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