Digital Competencies

Working Definition of Digital Health Technologies

Apps, programmes and software used in the health and care system. They may be standalone or combined with other products such as medical devices or diagnostic tests.

NICE, 2019

These digital competencies are applicable to all applied psychologists and psychological practitioners working online and via telephone.

	Knowledge	Ability
Meta-competencies	Knowledge of ethical practice, opportunities and limitations of digital practice related to access and efficacy	Ability to practice digitally, including establishing and maintaining a positive therapeutic alliance in online work
	Knowledge of the legal and security requirements for conducting digital psychological assessments, interventions and supervision	Ability to appraise the advantages and drawbacks of digital tools with reference to the evidence base and recommend these to clients and services in line with one’s clinical judgement
	Knowledge of professional and clinical boundary issues specific to online practice	Ability to reflect on one’s own digital psychological practice
	Knowledge of psychological frameworks specific to the online therapeutic relationship such as the online disinhibition effect and screen presence	An ability to recognise one’s own competences, training and supervision needs in relation to the particular context of digital practice
	Knowledge of the evidence base for digital practice (process and outcome) and how these compare to in-person approaches	Ability to recognise culture-specific requirements of clients and provide culturally appropriate psychological materials and interventions
	Knowledge of profession specific guidance regarding digital practice from one’s professional/accrediting body and how these interface with broader clinical competences	Ability to work ethically, safely and effectively – attending to professional and clinical boundary issues specific to online practice
	Knowledge of how diversity and cultural differences may interact with the online environment
Clinical Information Governance	Knowledge of clinical governance and professional context in relation to digital practice, including the legal frameworks for practice, clinical risk management and clinical safety online	Ability to obtain the client’s informed consent to digital work throughout the course of their contact
	Knowledge of information governance and legal context of information storage and sharing -including the Data Protection Act.	Ability to follow organisational policies and procedures regarding information governance, including completing mandatory digital training (as required by NHS or other organisational/professional body)
	Knowledge of specific patient information and other digital record systems used within one’s organisation and professional guidance regarding this
Assessment & Formulation	Knowledge of clinical safety issues (risk) associated with digital/remote therapeutic work	Ability to select online psychological assessments that are suitable for remote administration
	Knowledge of opportunities and limitations of these technologies related to client factors	Ability to administer online psychological assessment tools via remote means
	Knowledge of opportunities and limitations of these technologies related to clinical engagement/ therapeutic relationship	Ability to conduct accurate risk and clinical safety assessments given limitations of digital technologies
	Knowledge of clinical engagement issues when conducting online screening and psychological testing	Ability to assess and match client needs/interests/abilities to suitable digital modalities
	Knowledge of psychological assessment tools available for online administration in one’s own scope of practice	Ability to assess a client’s suitability for online interventions, revising this as necessary on an ongoing basis
	Knowledge of inclusion and exclusion criteria for online psychological assessment and outcome monitoring	Ability to create and share a collaborative formulation with a client remotely e.g. using screen sharing of documents or white board function to draw out a formulation
	Knowledge of the factors involved in choosing online platforms, ensuring their clinical safety
Psychological Intervention	Knowledge of contemporary digital technologies used in the direct and indirect delivery of psychological interventions	Ability to conduct therapy in individual and group format using digital technologies
	Knowledge of levels of intervention and how digital technologies may be integrated at different points in a stepped care model	Ability to adapt digitally informed interventions to the needs of clients from a range of ages and abilities
