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Types of intervention (in children and young peoples mental health services)

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20 Child & Family Clinical Psychology Review © The British Psychological Society 1. The building blocks of a psychological approach There are three basic steps to good psychological models of help or intervention. All three steps are essential to ensure that the child, young person or family are fully engaged in the process and that the first plans for treatment are as appropriate as possible with the best chance of success. For some problems, particularly at the stage of early intervention, the causes and treatment plans may be relatively simple. However, many difficulties which may originally appear simple are found to be more complex if assessed appropriately. Undertaking a full assessment before deciding on intervention is essential if the right course of action is to be developed first time with the best chance of a positive outcome.
20 Child & Family Clinical Psychology Review
© The British Psychological Society
1. The building blocks of a psychological
approach
There are three basic steps to good psychological
models of help or intervention. All three steps are
essential to ensure that the child, young person or
family are fully engaged in the process and that the first
plans for treatment are as appropriate as possible with
the best chance of success.
For some problems, particularly at the stage of early
intervention, the causes and treatment plans may be
relatively simple. However, many difficulties which may
originally appear simple are found to be more complex
if assessed appropriately. Undertaking a full assessment
before deciding on intervention is essential if the right
course of action is to be developed first time with the
best chance of a positive outcome.
Step 1: Assessment
A psychological assessment is based on our scientific
knowledge about child development and the ways in
which biological, psychological and social factors come
together for an individual child or family. As such, it will
cover the child’s developmental history and collect
evidence about their social experiences with family and
friends, significant life events and physical health. The
child’s experience in school is a key area of investiga-
tion, as are the social and economic family circum-
stances. The views and ideas of the child, young person
and family/carers, and the meaning of their experi-
ences to them from a personal and cultural perspective,
are a crucial part of the assessment, along with the goals
and wishes of the family and young person. All need to
be weighed against what is known about child develop-
ment.
The length and extent of an assessment will vary
depending on the need, from brief initial assessments
which may take less than an hour and can be completed
by one practitioner, though to complex multi-discipli-
nary assessments that may include formal cognitive,
and other psychological, assessments and may take
many hours to complete. The crucial thing is to get
enough of an understanding of the problem to
complete the next step in the model: formulation.
Assessment is not a one-off event, but is a continuous
process throughout an intervention as new information
inevitably emerges.
Step 2: Formulation
A formulation is a joint enterprise between the young
person and/or family and the psychological practi-
tioner. It summarises the child or young person’s diffi-
culties based on the information gathered at
assessment, and takes into account possible biological
factors, psychological factors and social factors that may
be impacting on their mental health. A good formula-
tion combines all these factors to explain why problems
may be happening, and begins to identify options for
appropriate ways to help – combining the evidence
base with the unique context in which the particular
child’s problems are occurring and takes into account
their views and wishes. A formulation is developed
initially through the assessment process and represents
a shared understanding which, like assessment, will
continue to evolve through any ongoing involvement.
Formulation may include a diagnosis, of an autistic
spectrum disorder, for example, but is fundamentally a
psychological understanding of the nature and causes
of the difficulties.
Section 4: Types of intervention
Julia Faulconbridge, Duncan Law & Amanda Laffan
The agreed formulation then points to an indi-
vidual intervention or treatment plan. The formula-
tions and treatment plan must consider all aspects of
the system that could be helpful to the child and should
point to where different agencies might offer different
parts of an intervention package, and consider how
these interventions should be organised and inte-
grated.
Step 3: Personalised evidence-based treatment for
young people and families
The formulation may indicate that a particular form of
treatment is most appropriate for a child or young
person, for example CBT work for an anxiety problem,
and this can then be carried out by a practitioner qual-
ified in that approach.
The formulation may indicate that more than one
approach may be helpful, perhaps at the same time,
for example, CBT for the child alongside changes to
education provision. This will require either multi-
modally trained staff and/or a team approach within
and across agencies.
