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Thinking Together: A collaboration of pediatricians and psychiatrists to improve patient care at the mental-physical interface for children and young people
No full textOnly 33 percent of London trainees surveyed felt that their current training program enabled them to achieve curriculum requirements in pediatrics or child and adolescent mental health. Child and adolescent mental health services (CAMHS) are increasingly stretched, raising referral thresholds, and making the need for working closer together across disciplines paramount. A working group of pediatric and psychiatry trainees developed the concept of Thinking Together to tackle this training gap. The scheme involves pairing pediatric and CAMHS trainees to share in each other's clinical encounters to foster a joint way of learning and working together, while fulfilling curriculum competencies that are otherwise difficult to achieve
Staying put & continuing care: The implementation challenge
No full textThe article is based on a qualitative study of residential child care practitioners’ views and perspectives of the blocks and enablers to the implementation of staying put and continuing care practice with three Scottish local authorities. This small-scale qualitative study involved semi-structured interviews with nine residential practitioners, working in five children’s homes across three Scottish local authorities. Key findings highlight issues around learning and development opportunities for practitioners; the importance of managers and leaders in
creating enabling contexts for practice; the challenges of resource pressures and limited capacity in the sector; and key issues around established culture and practice. What emerged was a consistent narrative of a complex, contradictory, nuanced context within which residential child care practitioners operate. The paper discusses these findings within the current context of challenges to implementing child care policy and the need to establish ‘a new norm’ for looked after young people transitioning from residential care settings
Interprofessional simulation training to promote working with families and networks in mental health services
No full textObjective: Working with the families and networks of patients with mental illness has significant benefits. There are, however, numerous barriers to this way of working, meaning that it is not universally privileged in mental healthcare services. This study evaluated the impact of an interprofessional simulation (IPS) course on working with families and networks on participants' confidence, attitudes, and perceived future clinical practice. Methods: A one-day IPS course pairing high-fidelity scenarios with reflective debriefs was developed. Simulated patients were engaged to portray patients and family members. Participants were mental health professionals from a variety of medical, nursing, and allied health professional backgrounds (n = 105). A mixed-methods approach to data collection was adopted, comprising pre- and post-course quantitative data on confidence and attitudes towards working with families and networks, and post-course qualitative data on participant experience and learning. Paired samples t tests and thematic analysis were conducted on the respective data sets. Results: Participants' overall confidence and attitude scores showed statistically significant improvements with large and medium effect sizes, respectively. Thematic analyses identified several perceived improvements in areas related to the following: personal professional development, interprofessional and team working, and patient care and experience. Key pedagogical features of IPS were also highlighted. Conclusions: These findings support the use of IPS to improve clinicians' capabilities in undertaking systemic work while also supporting its ability to alter clinicians' ways of working in general. The importance of interprofessional and team working for this was also highlighted. Longitudinal evaluation of the training's impact on clinical practice is warranted
How do staff in a post-16 college co-construct social, emotional and mental health (SEMH) needs in their setting? A discourse analysis
No full textIn the past three years, the Educational Psychologist (EP) profession has undergone significant developments as a result of the revised Special Educational Needs and Disabilities (SEND) Code of Practice (Department for Education, 2014). Two specific changes outlined in the SEND Code of Practice underpin the purpose of this research. The first was the change in terminology from Behaviour, Emotional and Social Development (BESD), to Social, Emotional and Mental Health (SEMH), as one of the four broad categories of identified SEND. The second change was the extended age range of which the SEND Code of Practice now relates to: 16-25 years. The aim of this research was to explore how college staff co-constructed SEMH needs in their setting, to offer a valuable insight as to how EPs can best support similar settings in the future. Existing literature highlighted an absence of EP research on SEMH needs in post-16 education, or how college settings conceptualise SEMH needs. This study used a Discourse Analysis approach to explore how participants in a focus group (6 staff members in a sixth form college) co-constructed SEMH needs through their discourses, and a social constructionist epistemology underpinned the approach to this study. The identification of dominant and suppressed discourses illustrated variation in the staff members’ talk, suggesting the difficulties and dilemmas that arose when co-constructing a term such as SEMH. Emphasis placed on various discourses of SEMH was seen to impact on practice, highlighting the importance in identifying dominant and suppressed discourses of SEMH in educational settings. The college setting was seen to hinder and support SEMH needs simultaneously, and contrasts between disempowering and empowering students and staff to manage SEMH needs were explored. The emotional energy required to work with adolescent students was highlighted, and the extent to which discourses of pathologising students with SEMH needs functioned to defend against social anxiety, was also explored. The role of reflexivity throughout the research process, strengths and limitations of the study, and implications for EP practice were discussed
Therapist self-disclosure and the therapeutic alliance in the treatment of eating problems
No full textEvidence is mixed regarding the potential utility of therapist self-disclosure. The current study modelled relationships between perceived helpfulness of therapist self-disclosures, therapeutic alliance, patient non-disclosure, and shame in participants (n = 120; 95% women) with a history of eating problems. Serial multiple mediator analyses provided support for a putative model connecting the perceived helpfulness of therapist self-disclosures with current eating disorder symptom severity through therapeutic alliance, patient self-disclosure, and shame. The analyses presented provide support for the contention that therapist self-disclosure, if perceived as helpful, might strengthen the therapeutic alliance. A strong therapeutic alliance, in turn, has the potential to promote patient disclosure and reduce shame and eating problems
'Thinking together' - a grass-roots project addressing an analogous experience of training issues in CAMHS and Paediatrics
No full textFisher and Teodorczuk highlight significant concerns in the care of the elderly population: that geriatricians are not suitably trained in mental health treatment and old age psychiatrists are similarly underprepared to recognise and manage physical health problems. They identify the unhelpful splits between services which should work hand in hand, as well as being trained side-by-side.
The problem is a familiar one for those of us working at the other end of the age spectrum. With the precipitous rise in mental health problems in those under 18, paediatricians are increasingly presented with problems in which they feel they lack expertise, particularly risk management in crisis admissions with self-harm or overdose. Equally, CAMHS trainees tend to deskill rapidly and lose confidence with regards physical health issues (even those as basic as physical examinations, reading ECGs and interpreting blood tests).
Both sets of trainees have a number of mandatory curricular competencies which can be difficult to come by in day-to-day practice, especially as services come under increasing strain. Just as in the elderly population, specific local services may be delivered by one specialty or another, but there is little consistency on whom leads (for example ADHD or ASD services).
To solve this worsening problem, a small group of trainees from London devised a 6 month pilot scheme to link trainees from each specialty - we called this the "Thinking Together" project. The simple and cost-neutral concept was to forge links between the specialties at a trainee level, by allowing attendance and participation in each other's outpatient clinics. We hoped to foster a novel, joint way of learning and working together