	Knowledge of group versus individual interventions delivered via digital technologies	Ability to recognise how employing digital technologies may influence how agreements are made with clients and/or supervisees about confidentiality and its limits e.g. safe recording and transfer of client sessions using secure cloud technology
	Knowledge of the role of apps in psychological assessments and interventions and awareness of app quality assessment processes	Ability to manage outcome data collected digitally and integrate this into treatment planning
	Knowledge of electronic self-help materials and platforms available to support the delivery of psychological interventions	Ability to evaluate the effectiveness and security of an app
	Knowledge of different digital tools for managing between-session therapeutic contact e.g. communicating via an online psychoeducational platform or by email about home-based tasks	Ability to reflect in supervision on the client’s response to different digital modalities and the impact on the therapeutic relationship
		Ability to introduce and support the use of self-help and/or blended complementary online materials to clients
		Ability to integrate and use creative non-verbal visual digital tools to complement online psychological interventions e.g. using drawings with the whiteboard, shared written documents, assisting the client to select images from the internet to illustrate their feelings
		Ability to adapt evidence-based protocols to online delivery e.g. assisting memory processing work in PTSD by facilitating a remote site visit using Google Street View
Evaluation and Research	Knowledge of the evidence base for digital practice (process and outcome) and how these compare to in-person approaches	Ability to critically appraise digital tools and interventions and use the evidence base to inform selection of these for clinical and research purposes
	Knowledge of digital tools for recording therapy process, evaluating client experiences and client outcomes (e.g. COREnet, etc.)	Ability to monitor patient experience and patient-reported outcomes using digital methods
		Ability to manage outcome data collected digitally and integrate this into treatment planning
Communication and Teaching	Knowledge of the pros and cons of online teaching methods and awareness of online teaching programmes	Ability to discuss the pros and cons of the digital modality with the client
	Knowledge of communication processes which may affect digital practice across individual, system and group work (e.g. turn taking and use of non-verbal information)	Ability to adapt communication style and employ different functionalities of the technology concerned to promote the formation of a therapeutic relationship (e.g. adapting communication style for older people or those with learning difficulties)
	Knowledge of professional and communication factors which require consideration when working with interpreters remotely.	Ability to work with interpreters remotely e.g. on a video call having a British Sign Language signer or foreign language interpreter joining a call to translate for a client
		Ability to manage boundaries if working remotely e.g. conducting a therapy session via video chat from home
		Ability to deliver e-learning related to clinical practice and psycho-education through synchronous and asynchronous methods (e.g. ebooks, vlogs, live webinars) to clients and professionals
Leadership, Supervision & Consultation	Knowledge of digital supervision models and ways to adapt in-person supervision to online delivery	Ability to engage in remote supervision
	Knowledge of leadership and consultation as it relates to digital interventions	Ability to integrate digital communications into supervision discussions (e.g. text/chat bot information, video or skype chats)
		Ability to follow organisational policies and procedures in the making, storing and sharing of recordings of sensitive clinical material for supervision or clinical purposes
		Ability to engage in leadership and consultation to promote an open and curious approach amongst others to digital practice
		Ability to work in remote digital teams and participate in remote digital meetings
Personal & Professional Skills and Values	Knowledge of one’s own attitudes, skills and values regarding digital practice	An ability to reflect on one’s own attitudes, skills and values regarding digital practice
		An ability to recognise and reflect on the limits of one’s own competence when translating original in-person professional training to online work

