the recording of potential risks within your service, to identify what the likelihood and impact of that risk is currently based on; existing policies and procedures, current experience within the service (both support workers and SLT’s), development pathways, amongst others. This identifies the current highest risks for the service and how the implementation of the framework can mitigate those risks.

It is an essential tool for evidencing the need for the framework within the service and for recording how the risks to the service have reduced over time as the framework has become embedded.

The toolkit matrix has examples of risks with details of the current risk and the expected position following the mitigators introduced by the framework. These are transposed on to the matrix to provide a visual reference of the existing and expected risk profile for the service.

• Download the Support Worker Toolkit Risk Matrix (Excel spreadsheet)

Reflective practice as a tool

In reflective practice there are many models for reflective conversation and writing.

Reflective learning is important in ‘enabling healthcare professionals to develop professionally throughout their career, to meet the challenges of the increasingly complex and changing environment of healthcare delivery and to integrate learning in theory with experience in professional practice’ (Campion and Fink et al, 2011).

Reflective practice can be standalone or within professional/clinical supervision. It is very relevant to initial training and CPD because it is a framework for lifelong learning.

As support workers we become more self-aware and able to be involved in identifying individual learning and developmental needs and then learning in daily practice.

You may find the following resources useful:

• The RCSLT’s reflective writing e-learning course gives a good grounding in the reflective models of:
  • Kolb (1984)
  • Gibbs (1993)
  • Driscoll (1994)
  • Brookfield (1995)
  • And the REFLECT model (Barksby 2015)
• Helen and Douglas House Clinical Supervision Toolkit (2014) is an excellent compilation which covers several reflective practice models:
  • Gibbs Reflective Cycle (1993)
  • Hawkins and Shohet’s Seven Eyed Supervision Model
  • Driscoll’s Model of Reflection (1994) – a reflective model based around the questions: What? So what? Now what? With ideas for specific questions
  • Johns’ Model for Structured Reflection – This model for structured reflection ‘is intended as a guide to help navigate reflection. It can be used by individuals for personal reflection, and within clinical supervision for individuals and for groups.
• HCSW learning framework (includes a reflective template) – The framework supports clinical support workers to learn and develop in post or progress to a higher-level support worker post.
  • The HCSW Learning Framework is full of learning activities which can support development using the Scottish model of the four pillars of practice and helps support workers to identify areas for development across clinical practice, facilitating learning, service improvement and leadership.
  • The learning framework can be used by support workers to:
    • develop in their current role,
    • understand and prepare for a higher banded post,
    • make informed choices about the right learning for them,
    • support meaningful conversations in personal development,
    • plan their future career,
    • understand the contribution their role makes in supporting students and helping others to learn,
    • identify opportunities to get involved with service improvement,
    • recognise themselves as leaders and actively look to enhance their skillset.

Reflective learning models

The reflective learning models document (PDF) provides examples of reflective models which can be used by support workers with their competency coaches.

The first important point is to try it and engage in reflective practice and reflective writing on a regular basis, ideally taking a few minutes each day to consider what went well/what could have been better. In addition, it is important to use one of the models for reflection and consider a particular point of practice or event.

Secondly, try to record your reflection as this can help clarify thoughts, support your development, and provide evidence of CPD. This summarises the benefits of reflective practice:

“Reflection can assist professionals to;

• analyse complex and challenging situations,
• consider the way you make decisions,
• make connections between your non-work activities and your practice,
• make it more likely that you will put what you have learned into practice,
• improve your problem-solving skills,
• identify future learning needs.”

(HSE, 2017)

Equality, diversity and inclusion

Being culturally responsive support workers

The essence of the framework project is about:

“Feeling included and that you have a voice, can express an opinion and will be valued”.

And this includes being culturally responsive support workers:

“Inclusive leadership requires us to both understand our own views and perspectives – where they come from and what experiences that have shaped them – and to hold the space open to those with different perspectives and experiences. Inclusive leaders recognise the value of diversity in all forms.” (RCSLT leadership toolkit).

