1. Managing Difficult problems Ann York and Steve Kingsbury

2. Difficult problems… Features Make it hard to Let Go End point may not be clear Lots of artificial / service variation in how managed Do you have a consistent approach as a team? As an individual?

3. Table discussion A Think about families you think of as difficult or a challenge or hard work. What about the family, child or situation makes you feel this? Write each idea / reason down.

4. Chronic, complex, severe or poor alliance? Chronic?- persistent and relatively stable problem / issue Complex?- multiple problems in many areas of life or many agencies or professionals involved Severe?- problem is really bad and having major impact Alliance? – care plan between clinician and family / young person no longer aligned or appropriate May need different approaches….

5. Table discussion B Go back and classify the reasons you gave in Table discussion A using one of the four difficulties 1. Chronic 2. Complex 3. Severe 4. Alliance

6. Things you can do…

7. Chronic problems Self management Support groups psycho education Rapid access to services in crisis Be creative Shifting to a management framework from a change framework

8. Have a systematic approach to long-term problems Many difficulties are chronic, complex and severe Actively plan for these Ask users what they want Aim for self management of chronic problems Multiagency involvement with complex problems Rapid crisis response to severe problems Active use of networks crucial

9. Expert Patient programmes Run by PCTs for chronic disease management 6 weekly sessions of 150 minutes 5 core self management issues at the heart: Problem solving Decision making Resource utilisation Developing effective partnerships with health care providers Taking action

10. Complex problems Multiagency / multiprofessional planning essential Consider use of Lead Professional (ECM) Be clear about different roles of Lead Professional and Key Worker in team

11. Severe problems Usually involve significant risk e.g suicidality; risk taking behaviours; child protection Clarity of risk assessment- who does it? Not the therapist… Sharing risk assessment across network Frequent contact Be clear about roles Zoning can help

12. Alliance Problems Acknowledge that you, clinicians, the child or family or the professional system are not aligned The alliance needs to be agreed developed again CHOICE… with families or others? The goals and intervention needs review CARE PLAN Multi agency agreement

13. Table exercise Go back to your list of Chronic, Chronic and Severe problems What solutions can you think of?

14. Table discussion C Think of interventions for the families you described