Knowledge of ethical practice, opportunities and limitations of digital practice related to access and efficacy

Core

Knowledge of opportunities and limitations of these technologies related to client factors

How client interests/abilities may influence choice of modality
Awareness that clients will differ in their confidence and skills using digital technologies and that extra training and support may be required.
Awareness of how client and staff attitudes/beliefs may affect their ability to engage in digital technologies e.g. Reluctance/fear of digital technology and be able to suggest strategies to overcome resistance where present
Awareness of how client and staff attitudes/beliefs may affect their ability to engage in digital technologies e.g. Reluctance/fear of digital technology and be able to suggest strategies to overcome resistance where present
Knowledge of opportunities and limitations of these technologies related to access
Awareness that client’s ability to access digital mental health technologies will vary according to personal circumstances and be able to suggest strategies to overcome digital inequalities where present
Awareness of potential digital exclusion/marginalisation due to technical issues (e.g. bandwidth limitations) and NHS issues which may limit clients or staff accessing digital technologies and be able to suggest strategies to overcome these issues, e.g. using an Ethernet cable rather than wifi, closing applications or unnecessary web browser pages running in the background and planning another modality when setting up the sessions initially for any instances where technical difficulties may arise.

Knowledge of professional and clinical boundary issues specific to online practice

Core

Knowledge of potential areas where boundaries may become blurred when working with colleagues or clients online e.g. professional attire and background when attending video call meetings/psychological sessions

Knowledge of psychological frameworks specific to the online therapeutic relationship such as the online disinhibition effect and screen presence

Core

An understanding of the online disinhibition effect and how clients may more rapidly disclose and process emotion in the online realm.
An understanding of the relationship between good screen presence and the development of the therapeutic alliance

Ability to practice digitally, including establishing and maintaining a positive therapeutic alliance

Core

Ability to set up the technology to promote the formation and maintenance of a good therapeutic alliance

In video work this includes creating good screen presence via appropriate lighting and camera positioning.
Screen presence is promoted by positioning the client’s thumbnail image close to the webcam so that the therapist is appearing to make eye contact with the client and not seeming to look down or away from the client’s eyes.
Practitioners should have the ability to situate their desk, webcam and lighting so their face is well illuminated. They should not sit with their back to a window or other strong light source as their face will appear in shadow.

Ability to recognise and manage the online disinhibition effect so that clients feel safe and contained.

Ability to appraise the advantages and drawbacks of digital tools with reference to the evidence base and recommend these to clients and services in line with one’s clinical judgement

Advanced

Ability to critically appraise the evidence and implementation of digital interventions, including the functionality and evidence base for commercial products and the appropriateness for the client and service context.

Ability to work ethically, safely and effectively attending to professional and clinical boundary issues specific to online practice

Core

Ability to adapt one’s environment so as to maintain professional boundaries with colleagues and clients especially when working from home e.g.

arrange for a private, secure space in which to conduct interventions;
ensure a tidy professional-looking background for video calls;
ensure personal items are not viewable on a computer desktop when screen sharing;
minimise intrusions which could be audible or visible to colleagues and clients during an audio or video call;

Attending to your own wellbeing when working remotely e.g.

monitoring the number of back to back video call meetings in order to minimise fatigue;
seeking ways to connect with team members informally online when there is infrequent face to face contact

Ability to obtain the client’s informed consent to digital work throughout the course of their contact

Core

An ability to outline the risks, advantages and disadvantages of engaging in a psychological intervention online
An ability to answer client questions about the nature of in-person and remote intervention options, and to acknowledge if either of those options are unavailable

Knowledge of clinical safety issues (risk) associated with digital/remote therapeutic work

Core

Clinical Safety

Understanding limitations to effective clinical safety assessment, also called ‘risk assessment’ (e.g. identifying problematic alcohol/drug misuse, self-harm with limited visual information)
Awareness of staff safe working protocols for digital practice when working remotely (e.g. informing wider team when sessions are taking place with client).
Knowledge of support systems local to the client will be necessary in order to safely manage emergencies when working at a distance. Where work is taking place across national boundaries, this should include knowledge of legal jurisdiction and ways to access emergency support in the client’s own country

Confidentiality

Awareness of the need to protect client confidentiality when working online and the potential challenges to this, especially when the sole means of communication is digital.
Checking the identity of clients when communicating digitally.
Ensuring clients are able to make an informed choice regarding digital communications and how different methods may variously impact on their privacy and confidentiality.
Email: ensuring client privacy by considering use of encrypted platforms when communicating sensitive matters; not including patient identifiable information in the subject line or body of emails; password protecting or encrypting email attachments; therapists avoiding using a publicly available email address with which to communicate sensitive matters with clients as this may identify clients as being in receipt of mental health services; care when using autocomplete or forwarding emails in order to prevent emails being sent to the wrong client.
Phone and text messages: making clients aware of the unencrypted nature of these communications.
Live chat such as WhatApp, Facebook Messenger, Signal etc: ensuring clients understand how chat platforms differ in who is able to access their data and its level of encryption.
Video call: ensuring clients understand the relative risks and benefits of using different videoconferencing platforms such as Skype, AttendAnywhere, Zoom, FaceTime, GoogleHangouts etc. in terms of their varying ability to encrypt calls, who is able to access to their data, and how different methods of setting up and joining a call may impact privacy and confidentiality.

