clinical psychology services dr simon smith clinical psychologist child and adolescent mental health...
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Clinical Psychology Services
Dr Simon Smith
Clinical Psychologist
Child and Adolescent Mental Health Services (CAMHS)
Glasgow City Community Health PartnershipSouth Sector
Overview Language and definitions Who we are and what we can offer What you can do How and what to refer to us Useful resources
Language and mental health
Part 1
Who we are and what we can offer
Who we are
Most NHS Clinical Psychologists work within multi-disciplinary Child and Adolescent Mental Health Services (CAMHS)
Also, unidisciplinary psychology services Community and inpatient settings
Who refers to CAMHS?
Approx 70% from GPs Others: Social work/Educational
Psychology/Health Visiting/others within health
The information we receive varies widely General rule of thumb: 10% of
children/young people in general population have some form of mental health difficulty
Types of difficulties we would see in younger children
Temper tantrums Sleeping, feeding, & toileting
problems Common fears & anxieties Adjustment difficulties Developmental delay &
disorders Social interaction difficulties
Types of presenting difficulties we would see in older children
Most of the above!! Plus… (Temper tantrums become behaviour problems) Adjustment difficulties (e.g. parental
separation/bereavement) Learning difficulties Mood disturbance Social interaction difficulties (incl. ASD) ADHD Eating disorders Self harm/suicidal thoughts
Our assessment
Child and family interview first Might then see parents alone/child alone Information we need:
From antenatal onwards Developmental history Child within context of home, school, community Risk and resilience factors Impact What has been tried Family’s best hopes
Assessment 2
Standardised measures School observation Liaison with other involved professionals Review of case notes
Assessment 3
Develop a formulation and share with family and professionals
From this a plan of intervention (if needed) can follow
Some helpful info on typical development/children’s
needs
Normal Expressions of Anxiety
Infancy – loss of support, loud noises, strangers 1-2 – year olds – separation from parents,
strangers 3-4 year olds – darkness, being left alone,
insects and small animals 5-6 year olds – wild animals, ghosts, monsters 7-8 year olds – aspects of school, supernatural
events 9-11 – social fears, fears about wars, health and
bodily injury, school performance
Maslow’s hierarchy of needs
What we do
Pre-referral advice, incl. signposting Direct clinical work
assessment, formulation, interventionChild/parent/family/group/system work
Capacity building Teaching/training Consultancy
Parenting
Many of the referrals for younger children involve us working with the parents/carers
‘parenting’ (especially in groups/classes) still carries a stigma/judgement for many parents
www.incredibleyears.com
Part 2
What can you do?
Why might you see difficulties?
Put the behaviour in context
Why might you see difficulties?
Child factors including physical health
Why might you see difficulties?
Parental mental health
Parental / family history
Why might you see difficulties? Economic austerity
Socioeconmonic impact on mental health (WHO, 2011)
Unemployment and service engagement (Evans-Lacko, 2013)
Lack of opportunityPublic spending cuts
Impact on the vulnerable Diminish the capacity to support
Why might you see difficulties?
Development
Developmental stage
The strength of the relationship between client and clinician is vital in achieving good outcomes
Consider why seeking help may be difficult Recognise the effort that the parent is making Need to discuss any stigma re
psychologist/mental health services?
Engaging with parents
Engaging with parents
Listen carefully Empathise Respect their views Think problems through together Empowering clients Attribute changes in child’s behaviour to
parents efforts
Listening skills
Resist the temptation to try to ‘make better’ instantly
Don’t say ‘I know how you feel’ – you don’t!
Take parental concerns seriously
Some overarching principles for parents
Adults as role models Calm, patience, timing Focus on encouraging acceptable
behaviours Consistent routines Predictable responses Praise, rewards, distraction
When do we give attention?
Give attention to anything you’d like to see more of, eg. good eating/toothbrushing/
hand washing/going to bed
How to give commands
Tell children what you want them to do
Can feel counter-intuitive (e.g.tempting to always say ‘stop shouting’ rather than ‘please talk quietly’)
What you can do in ten minutes!
5 minutes: allowing the parent or child to speak
1 minute: identify the primary problem 2 minutes: strategies that they have
previously tried 2 minutes: advise on appropriate strategy /
alternative resource
Part 3
How and what to refer
When to refer…
If immediate risk: Suicidal→call local child mental health team Child protection →call social work
Think first about: voluntary sector self help parenting programmes (think: timing and containment)
Under 5s: is the Health Visitor involved?
School based difficulties
When to refer 2
Is it possible that today’s consultation (listening and containment) is enough to improve things?
Is it possible for them to monitor the situation and report back to you?
If it is a school based problem only, this needs to stay with school
Models of Educational Psychology provision
When to refer 3Think about:
The impact of the problem
The duration of the problem
What has been tried
What does the family/you think will help
Your observations
The context around the child, e.g. how doing in nursery/school
Helpful resources
Parenting resources: www.incredibleyears.com www.bbc.co.uk/parenting www.triplep-staypositive.net www.parentingacrossscotland.org.uk (incl.parentline
on 0800 028 2233) Leaflets for parents:
www.rcpsych.ac.uk/mentalhealthinfo www.understandingchildhood.net
Resources cont.
Books for parents: Toddler troubles:coping with your under 5s by Jo
Douglas What every parent needs to know by Margot
Sunderland Scottish child law centre: www.sclc.org.uk Children, physical punishment and the law
leaflet www.scotland.gov.uk/publications/2003/10/18406/28340
Excellent resource for professionals: www.handsonscotland.co.uk
Remember…
Try to get as accurate a picture of the difficulty as possible
If not life threatening, try to give the family something to try and come back to you
Try to give us the nursery/school name You can call local services to discuss a
potential referral if you are unsure