For children and young people with more complex
problems or where there are difficulties in developing
and sustaining the necessary relationships, highly qual-
ified multi-modally trained practitioners will be needed
to work developmentally to craft systematic therapeutic
and support work to meet the needs. This should
involve the system around the child to meet their whole
needs and not be simply symptom-based treatment.
Evidence-based practice incorporates within and
between session outcome monitoring and joint
ongoing review of the treatment plans, which may lead
to modification of the formulation and the therapy –
these changes should always be discussed with the
young person and/or family in a process of ongoing
discussion and agreement about how best to proceed –
this should be led by the young person and guided and
advised by the therapist, as best suits the wishes of the
young person.
There will also be times when a psychological
approach is required to understand problems in organ-
isations, networks and systems. The same three basic
steps would underpin a psychological approach
assessing the nature of the systemic problems in their
complexity, agreeing a formulation with the people in
the system and then developing solutions with them,
combining psychological knowledge with their in depth
working knowledge.
Whatever domain, or part of a system, a psycholog-
ical practitioner is working in, psychological interven-
tions and care can be delivered in a variety of ways –
direct therapy should not be thought of as the only, or
indeed the best, way to intervene1. This next Section
looks at the different methods of intervention and care.
2. Direct involvement with a young person
or family
As will be discussed in each of the specialist papers in
Part II, there is a growing evidence base of what types of
therapy work best for particular problems. However, it
must be recognised that few children, especially in
specialist services, have only one problem and that
making decisions on, and delivering, the best care is
often a complex process requiring a holistic approach.
Indeed, the need for further research and the develop-
ment of new evaluated approaches is pressing if we are
to improve the psychological wellbeing of our children.
However, all psychological services should have practi-
tioners who, across the team, are able to deliver the
evidence-based treatments, as well as those who are able
to develop the plans for those with complex needs.
Whilst individual work alone may be appropriate for
some young people, with younger age groups the
evidence indicates that work is best if parents and fami-
lies are included. There may also be individual work
with a child, but this should not stand alone out of the
context of the wider system.
It should also be recognised that for some young
people, long-term support as they grow up is what is
needed to enable them to understand and cope with
the adverse circumstances in which they live, for
example, parental mental health problems. This
support functions to prevent the development of more
serious long-lasting psychological problems. But it must
be stressed, the primary aim of any intervention in the
system should be to change the difficult context in
which a child lives and not to help them cope with intol-
erable life circumstances.
Other families and young people may need to dip in
and out of direct work over the course of their devel-
opment. One example of this can be children with
neurodevelopmental difficulties whose parents may
need input at intervals depending on other factors in
the child’s life, for example, when there is additional
stress like transition to secondary school, or changes in
presentation like new and problematic rituals.
3. Consultation, support and supervision to those
who are better placed to work with the family
Many young people and families are best supported in
settings in their own communities and by people with
whom they already have relationships. Others, whilst
they would benefit from more specialist support, will
not take it up, even when access is made easier. In these
cases it may be more productive to support the people
who are already involved with them to provide appro-
priate psychological help. This may also be the best
pathway to helping the family or young person access
more specialist help later.
No 3 Summer 2015 21
Section 4: Types of intervention
22 Child & Family Clinical Psychology Review
Children and young people who are being seen by
psychological services may be causing difficulties in
other settings, for example, nurseries and schools. The
provision of consultation and support as part of a treat-
ment package will not only enable those settings to
understand and, therefore, work with the child more
appropriately and possibly enable them to maintain
their presence there, but also positively support the
more specialist work.
One model of consultation and support that could
be developed much more is peer group support. This is
specifically endorsed in Future in Mind and there are a
number of examples of such work in schools, particu-
larly around bullying. Psychological practitioners can
take the lead in developing such approaches with other
organisations like schools and youth services but will
also need to maintain ongoing involvement to reduce
risk to the young people receiving and providing the
service.