Cybersecurity

Knowledge of cybersecurity and how different digital technologies may have certain strengths and limitations in comparison to in-person working
Knowledge of the Data Protection Act 2018 and how it applies to working online
Knowledge of how an individual’s roles and responsibilities towards cyber security may differ according to the employment setting in which they work i.e. NHS v private or third sector

Knowledge of opportunities and limitations of these technologies related to client factors.

Core

How client interests/abilities may influence choice of modality
Awareness that clients will differ in their confidence and skills using digital technologies and that extra training and support may be required.
Awareness of how client and staff attitudes/beliefs may affect their ability to engage in digital technologies e.g. Reluctance/fear of digital technology and be able to suggest strategies to overcome resistance where present
Awareness of how severe and enduring mental health conditions may limit (but not preclude) the use of technology – e.g. paranoia

Knowledge of opportunities and limitations of these technologies related to clinical engagement/ therapeutic relationship

Core

Awareness of the greater flexibility that digital technologies can offer clients and clinicians when compared to in-person therapies e.g. accessibility (video conferencing etc); controlled experiences/exposure (VR etc)
Awareness of how certain modalities may circumvent emotional barriers (e.g. shame, self-esteem)
Awareness of how certain modalities can compensate for cognitive/sensory issues (e.g. recording sessions for client to re-examine)
Awareness of how different channels of communication in digital technologies may limit or augment communication with clients or staff e.g. audio only prevents interpretation of body language
Awareness of how therapeutic boundaries may be affected by digital technologies e.g. conducting a therapy session via video call when both client and therapist are calling in from home
Awareness of how the ease of digital communication may lead therapists to unwittingly engage in unsafe, unethical or boundary violating behaviours e.g. forwarding an email to the wrong patient, recording an online therapy session without the client’s written consent, conducting a video call therapy session from a location where they may be overheard or researching patient’s backgrounds by looking them up online (Patient Targeted Googling).
Awareness that patients commonly search for information about their therapist online (Therapist Targeted Googling). Given that unintended disclosure may impact the therapeutic relationship, therapists should ensure publicly available information about their personal or professional life conforms with ethical standards set by their professional body.
Awareness of the relative risks and benefits of engaging in social media use. E.g. avoid ‘friending’ or accepting friend requests from patients; separating personal and professional social media accounts; care when posting clinical questions in online professional forums so as to not reveal patient’s identity; awareness that patients may seek to gain access to professional forums and therefore any posts therapists make should be professional.

Ability to select online psychological assessments that are suitable for remote administration

Core

An ability to refer to organisational policy and/or the research literature when selecting psychological assessment tools appropriate for remote administration

Advanced

An ability to select psychological assessment tools with reference to published norms and weigh up the pros and cons of administering them where norms do not exist for remote administration
An understanding of the relationship between good screen presence and the development of the therapeutic alliance

Ability to administer online psychological assessment tool via remote means

Core

An ability to administer self-report measures via remote means

Sending secure links to online questionnaires via email
Screen sharing an electronic questionnaire during a live video call

Advanced

An ability to administer performance-based, interview-based or cognitive assessments using normed and established digital platforms such as Pearson Q Interactive using standard procedures.
When adapting performance-based, interview-based or cognitive tests for remote delivery and in the absence of published norms and procedures, practitioners should have an ability to draw upon specialist guidance when weighing up the risks and benefits to the patient of testing remotely or delaying until in-person administration becomes possible

