National trainee day for paediatric mental health

Date:     7th January 2016

Venue: Conference Room, Children’s Neurosciences Centre, St Thomas’ Hospital, First Floor, Block D, South Wing, Westminster Bridge Road, London SE1 7EH. Tel: 020 7188 7188

This training day is designed to provide information and practical advice on various diagnostic and management issues related to mental health of patients and/or their family across acute and community paediatrics. We have focussed topics around those “most wanted” by Paediatric Trainees in a recent UK-wide survey.

Programme:10:00     Registration and coffee

10:15     Medically unexplained symptoms

Dr Lee Hudson, Consultant Paediatrician,  Great Ormond Street Hospital & Honorary Research Associate, Institute of Child Health

11:15     Self harm and emergency assessment

Dr Esther Sabel, Consultant Child and Adolescent Psychiatrist, Hertfordshire CAMHS

12:15     Lunch

13:00     Eating disorders – what do Paediatricians need to know and do?

Dr Nasima Matine, Consultant Child and Adolescent Psychiatrist, The Phoenix Centre, Cambridge

13:45     Behavioural and emotional difficulties – workshop

Dr Nicola Herberholz, Consultant Paediatrician/Paediatric Mental Health and Dr Bo Fischer Specialist Registrar in Paediatrics/Paediatric Mental Health

14:45     Coffee                                                                                                            

 15:00     Paediatric liaison

Dr Rory Conn, Specialty trainee Child and Adolescent Mental Health and Darzi Fellow in Quality Improvement and Patient Safety, Great Ormond Street Hospital

15: 45    Overview of psychological therapies and their indications

Dr Sophie Bennett, Research Associate, UCL Institute of Child Health & Honorary Clinical Psychologist, Great Ormond Street Hospital

16:30     Close and certificates

All for £50! Bargain!!

 Download application below! 

2nd_Paediatric_Mental_Health_Traingin_Day_Final

Contact :      Bo Fischer                           bo.fischer@nhs.net

Nicola Herberholz            nicola.herberholz@nhs.net

5 minute tips for anxiety in children and young people

This post allows you to give brief advice if it send that a child has problems with anxiety. It should be read after you have gone through our introductory post, and is intended for non specialists working in health services.

When to think of anxiety
Excessive anxiety is common in childhood, but is particularly common in chronic or recurrent pain (up to 80%) and in developmental conditions, especially autistic spectrum disorders.

What are the key questions to ask
Worries: in quiet moments, does the child worry about going to school, harm coming to their family or themselves, any imaginary creatures or anticipated events
Avoidance: anything that the child doesn’t do, or doesn’t want to do
Sleep: difficulty settling, frequent waking, nightmares
Eating: restrictive patterns, poor appetite

Safety checks: (seek advice if these are happening)
Is the child harming themselves, or consider doing so?
Does the child feel worthless?

What advice can you give?

There are two main forms that therapy takes, both of which can be applied in a ‘low-voltage’ fashion in non-specialist settings.

Firstly, it is helpful to draw out the thoughts and beliefs that underlie the anxiety.  This is not so that the adult can dismiss them as silly or mistaken, but so the child can be helped to compare the harmful cognitions with their other beliefs and feelings (e.g. monsters aren’t real) which can then be used to challenge the anxiety. Equally, it’s important when a child is worried about a particular event to talk through what consequences may result, and again check that the child really thinks these consequences are likely, and plausible. In some cases, especially involving social situations, it may that the child’s fears are justified, in  which case negotiation with third parties (teachers, family) would be useful.

Secondly, some kind of graduated exposure is often helpful. Say the child is scared of going to the toilet alone. Going with a parent, but with the parent then standing in the doorway would be a good start, which the child could be rewarded for. Next time, they would need to tolerate the parent being in the hallway in order to earn a reward, and so on.

