Mental health training for community paediatricians: survey and proposal

Questionnaire Survey of BACCH Members to Ascertain Perceived Training Needs in Child Mental Health

Rachel Atkinson, Max Davie

Introduction

The work of Community Paediatricians has a large and increasing behavioural/ mental health component, involving both joint work and liaison with CAMHS, and work within community health services, education and social care aimed at promoting and safeguarding the emotional and mental well-being of children and young people. As a result, Community Paediatricians frequently voice a need for greater understanding of children’s mental health. Informally, this has been found to include requirements for better understanding of the relationship between emotional and developmental processes, ways of working with families around behaviour, as well as specific therapeutic methods and ways of working in specialist CAMHS.

The aim of this survey was to develop this informal understanding into a more rigorous analysis of the training needs of Community Paediatricians in this area, with a view to developing training materials and courses, jointly between BACCH and BPMHG.

Methods

A survey was designed using Survey Monkey, and sent via the BACCH electronic mailing list to all members in August 2013. The survey questions are shown in the Appendix. A ranking scoring analysis was applied to questions requiring respondents to rank their opinions. A higher score indicates that a particular response was given a higher number of top rankings in composite.

Results

64 responses were received, out of a BACCH emailing list of 1089

60 of 64 respondents (93.75%) said they would value training in child mental health. The answers given by respondents to the questions asked are shown below.

1.“How often are Child Mental Health skills and knowledge involved in the management of the children you see?”

Most people felt they need skills in mental health for every, or most children seen.

Answer givenNumberPercentageEvery time I see a child  3554.69Every one or two days  1929.69Once or twice a week57.81Once or twice a month  34.69Total62100

2.“If training was offered by BACCH/ PMHA what form would you prefer?”

Respondents ranked answers by preference. Average ranking was fairly even, though a blended model of training was the most popular, with E-Learning second.

Answer givenRanking composite scoreBlended model2.9E-learning2.59Series of one day events2.33Single course over several days2.21

3.“How far would you be prepared to go for this training?”

Most respondents were happy to travel for training, within reason.

Answer givenNumberPercentageAnywhere in the UK (within reason)  2539.06Within my deanery  3148.44Within my local area.  812.50Total64100.00

4.“What in your view would be the main purposes of training in Child and Adolescent Mental Health for Community Paediatricians?”

Respondents felt that skills would enable better practice rather than better referral.

Answer GivenAverage rankingTo Give clarity to our analysis2.98For a holistic approach2.94To enable Paediatricians to help with behavioural problems 2.52To enable better referral to CAMHS1.58

5.“Please indicate which topics within Child and Adolescent Mental Health are of most interest to you”

Answers were ranked by preference, and two groups of answers clearly emerged. The skills relating to everyday practice formed a more highly ranked group, with high ranking scores (6 to 8), and the other group comprised specific therapeutic skills, was less in demand, with lower scores (3 to 4). In the table below the shaded answers in the top part of the table below represent the popular interests. This seems to reflect a desire among respondents to improve everyday Paediatric practice by improving skills and understanding.

Answer GivenComposite Ranking ScoreGaining skills to help families who are struggling with their children’s behaviour7.84Understanding Attachment, its relationship with neurodevelopment and its consequences7.24Gaining skills in engaging with children to get their views and perspective6.70Gain skills in detecting disorders and disturbances of mood, intervening and referring appropriately6.30Gaining skills to promote and safeguard good mental health in all children and young people6.09Helping children and young people with long-term conditions to safeguard their mental health4.86Understanding the nature and management of Conduct Disorders, and their relationship to development4.74The appropriate use of psychopharmacology in community paediatrics.4.51Understanding Family Therapy and its use3.67Understanding Cognitive Behavioural Therapy and its use3.33

6. Characteristics of Respondents

How long had they been in their current post? The answers varied between 1 and 27 years

And how senior or junior were the respondents? They were a mainly senior and experienced group.

What group of doctor?Number (percentage)ST 6 to 82 (3.23%)Staff Grade Doctor  3 (4.84%)Associate Specialist16 (25.81%)Consultant41 (66.13%)

Conclusions

The conclusions of this survey need to be treated with some caution, as the response rate was relatively low, but on the other hand they accord with our own informal discussions with colleagues. The important conclusions are these:

1. Community Paediatricians as a group, would value training in Child and Adolescent Mental health.

2. This training would help them do a better and more satisfying assessment and management of the children seen on a daily basis.