Knowledge of contemporary digital technologies used in the direct and indirect delivery of psychological therapies

Core

Knowledge of contemporary digital platforms for practitioners to use for delivery of psychological therapy

Videoconferencing (incl. audio only communication)
Chat – synchronous (e.g. IESO, chat function on Zoom, Kooth (YP)
Phone
Email
SMS – asynchronous (e.g. mobile phone messaging functionality)
Computerised therapy programmes/apps
Web-based platforms (e.g. Silvercloud, Minddistrict)
Apps – no attached web platform (e.g. Headspace)

Knowledge of other digital interventions

Technology used as a tool for use in face-to-face psychological therapy
Virtual Reality (immersive via headset & desktop-based)
Artificial Intelligence
Social media platforms (e.g. Instagram campaigns supporting mental health literacy)

Knowledge of levels of intervention and how digital technologies may be integrated at different points in a stepped care model

Core

Knowledge of how digital technologies may be integrated at different points in a stepped care model, including:

Self-help: awareness of the indirect role practitioners may play in organisations employing watchful waiting/unguided self-help e.g. advising services on digital technologies to offer clients or the general public to support their mental health
Guided self-help: while practitioners may not use digital technologies themselves directly at this level, they may be supervising or managing teams in which Step 2 practitioners are providing guided self-help via platforms such as Silvercloud or Minddistrict
Blended or online therapist-delivered: practitioners may integrate digital technologies into face-to-face sessions, provide some or all sessions of an intervention via video call or other technologies, or use therapist-guided online interventions to deliver treatment.
Adjunctive technologies such as AI, apps etc, may play a part in any of these levels of interventions

Knowledge of group versus individual interventions delivered via digital technologies

Core

Awareness that each modality has certain strengths and limitations
Awareness and ability to select in an informed way relevant digital platforms that can facilitate individual or group working

Knowledge of the role of apps in psychological assessments and interventions and awareness of app quality assessment processes

Core

Knowledge of Apps relevant to one’s specific area of practice, including awareness of their evidence base

Advanced

Knowledge of apps relevant across a wide range of client groups e.g. children and young people; adult mental health and well-being; psychological management of physical health conditions; psychological problems experienced by individuals diagnosed with dementia and learning disability

Knowledge of the process and criteria for approval of Apps and the difference between NHS approved and currently tested in NHS, and other approval sources e.g. ORCHA – https://digital.nhs.uk/services/nhs-apps-library

Ability to conduct therapy in individual and group format using digital technologies

Core

An ability to conduct individual therapy using a single digital modality e.g. email, text chat or video call
An ability to manage the technology necessary to conduct an individual intervention online

Advanced

Ability to critically appraise different technology platforms and apps, selecting the most appropriate for the intervention planned
An ability to conduct individual therapy using several digital modalities e.g. email, text chat and video call
An ability to conduct group therapy by video call

Knowledge of communication processes which may affect digital practice across individual, system and group work (e.g. turn taking and use of non-verbal information)

Knowledge

Awareness of how the lack of access to non-verbal cues such as eye gaze or body orientation may impede fluent communication and turn-taking when working in individual therapy or group settings.
Awareness of how being a member of an online group may lead to an illusion of ‘invisibility’ and disinhibited or disengaged behaviour.
Awareness of the advantages and disadvantages of the chat function when working individually or a group. For example, in individual therapy communication by chat may facilitate conversation with a client high in shame. In group settings, the chat function may encourage contributions from a greater range of group members. Disadvantages in group settings include the potential for it to be used for unhelpful private conversations between group members.

Ability

An ability to compensate for the lack of non-verbal cues in digital communications by utilising alternative means e.g. using emoticons and ‘thumbs’ up in video calls or gathering contributions from group members by calling their name
An ability to contract around appropriate behaviour when convening online groups
An ability to integrate effectively the chat function in individual and group settings.