Resources to help develop cultural competency

• Our page on equality, diversity and inclusion in the support workforce should be referred to, alongside our further resources on EDI for support workers, and the framework.
• The RCSLT’s leadership resources can be used for strengthening confidence and provides the foundation for developing skills as a culturally responsive practitioner.
• We also provide a range of resources focused on diversity, inclusion and anti-racism: resources, guidance and updates. This information can help to develop cultural competency and includes a focus on competencies in cultural awareness and inquisitiveness.

Cultural competence includes confidence in engaging curiosity:

“…sending clear messages about being ready to learn perspectives, supporting and engaging with Black, Asian and minority ethnic colleagues” (RCSLT)

You may also find the following useful:

• Strategies to increase cultural competency (PDF)
• Cultural competence checklist (PDF)

Podcasts and videos

AHP Role Model podcast

Changing the culture of conversations, AHP leaders podcast special edition June 2020 – this series reaches out to support and engage with Black, Asian and minority ethnic colleagues.

• Changing the culture of conversation; Senior AHP Leaders and Managers: part one (length 59:03)
• AHP Role Models Podcast 2: AHPs from LGBTQIA+ Community (length 48:03)
• Changing the culture of conversation; new leaders (length 48:03)
• Changing the culture of conversations; emerging leaders (length 1:18:56)

Hertfordshire Community Trust

• HCT BAME staff share their experiences

Staff members share their experiences (Sept 2020).

Thinking contextually

Cultural competency involves ‘thinking contextually’, a term used by Kenneth Hardy and Toby Bobes (2017) for the process of developing a deeper understanding of ourselves and others. Thinking contextually “enables us to view multi-layered realities, perspectives and experiences that are overlapping and interconnecting”.

Conversations about cultural context look beyond the immediate situation and lead to consideration of the complex multiple influences which impact on any situation, (Hardy and Laszloffy 2002). There is a need to shift from considering an individual in isolation to considering that individual within a wider context (Reichelt and Skjerve 2013). 

Supporting communication difficulties in a bilingual context

You may find it useful to read our overview of bilingualism and clinical guidance on bilingualism.

Here are some examples of working with bilingual support workers (co-workers):

“It is important to have colleagues from different backgrounds and cultures who speak different languages as it helps to make our service more accessible for the range of children/families that we support.

“Colleagues who speak the same language as these families can help support them to understand how the support will be delivered for their child in their first language and to make sure their views are heard. Colleagues with similar backgrounds can also ensure that cultural differences are acknowledged and respected.

“Having colleagues who speak different languages and are from different cultures helps us to learn about different cultures outside of our own so that we can ensure that the work that we do with these children/families considers any cultural/linguistic differences. Personally, I feel that the speech and language therapy profession need to become more diverse to reflect the diverse range of children that we see.”

(Band 5 SLT)

“Working with colleagues who are bilingual gives opportunity for those to help when there are children who speak that language, e.g. working with a Polish speaking family with a colleague who spoke Polish. It also helps to get their view on that culture and how things may work differently for that family.”

(Band 6 specialist SLT)

A personal experience of a support worker working with an interpreter

“I had the opportunity to work with an interpreter last year during the lockdown to support a Portuguese family with their child’s speech and language needs.

“The process was smooth, but I must admit, I was lost at first, as I never worked with an interpreter before, and it was never mentioned when I applied for the job. It can be quite overwhelming! Luckily, my line manager guided me through the whole process as in our team, therapists seem to work more than assistants do with interpreters.”

(Senior support worker)

Further resources for bilingual support

• Bilingualism Matters
• Bilingualism CEN
• Greater Manchester Combined Authority – resources for working with multilingual families.
• SLTS of Colour
• Nomis – Official Labour Market Statistics – information on your local authority (from 2011 census) and consider the different communities represented/languages.