All psychological services should contain a signifi-
cant capacity to undertake consultation, support and
supervision to other settings and services. This not only
helps with the individuals discussed, but also increases
the psychological understanding and the capacity of
those staff to help a much larger population than can
be seen individually by psychological practitioners.
There will be concrete examples of this type of work
in the specialist papers.
4. Psycho-education
This type of work is valuable in all settings, both as a
prevention strategy and as an effective aspect of thera-
peutic work.
An example of its use as a prevention strategy would
be inviting parents whose children have been newly-
diagnosed with a particular condition, like Down’s
syndrome or ASD, to a series of workshops to help them
understand the nature of the condition, likely issues
and helpful strategies2.
Within therapeutic work it may be a formal part of
the therapy, for example, in CBT. It can also be
combined with group work approaches, for example,
for parents whose children are struggling in school,
home and socially as a result of ADHD symptoms3.
Julia Faulconbridge, Duncan Law & Amanda Laffan
1. Rogers, A.R., McMahon, J. & Law, D. (2011). Expanding
therapy: Challenging the dominant discourse of individual
therapy when working with vulnerable children and young
people. A discussion paper. DCP Clinical Psychology Forum, 222,
9–14.
2. McAleese, A., Lavery, C. & Dyer, K.F. (2014). Evaluating a
psycho-educational, therapeutic group for parents of children
with autism spectrum disorder. Child Care in Practice, 20(2),
162–181.
3. East and North Hertfordshire NHS Trust. ADHD psycho-educa-
tion. Accessed 19 July 2015, from:
https://www.enherts-tr.nhs.uk/patients-visitors/our-
services/adhd-add/adhd-psych-education-groups/
References
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
This paper seeks to challenge the powerful and growing discourse that individual, face-to-face therapy is best and only way for clinical psychologist to help children with mental health and emotional needs. We propose that it is timely to rechallenge narratives of what is therapeutic and argue that taking a broader definition of therapy is vital if we are to continue to help the most vulnerable and complex cohorts of children and young people.
Article
The current study aimed to review and evaluate a three-session psychoeducational and psychotherapeutic group programme for parents of children with autism spectrum disorder (ASD). The group programme was facilitated through an ASD diagnostic and intervention service within a Northern Ireland Health and Social Care Trust over a 12-month period, throughout which time 83 parents attended a three-session course covering various aspects of ASD-specific material. Knowledge of ASD, understanding of behavioural management techniques and parental self-efficacy were measured through pre-course and post-course questionnaires, completed by the parents. Participants also completed a questionnaire regarding their experience following course attendance. The data were analysed using a mixed-methods approach. Results from pre-course and post-course analysis showed that parental understanding of the social deficits and the cognitive and behavioural difficulties associated with ASD significantly increased following course attendance. Course attendance also significantly increased parental understanding of the strategies used to support a child with ASD and parental self-efficacy. Client experience questionnaires were analysed using thematic analysis, with themes centring on the importance of peer and professional support, timeliness of intervention and relevance of information covered within the course. The parents' evaluation of the course was rated predominantly as a positive experience. The importance of parents receiving involvement through an intervention programme is explored and the results are discussed in relation to potential impact on service provision, identifying future need and areas for further research.
from: https://www.enherts-tr.nhs.uk/patients-visitors/our- services/adhd-add/adhd-psych-education-groups/ References
  • North East
  • Nhs Hertfordshire
  • Trust
East and North Hertfordshire NHS Trust. ADHD psycho-education. Accessed 19 July 2015, from: https://www.enherts-tr.nhs.uk/patients-visitors/our- services/adhd-add/adhd-psych-education-groups/ References
ADHD psycho-education
  • North East
  • Nhs Hertfordshire
  • Trust
East and North Hertfordshire NHS Trust. ADHD psycho-education. Accessed 19 July 2015, from: https://www.enherts-tr.nhs.uk/patients-visitors/ourservices/adhd-add/adhd-psych-education-groups/