These techniques are explained further in resources

Resources

This fact sheet can be a useful start for parents . Simple-ways-to-help-children-with-fears-and-anxieties

Cathy cresswell’s article in the Archives of Disease in Childhood is very good, as is her book for parents

The Mind Ed portal has a lot of information on anxiety. It’s designed for professionals, but there is really no reason why a motivated parent can’t access it, especially

The worried child

Anxiety disorders

The session on school avoidance is excellent, and there are loads of generalisable tips in it

Troubled teens – recognising and responding to the health needs of looked after young people | British Association for Adoption and Fostering

‘ Negotiating adolescence is a challenge for any young person but it is particularly difficult for looked after and adopted young people and care leavers, including those on remand. Although these vulnerable young people experience a wide range of health inequalities, and high levels of mental and emotional health difficulties, professionals may find it difficult to engage with them to address difficulties with school, relationships, sexual health, bullying, including through cyber-space, self-harming and other challenging behaviours, and to safeguard them from child sexual exploitation.
 
This fascinating conference will consider the evidence base and assist health, social care and education professionals to understand these issues and risks, and how to approach them. The themes of engagement, health promotion, building resilience and developing skills for the adult world, all of which are required to promote health in the broadest sense, are considered throughout the conference’

Couldn’t have put it better myself!
http://www.baaf.org.uk/node/7444

Building resilience in children and young people: talk by Alys Cole-King

Important to build resilience in yourselves before you can do so in others. This can decrease stigma in others if you do it openly.

Resilience is the ability to cope with adversity. Not toughness, stiff upper lip. It’s good mental well-being and resourcefulness.
Analogy of a tree in a hurricane is useful, bends not breaks.

Resilience is not a dichotomy, have it or not. Small degrees of improvement, slowly build.

Personal resilience built by respect, care

Suicidal thoughts quite common, but no-one talks about it. Taking about it will not make someone want to do it, but particular methods may be copied.

Identification of suicide risk currently very poor.

Self harm connected to suicide, although not invariably. Often an expression of distress which is temporarily relieved.

Adolescents are vulnerable to taking ‘small things’ as massive issues.

Resilience associated with optimism, self-esteem, gratitude, emotional awareness, flexibility, problem solving ability, self regulation.

One thing better is worth doing. External motivators e.g. pledges, social pressures, can help.
Gadget free time.
Mindfulness application in families needs to include self compassion. Your inner voice needs to be kind as much as possible.

Suicide prevention requires: awareness, compassion, skills, governance.
Professionals need to lose their fear of suicidal people. Need consistent assessment framework applied across professions.For pediatricians, awareness, triage, co- create, effectively refer,  common language are key.
Human factor errors important.  E.g. good assessment leads to poor documentation.
Suicidal thoughts can be classified into passive, active, dangerous and dangerous and imminent.
Talking through scenario can be beneficial.

Connecting with People is a not-for-profit organisation formed to develop and deliver training packages for a range of sectors, including healthcare, social care, statutory bodies and communities.Our modular training includes bite-size suicide awareness and prevention courses and we have also developed resources and training for young people, professionals and the wider community

http://www.connectingwithpeople.org/healthcare-front

 

Substance using adolescents: Dickon Bevington talk

Hard to work with people who don’t want to work with you. Stressful and worrying

Recommended Michael Ungar and John Weisz

Quality of service more important than number of services. Vulnerable young people can feel overwhelmed by numbers of contacts

Alternative model of multi modal worker supported by others. This support needs strong structure

Team structure helped by aggregation of marginal gains.

Networking complexity
Family system, social ecology, local service ecology, political context

Negative feedback about professionals is a way of help seeking, but corrosive to local joint working.
Respect for local practice and expertise

Mentalising is a framework for bringing perspectives together. It’s a process of wondering, reflecting on what current needs are.

Csibra and Gergely: epistemic trust
There needs to be formation of a bond by understanding the particular situation of the person in front of you.  Then teaching, persuasion can occur.

Mentalising is born in attachment.
Therapeutically, you need to ‘get’ the person before you can make progress.
The job of a therapist is to show ‘I’m changing my mind about you not I’m trying to change you’

When contacting someone, important to mark the task. Mentalising had to start with us.
Never in a set balance, constant movement around tensions.

Consider levels of dis agreement, explanation, intervention, responsibility

If this summary tantalises you, Dickon’s slides are in our Member’s area