Knowledge of professional and communication factors which require consideration when working with interpreters remotely.

Knowledge

Awareness of how the lack of access to non-verbal cues such as eye gaze or body orientation may impede fluent communication and turn-taking between therapist, interpreter and client.
Awareness that when working with interpreters by video call management of the technology will need to be discussed with both the interpreter and client.

Ability

When working with a client and interpreter via video call, a therapist should be able to communicate in a structured and assertive way. For example, therapists should indicate clearly who they are addressing by using the person’s first name before speaking.
The therapist should have the ability to negotiate ground rules and explain technological considerations to interpreters before meeting with the client, e.g. indicating that all communications during the video call should be interpreted including directions around the technology.

Knowledge of digital supervision models and ways to adapt in-person supervision to online delivery

Core

Knowledge of tools and methods for participating in remote supervision e.g. awareness of screen sharing function for sharing of formulations; live observation of a supervisee by attending their intervention by video call; reviewing supervisees’ email or written materials exchanged as part of a psychological intervention
Knowledge of secure ways to record remotely delivered psychological interventions for later review in supervision or for clients to use as part of their homework

Advanced

Knowledge of organisational policies relevant to supervisees’ sharing of sensitive clinical material in supervision e.g. advising trainees and supervisees on how to make, store and share live examples of their clinical work

Knowledge of leadership and consultation as it relates to digital interventions

Core

A knowledge of the government strategies and organisational drivers affecting one’s personal digital practice

Advanced

Knowledge of local digital polices and resources in order to promote their use amongst colleagues e.g. acting as an internal consultant or ‘digital champion’
Knowledge of psychological models and processes relevant when implementing digital interventions in organisations

Ability to engage in remote supervision

Core

Ability to present cases in supervision using digital tools e.g. skilled at using the screen share for documents and white board function when presenting case formulations to a supervisor
An ability to access supervision from a digitally competent supervisor

Advanced

Ability to deliver individual and group supervision via digital means and adapting to the diversity characteristics and needs of supervisees and their clients
Ability to advise teams and services on the GDPR and information governance aspects of making recordings of remote psychology practice for supervision e.g. working with cyber security experts in order to draw up policies and procedures around recording, storing and sharing of video conference sessions.

Ability to engage in leadership and consultation to promote an open and curious approach amongst others to digital practice

Core

Ability to act as a positive role model to peers by demonstrating an open and curious approach to the adoption of innovative digital ways of working, trying out new ways of working as appropriate (e.g. by asking to have a meeting remotely; volunteering to try a new digital resource)

Advanced

Ability to use leadership and influencing skills to challenge preconceptions about digital technologies amongst staff teams and assist staff to approach them in a balanced, critically informed way e.g. when chairing team meetings offering staff the option to attend in person or remotely; questioning established practices and introducing digital options
Ability to provide a safe space to discuss and reflect with staff teams about the advantages and disadvantages of digital practice and the personal values and attitudes that might influence staff engagement with digital tools

Ability to work in remote digital teams and participate in remote digital meetings

Core

Ability to participate in professional meetings online
Ability to be sensitive to the greater wellbeing needs of fellow team members and the challenges of maintaining team cohesion when working remotely e.g. being open to participating in informal team building forums such as ‘water-cooler’ catch-ups by video call, participating in team chats

Advanced

Ability to chair professional meetings online
Ability to promote team well-being by establishing and encouraging use of digital forums for team members to connect informally when working remotely

An ability to recognise and reflect on the limits of one’s own competence when translating original in-person professional training to online work.

Core

A commitment and ability to engage in regular CPD in relation to the rapidly changing landscape of online practice
Approaching the self and others with compassion, recognising the challenges and frustrations that for some digital technologies may present on first encounter.

Advanced

An ability to act as a whistle blower and challenge colleagues and organisations when the ethical and skilful conduct of digital clinical interventions and professional ways of working is compromised