Working With Children and Young People Dr Susie Willis Clinical Psychologist Paediatric Clinical Psychology Royal Belfast Hospital for Sick Children

Outline What is Child Psychology and why is it needed? What does a Child Clinical Psychologist do? Where Do We Work? How Do We Help?

What is Child Psychology Branch of Psychology interested in infants, toddlers, children and young people Our focus is helping understand, prevent and treat developmental, cognitive, social and emotional issues

Is there a need for Child Psychology? World Health Organisation state up to 20% of children and young people will experience mental health difficulties in any given year: e.g. low mood and anxiety The WHO states that 20% of children experience mental health difficulties before the age of 16 /18 years. This can range from mood, conduct, psychosis to trauma reactions, to name but a few. Dog phobia to toileting problems, the list is endless….. We also know that the earlier years in our lives are so important for later development. We know that by the age of 3 our brains our 90% percent of their adult size Child Psychology is one of the many branches of clinical psychology, which focuses on the social and emotional development of child and young people We can say this from the earliest points in our lives from prenatal development right up through to adolescents.

As a psychologist this is probably the most important human organs we are interested in. The Brain is at the centre of thoughts, feelings and action. Specifically for child psychology, we know that by the age of 3 years old the brain has developed to 90% of its adults size. Now that is just some evidence to indicate how important our earliest years can be.

This is where Child Clinical Psychologists come in… Why do children experience emotional and social difficulties? What makes children be resilient in the face of adversities? How and who we can we help? If these sort of questions interest you then, child psychology may be an area of interest for you…

Psychological Theories Developmental Stages – Erickson Models Basic Human Needs – Maslow’s Hierarchy Influences from the Environment Social Learning Theory - Bandura Before I go on to explain what a child psychologist does, you need to know a bit of the background. Therefore we have a range of psychological theories to help us understand some of the questions from the previous slide. arise…. Developmental Psychology – We need to have a good knowledge of what is typical development of children and young people…In the past children were often viewed as ‘mini adults’ in terms of how they think and cope, however we now know that children develop thinking, language skills over time. Basic Human Needs – Hierarchy of what every human , including children needs to have a fulfilling meaningful life Influences from the environment – a number of theories stating the Influence of environment on children e.g. family, schools, hospitals e.g. if a child is aggressive and violent e.g. social learning theory: a child will learn by directly observing people in their lives.

Maslows Heirarchy of Needs Maslow was a psychologist back in the 1940’s and came up with this pyramid of needs. This hierarchy is most often displayed as a pyramid. The lowest levels of the pyramid are made up of the most basic needs, while the more complex needs are located at the top of the pyramid. Needs at the bottom of the pyramid are basic physical requirements including the need for food, water, sleep, and warmth. Once these lower-level needs have been met, children can move on to the next level of needs, which are for safety and security. E.g. safety at home and school, freedom of fear from bullying etc. Next is the needs of belonging from family, friends, teachers Next moving up to Self Esteem and achieving success – we know this can be a great place for children to achieve at school, Self Actualisation is the final stage – actually Maslow initially claimed not many people will achieve this in their lifetime, however it is now understood as a means of pursuing a childs inner talents and creativity.

5 Basic Needs Maslow’s Hierarchy of Needs Maslows Heirarchy of Needs ….in 2014) 5 Basic Needs Maslow’s Hierarchy of Needs

Working with children and young people and their Families

Now working with children will always involve working and support their families. They represent a significant place where children and young people spend most of their time and where they try and strive for those areas of Maslow Heirarchy of need.

But we also know families can sometimes feel a bit like this… So what additional challenges does a child and their families Family face? Relationships – Marital Separation – building new relationships with step parents/ siblings/fosters family etc. Transitions and Adjustment e.g. starting nursery/primary school/secondary school/ moving house/birth of a sibling. A parent starting a new job. A child receiving a diagnosis of illness Bullying, Loss & death, trauma, abuse – or general adverse life experiences can lead to: Family Conflicts and unhelpful communication

The Family Life Cycle Although the child themselves are often referred to services, with a problem – we need to be mindful of difficulties of their presenting issues within the context of their family. This shows the Family Life Cycle and often families can present to services as they transition between different stages of the life cycle.

Families are also a great resource. However, we also now families can the of great source of support and resilience when coping with difficult life experiences. Where I work in the Childrens Hospitals it never stops to amaze me how families cope and how resilient they are. E.g. of resilence

How We Help?

First of all we look to complete an assessment of the presenting problem but also how the people around the problem are struggling and/or coping. We can see here some of the most important factors to childs development, and as a clinical psychologist I am always curious and interested in theses areas of a child life. A big part of assessment it to get an understanding of a childs internal world their belief and coping Health, Education, Emotional Development, Identity, Familiy Relationships, Social Presentation – at home/school/hospital/ self care skills To Do this : Interview with the child and family – this can take a number of sessions, spending time together (and sometimes individually) with children and parents. Speaking with school, doctors, social workers and other important people who know the child Aim is to try and understand this from a child’s perspective Assessment

Childs Experience Family Relationships Education Factors Formulation We then piece together all information we gather from our assessment to come up with a psychological formulation. This ties in with what we know from psychological theories and applying this to the child and family we meet. This helps us build and understanding of the presenting difficulties, as well as giving us a road map to how to.

What are the goals for treatment? Based on our formulations Thinking about all people in the system (family system but also the wider system) We often ask the question ‘how would you know our work is being helpful?’ ‘What would be different?’ Using the formulation we come up with goals for treatment

Intervention – How We Help… Directly with Children and Young People

Directly Working with their Families Meeting Potential Feeling better More Relaxed Engaged with Peers Are family more harmonious? More Calm Better Communication Supportive Relationships

Indirectly working with people around that child or young person Medical teams Nurseries Social Services Schools GPs Policies and Research We also work and support the people and professionals involved in the child’s life. There may be times when we never need to meet the child or young person by supporting the system around them. This might mean giving people an understanding of the child’s behaviours. Indirectly working with people around that child or young person

Where We Work Hospitals Schools and Education Child and Adolescent Mental Health Services Looked After Children Services Youth Justice Agencies Universities - Research Given the diverse range of work we do this means we work across a range of settings

A day in the life of a child clinical psychologist Screen referrals – is it appropriate? Meetings with children and families. Assessment – interview, psychometric, observations Therapy – family therapy, play therapy, CBT, psychodynamic therapy depending on the problems and needs and our formulation. Consultations with other professionals to help increase understanding Teaching and Training Screen Referrals – is it appropriate, we know that from developmental theories that child behavior may be normal given their development. If we receive a referral that is inappropriate we help that service understand why. This prevents unnecessary meetings with children and young people Meetings with child and Families. Assessments – range: IQ tests, school or hospital observations Therapies – play therapy, CBT Family Therapy Consultation with families and other professionals- There may be times I will never meet the child but influence and support the people around them. Teaching and Training – to increase other knowledge and awareness of the psychological needs of children and how they can help them.

What is it like? Rewarding…and Challenging ALWAYS learning from children and young people Fun Early Intervention – hopeful! Giving improved opportunities for children, young people and their families

Thank you for listening Any Questions???? Thank you for listening Thanks for everyone for listening