PS5306 Lecture 08-10 - Dr Helen Pote PDF

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Dr Helen Pote...

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CATA Lecture 08-10-18 Assessment and case formulation with children - Dr. Helen Pote Drop in session Thurs. 11 Oct. 13-14h

Why is it important to address the mental health of young people? - Mental health problems are common - Three children in every classroom have a diagnosable mental health disorder - Childhood is a time we can intervene and make a difference to young people - Mental health problems link to a range of other difficulties - Poor school attainment - Exclusions - Teen pregnancy - Prison sentences - Drug dependency - It’s difficult to diagnose mental health issues in young people - Child mental health problems lead to adult mental health problems - Only ¼ of children in need will see a mental health professional Contexts to consider when working with children/families - Systemic context - Influence of family, peers, society, etc. - Affected by developmental/historical time (e.g. before hitting a child was okay as punishment, but now it’s more taboo; before ADHD wasn’t really a thing, but now it’s really prevalent in kids) - Genetic factors as well as socioeconomic factors to be considered - Distress is an interactive process - Child shouting and hitting → parents struggling to cope → father withdraws, mother shouting at child → parents argue → child shouting and hitting… → - When parents are distressed, children are distressed and vice versa - Chicken and egg situation - Developmental context - Necessary to have an awareness of where the child should be in their cognitive, emotional functioning, language, other development, etc. - Important to recognise a baseline - If they are struggling more than his peers, need to look more into developmental issues and relation to psychological issues - And so you’re able to communicate effectively and comfortably with the child - Development - Infancy: 0-1 year - Toddlerhood: 1-2 years

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- Early childhood: 2-6 years - Middle childhood: 6-10 years - Pre-adolescence: 10-13 years - Adolescence: 13+ years Service context - Working with professional systems around the child and family - I don’t get this one lol

Prevalence of common mental health problems - 10% of children aged 5-16 had a clinically diagnosed mental disorder - Data on prevalence from 2005: - Anxiety - Lifetime prevalence of “any anxiety disorder” in studies w children or adolescents is about 15-20% - Depression - The number of young people aged 15-16 with depression nearly doubled between the 1980s and the 2000s - Nearly 80,000 children and young people suffer from severe depression - Over 8,000 children aged under 10 years old suffer from severe depression - Conduct disorder - The proportion of young people aged 15-16 with a conduct disorder more than doubled between 1974 and 1999 - Self harm - There has been a big increase in the number of young people being admitted to hospital because of self harm - Over the last ten years this figure has increased by 68% - At risk groups - 72% of children in care have behavioural or emotional problems - these are some of the most vulnerable people in our society - 95% of imprisoned young offenders have a mental health disorder. Many of them are struggling with more than one disorder - Prevalence problems: - Old data from 2005 - Variation in age of onset - Gender differences - Self-report and retrospective data Assessing children’s difficulties and their development What is a clinical-psychological assessment? - A structured way to gather information and test hypotheses about a client’s presenting problems - Gather the info necessary to formulation and treatment plan to address the client’s presenting

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problems Answer specific questions the client/referer has about the client’s presenting problems Evaluate the client’s goals, motivation, and appropriateness for psychological interventions To establish engagement (alliance, rapport, and trust) in order to deliver a psychological intervention

Principles of assessment w young people - Collaborative - engaging young people - Attention to multiple contexts - developmental/systemic - Multiple informations - child/family/school - Multiple data sources - interview/measures/psychometric testing - Importance of observation and natural data collection (behavioural monitoring) - Leads to formulation and intervention focused on child and family goals Assessment structure - Detailed history of presenting problem - Child’s perspective - family drawing, play - Who defines the problem? Relationship to help - Family background - genogram/mapping relationships - Life cycle/transitions/trauma - Developmental history - Parent-child interaction - Functional analysis - Risk and protective factors - child protection concerns - diagnostic/symptom screening tools - cognitive/development assessments Assessment: genograms - Efficient and informative way of collating information pertaining to: - Family of origin - Current family - 3 generations - Themes and Relationships Assessment behaviour: functional analysis - Based on behavioural theory – operant conditioning - Understand behaviour in context - Identify target behaviours - ABC Monitoring, Antecedent, Behaviour, Consequences - Desired outcomes and behaviours - Praise and reward opportunities - Contracting with family and child

What is a formulation? - A detailed description of the individual client’s problems and an explanation of why the person has these problems at this time and in these situations - “A formulation is the tool used by clinicians to relate theory to practice…It is the lynchpin that holds theory and practice together…Formulations can best be understood as hypotheses to be tested” (Butler, 1998) Formulation for young people - Developmental milestones - Developmental theory - Psychological models - behavioural/cognitive/systemic - Family background/context - 5 P’s approach to formulation - Problem - Predisposing factors - Precipitating factors - Perpetuating factors - Protective factors Formulation: risk and protective factors - Risk - Genetic disorders/Illness/IQ - Difficult temperament - Peri & Post natal complications - Low self-esteem - Attachment difficulties - Authoritarian/permissive/neglectful/inconsistent parenting - Family stressors – parental mental health, divorce, neglect, bereavement - Life stressors – trauma, abuse, social deprivation - Protective - Good physical health - High IQ - Easy temperament - High self-esteem - Functional coping strategies - Family accepts/committed to solving problem - Accepts formulation - Good coordination in network - Secure attachment - Positive educational placement...