It Needn t be a  Lottery

It Needn t be a Lottery PowerPoint PPT Presentation

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A well thought out and planned placement which can meet the needs of the most vulnerable and distressed young people can become their long-term settled home, a platform for a positive future, and a real opportunity to turn their lives around"Stanley, Rich,

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It Needn t be a Lottery

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1. It Needn’t be a Lottery Integrating mental health provision into therapeutic social care Chris Taylor: Bryn Melyn Care - Clinical Service Manager Barry Nixon: Director - Cme in the Community 1

2. “A well thought out and planned placement which can meet the needs of the most vulnerable and distressed young people can become their long-term settled home, a platform for a positive future, and a real opportunity to turn their lives around” Stanley, Rich, & Trainor, for DfE (2011) 2 Optimism for young people’s future

3. No neat diagnostic category Multiple, enduring and complex difficulties Attachment difficulties and multiple early traumas are common Some young people attract a range of “mental health” descriptions 3 A “hidden group”

4. What do we mean by mental health? 4

5. Mental Health: Definition “A state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” 5

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9. Significant need and Increasing Mental health problems in young people are associated with educational failure, family disruption, disability, offending and anti-social behaviour Mental health problems in CYP are a strong predictor of adult mental health problems May continue into adult life and affect the next generation Importance of children and young people’s mental health? 9

10. 1 in 5 CYP has a mental health problem 10% of CYP between 5 and 15 have a clinically diagnosable mental disorder (“considerable distress and substantial interference with personal functions”) Prevalence of Mental Health Problems higher within vulnerable groups From 60,000 children looked after by England LAs (2007) research suggests that: 27,000 had mental health disorders and up to 48,000 have various difficulties and problems. 45% of looked after children in the UK have a diagnosable disorder 70-80% have recognisable emotional and/or behavioural problems necessitating intervention. (Children looked after in England 2007, DCSF) What is the prevalence? 10

11. Key Questions What are your expectations as commissioners from a “therapeutic placement” Are “Mental Health” needs met in a “therapeutic placement” 11

12. Commissioners search for “therapeutic placements ” for a significant group of young people They may find contrasting models: Care + therapy Integrated therapeutic approach (includes therapy) 12 How to Choose?

13. An overarching therapeutic approach Supported by psychotherapy & psychology The Standards for Therapeutic Communities for Children and Young People provide a useful benchmark for assessing whether the home is genuinely “therapeutic” Having a therapist on the staff team / consulting to the home does not in itself make a home “therapeutic” 13 Therapeutic community model

14. Therapeutic needs met within an overarching approach Safety Healthy environments Healthy relationships Emotional self-regulation Trauma integration 14 Best practice: Trauma-informed care

15. But how “best practice” occurs is not straightforward What is needed therapeutically cannot rest with one person (the Therapist) It is found in the network of relationships around the child This won’t happen by accident The relationship network needs to be nurtured and sustained if it is to survive 15 Therapeutic approach

16. 16 Integrated psychosocial model 1

17. Common values Shared beliefs about the child Clearly identified therapeutic goals and explicit ways of working Therapeutically informed practice Communication Commitment 17 Integrated working

18. May be occur along with “top-line” presenting conditions May emerge in placement Adult psychiatric illnesses surface during adolescence “Personality” emerges into adulthood May be the main presentation for placement More likely if PD than organic mental illness 18 Mental health difficulties

19. No one can provide everything 19 BMC’s psychologists & psychotherapists provide: Formulation based Cognitive Behavioural Psychotherapy Schema Therapy Integrative Psychotherapy Person Centred Psychotherapy Psychoanalytic/Attachment Based Disabilities Psychotherapy Integrative Movement Psychotherapy Solution-Focussed Brief Therapy

20. When young people get a “mental health label” we can feel we have to look outside for additional services This can be “taking the problem to CAMHS” Community CAMHS teams experience pressures on their service Some CAMHS report waiting times as too long These complex needs are not easily met in Tier 1 services It’s not always clear what they are being asked to do 20 Looking outside for help

21. The 4-tier model for CAMHS 21

22. 22 Integrated psychosocial model 2

23. Presenting Problems 23

24. Matching Need to The Evidence 24

25. Matching the Evidence to Skills & Competencies The Skills required: CBT & Behavioural Therapy IPT Family Systemic Therapy Prescribing & Medicines Management Psychotherapy Specialist Interventions: Trauma based Therapy Parenting Therapeutic Milieu 25

26. Improved care, treatment and intervention in cases with “mental health” difficulties Residential staff, teachers and clinicians are better equipped to meet mental health needs Mental health input for ASD promotes confidence in staff and helps manage melt downs More sophisticated mood and mental state monitoring Improved medicines management Better communication with Tier 1 services Access to additional “modalities” (e.g.) Speech and Language Therapy Systemic/Family Therapy 26 What we’ve found

27. General outcomes for young people do not make comparisons with a meaningful “control group” Some “distance travelled” measures now widely used Goodman’s Strengths & Difficulties Questionnaire (SDQ) Health of the Nation Outcomes Scale for Children & Adolescents (HoNOSCA) Case specific measures may capture individual change, but may be highly situational E.g. Less absenting may only reflect less absence from that home, not an underlying change Psychometric assessments can be a burden on the child 27 Measuring outcomes for C&YP

28. Assessment should lead towards ethical intervention Plan- Do-Review model Research through Knowledge Transfer Project A core packet of validated measures for baselines and “distance travelled” SDQ HoNOSCA Beck Youth Inventories Child Hope Scale (Snyder et al, 1997) Attachment Questionnaire Children (Muris et all, 1999) Plus a bundle of case specific instruments (e.g.) Weschler Intelligence Scale for Children 4 Child Post-Traumatic Stress Disorder Inventory Structured Assessment of Violence Risk in Youth 28 Developing a Child Assessment & Progress Evaluation Toolkit

29. In keeping with an overarching therapeutic approach “Ethnographic” observations in placement Quantitative observation for specific, observable behaviours Discussion with young person (their views) Targeted observation & monitoring, e.g. Birleson Depression Scale Connors Rating Scale (ADHD) 29 Developing a Child Assessment & Progress Evaluation Toolkit

30. Forms are usually completed by self, parent and teacher raters. Raters consider behaviour over the last six months and rate 25 items on a three point scale: not true somewhat true certainly true These items divide into five scales, a positive pro-social scale and four problem scales: Hyperactivity Emotional symptoms Conduct Problems Peer Problems The score on each scale can range between 0 and 10. Strengths and difficulties Questionnaire (SDQ) 30

31. HoNOSCA Developed in response to the need to measure the health and social functioning of those suffering from mental illness A routine outcome measurement tool that assesses the behaviors, impairments, symptoms and social functioning of children and adolescents with mental health problems. HoNOSCA therefore provides a global measure of an individual’s current mental health status thus provides a means of evaluating the success of attempts to improve the health and social functioning of mentally ill children and adolescents. 31

32. Key question What can be done to support your organisation to improve and respond to the mental health and well-being of the children and young people you work with? 32

33. 33 From the back cover: ‘This book provides a wealth of information and practical ideas for parenting young people who have experienced early trauma and disrupted attachments. This book is a treasure trove of theory and practical ideas for foster carers, residential care workers and for the professionals who are supporting them.’ - Kim S. Golding, MSc Clinical Psychology, DClinPsy Published by Jessica Kingsley Publishers

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