1. Clinical Psychology Services Dr Clare Roberts Consultant Clinical Psychologist Child and Adolescent Mental Health Services (CAMHS) Glasgow City Community Health Partnership South Sector

2. Overview Psychology of Parenting Project Language and definitions Who we are and what we can offer What you can do How and what to refer to us Useful resources

3. Psychology of Parenting Project

4. Language..and the importance of! Mental health problems/difficulties/issues Psychiatric disorder Emotional and behavioural difficulties Psychological difficulties/disorders Externalising = not defining the person by the difficulty

5. Part 1 Who we are and what we can offer

6. Who we are Many Clinical Psychologists work within multi-disciplinary Child and Adolescent Mental Health Services (CAMHS) Also, unidisciplinary psychology services Community and inpatient settings

7. Who refers to us? 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

8. 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

9. 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

10. 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

11. Assessment 2 Standardised measures School observation Liaison with other involved professionals Review of case notes

12. Assessment 3 Develop a formulation and share with family and professionals From this a plan of intervention (if needed) can follow

13. Some helpful info on typical development/children’s needs

14. 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

15. Child’s Basic Needs (Douglas, 1993) Physical Care Affection Security Stimulation of innate potential Guidance & control Responsibility Independence

16. What we do Pre-referral advice, incl. signposting Direct clinical work  assessment, formulation, intervention  Child/parent/family/group/system work Capacity building Teaching/training Consultancy

17. 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

18. www.incredibleyears.com

19. Part 2 What can you do?

20. Why might you see difficulties? Put the behaviour in context:  Child factors eg poor physical health  Parental eg mental health issues/drug use  Social eg unemployment/overcrowding  Developmental stage Many behaviours considered problematic in older children e.g. defiance, anxiety in new situations & lack of emotional & behavioural control may be part of normal development in younger children (Wener, 1994)

21. 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

22. Engaging with parents cont. Listen carefully Empathise Respect their views Think problems through together Empowering clients Attribute changes in child’s behaviour to parents efforts

23. 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

24. Some overarching principles for parents Adults as role models Calm, patience, timing Focus on encouraging acceptable behaviours Consistent routines Predictable responses Praise, rewards, distraction

25. 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

26. 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’)

27. 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

28. Part 3 How and what to refer

29. 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 problems→Educational Psychology

30. 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, this needs to stay with school/Educational Psychology

31. When to refer 3 Think 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

32. Helpful resources Parenting resources:  www.incredibleyears.com www.incredibleyears.com  www.bbc.co.uk/parenting www.bbc.co.uk/parenting  www.triplep-staypositive.net www.triplep  www.parentingacrossscotland.org.uk (incl.parentline on 0800 028 2233) www.parentingacrossscotland.org.uk  Leaflets for parents: www.rcpsych.ac.uk/mentalhealthinfo www.understandingchildhood.net

33. 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.ukwww.sclc.org.uk Children, physical punishment and the law leaflet www.scotland.gov.uk/publications/2003/10/18406/28340 www.scotland.gov.uk/publications/2003/10/18406/28340 Excellent resource for professionals: www.handsonscotland.co.uk www.handsonscotland.co.uk

34. 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