3. Training should focus not on specific paediatric diagnoses, but on generic mental health skills.

4. The training should focus on improving skills for everyday assessments, not so much on learning new techniques such as Cognitive Behavioural Therapy

5. A blended model of learning, combining e-learning, study days and tutoring, is preferred.

6. Although many people are prepared to travel far for this training, there is a strong preference for local availability.

So what do we intend to do about this?

In a joint venture between BACCH, the PMHA and the RCPCH, we plan to deliver as close to the training that BACCH members want as we possibly can. We need to start small: partly due to resource constraints, and partly because we need to learn from every step.

In mental health work the need to back up relevant knowledge with well-honed skills and reflective, considered attitudes. Our model reflects the fact that simple didactic study days cannot fulfil this function.

The proposed model is as follows:

September-December 2014: Delegates sign up for training, and commit to complete 4-6 e-learning modules from MindEd and the Healthy Child Programme (precise details tbc). Anyone working in community paeds is welcome, from ST4 to clinical director.

January 2015: Delegates spend time thinking about the mental health aspects of their work and prepare an anonymised case to discuss with the group

February 2015: the study day: How to manage emotions and behaviour in community practice, is held at the RCPCH. The day will be practice-based, with Q&A expert sessions interspersed with case-based small group workshops.

We propose to run the workshops on:

Helping families to understand and influence children’s behaviour

Advanced skills in engaging with families, children and young people

Detecting disturbances of mood in children and young people

And expert Q&As on:

1. Understanding attachment in the context of psychological development.

2. Promoting and safeguarding mental health in children and young people

Ongoing support: certificates will be issued at the end of the study day, but those who wish to will be invited to join the PMHA Google+ group, for further facilitated discussion.

What happens then will depend on you!

We want to know what YOU think of our proposed model, and whether you think our survey is representative of the true training need in Community Paediatrics. Have we missed out a crucial workshop we MUST have in February? Email maxdavie@gmail.com or leave a comment under this article at pmha-uk.org. We look forward to hearing from you.

Appendix: Questionnaire

Please take the time to answer these questions and give us your view:

1. Would you value extra training in current methods and knowledge in treating and preventing problems with children’s/family’s mental and emotional health?

Tick one:

Yes

No

2. In your view how often are Child Mental Health skills and knowledge involved in the management of the children you see?

Tick one:

Every one or two days

Once or twice a week

Once or twice a month

Other, plase specify……………………..

3. If training was offerred by BACCH/ BPMHG what form would you prefer

Please rank by preference

A series of one day events spread over a six to nine month period,

A single course over several days

An e-learning module/series of modules

A ‘blended learning’ model of e-learning combined with study days and tutoring.

Other: Please specify……………………………………………

4. How far would you be prepared to go for this training (tick one)

Anywhere in the UK (within reason)

Within my deanery

Within my local area.

5. What in your view woud be the main purposes of training in Child and Adolescent Mental Health for Community Paediatricians?

Please rank by preference

To help give clarity in the initial assessment of complex cases to inform a clear management plan

To enable paediatricians to work with families encountering problems with behaviour, feeding, sleep, toileting, physical symptoms etc.

To enable Community Paediatricians to refer to specialist CAMHS more appropriately

Other, please specify……………………………………………………………….

6.Please indicate which topics within Child and Adolescent Mental Health are of most interest to you:

Please rank by preference

Gaining skills to help families who are struggling with their children’s behaviour

Gaining skills to promote and safeguard good mental health in all children and young people.

Gain skills in detecting disorders and disturbances of mood, intervening and referring appropriately

Understanding Attachment, its relationship with neurodevelopment and its consequences

Understanding Family Therapy and its use

Understanding Cognitive Behavioural Therapy and its use

Understanding the nature and management of Conduct Disorders, and their relationship to development

Helping children and young people with long-term conditions to safeguard their mental health

The appropriate use of psychopharmacology in community paediatrics.

Other, please specify……………………………..

7. If you have any comments or ideas on Mental health training for Community Pediatricians please write them here:

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