Leisure and Therapeutic Activity

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“Leisure activities give young people an opportunity to enjoy increased social inclusion.”

Department for Education, 2011

Stuff to Do, Ways to Feel Better



Cater for young people’s hunger for structure, stimulation and recognition and the ward will be a happier and more productive place. Great CAMHS wards provide a range of individual, group and family interventions facilitated by a multidisciplinary team. A timetable offering a rich blend of structured and unstructured activity, including mealtimes, group work, therapies, physical activity, play, rest periods, free time, visiting and education is a must on any mental health ward. How? With loads of creativity, imagination and flexibility. Heroic CAMHS staff have the gift of thinking creatively and flexibly yet are able to retain appropriate boundaries. They provide well-timed interest, curiosity, empathy and compassion along with mindful responses, all of which ease the experience of mental health problems for young people.
Most wards draw influence from theoretical values developed in therapeutic communities, which emphasise the importance of psychosocial nursing and a living-learning therapeutic environment. CAMHS staff should be trained, supervised and supported to be skilled in delivering a full range of specialist interventions, based upon the best available evidence.
This theme aims to champion young people having constructive, therapeutic, meaningful and enjoyable things to do while in hospital, and maintaining, as far as possible, activities, hobbies and interests from their home life. Young people often have at least one hobby or interest, and enjoying these while in hospital can be as important as enjoying them at home - sometimes more important. 15 and 16 year olds in particular, typically develop a strong interest in an artistic subject such as music or drawing, so feeling connected to this can be highly reassuring and beneficial while living in a somewhat alien place. Children are noticeably happiest when they have ample opportunity to explore their inner and outer world, through play for example (Payne & Ross, 2009). Children use play instinctively to process both environmental stress and inner conflict. Play therapy helps them make sense of distressing experiences and eases their anxiety (Lansbury, 2014). It’s also beneficial to maintain a good balance between encouraging young people to do stuff and interact with others and allowing them their own ‘headspace’. Young people often need regular, short breaks to process what they’re feeling and learning.
Structure and routine are important to all patients of all ages, but they’re essential for a developing person. The structures that are in place provide security, focus, meaning and predictability. Throughout their development, young people internalise external structures and they become part of the way they relate to themselves and the world.
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In practice, the boundaries between what is therapeutic and what is therapy can be blurred. Here’s one way to think about this:

Food labelling law states that foods with flavour from real ingredients must be called ‘flavoured’. Bear with us here… Foods made with synthetic flavour must be called ‘flavour’ e.g. strawberry flavour.

So… some aspects of ward life are flavoured by therapy and are therefore classed as formal therapy, while others have the flavour (influence, inspiration, principals) of therapy and are therefore therapeutic. Of course, there’s nothing synthetic or artificial about these therapeutic qualities!

A timetable offering a rich blend of structured and unstructured activity is a must on any mental health ward: constructive, therapeutic, meaningful and enjoyable things to do.

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Living and Learning Together



One of the central foundations of ward life is community; one that lives, works and plays well together, one that feels safe and constructive for everyone. Feeling involved, and, therefore, able to engage and interact with others, can welcome an important internal shift in the way young people experience and respond to themselves and others. Culture influences everyone’s emotional expression and management - young people and staff alike.

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In her superb book, ‘From Toxic Institutions to Therapeutic Environments: Residential Settings in Mental Health Services’, Consultant Psychiatrist in Psychotherapy, Penelope Campling says that therapeutic environments should ideally provide a living-learning experience for all involved: “This means that mistakes will be made and there needs to be a firm commitment to maximising the learning potential within the culture and minimising the temptation to blame and humiliate when things go wrong.” (A point well-made when it comes to responding to staff mistakes, as much as to those of patients.) Within this kind of healing environment, young people actively participate in their own treatment and that of others. The community can help acknowledge and celebrate achievements and success and offer rewards. This interpersonal learning is especially crucial for young people at this tender point in their development. It often happens though groups and everyday living tasks, as well as through social, creative and physical activities. Regular community meetings for example, provide a space to think about relationships, reflect on any difficulties they bring and facilitate mutual support.
Attitudes which foster therapeutic interaction:

  • Open-mindedness

  • Curiosity

  • Attending to verbal and non-verbal communication

  • Taking feelings seriously

  • Understanding, holding and containing pain


(Salzberger, 1970)
Features associated with health-promoting school cultures (which also apply to wards):

  • Warmth and positive interest.

  • Influential adult-young person model of interactions.

  • Clear messages that violence is not expected or accepted.

  • Positive, active involvement of parents and teachers.

  • The use of consistent, non-hostile, non-physical limits in a manner that preserves the dignity of all involved.

  • Positive, professional interactions between staff.


 

Source: Get Wise - see here

One of the central foundations of ward life is community; one that lives, works and plays well together, one that feels safe and constructive for everyone.

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More Milieu



When the ward offers regular opportunity to reflect on behaviours and situations, young people are able to use the space as a reference point for their own experience of themselves and others. The ‘milieu’ - a person’s social environment - is a supportive space in which CAMHS staff work with young people to provide safety and structure, while assessing and supporting their relationships and behaviour. A milieu is considered therapeutic when the programme’s community provides a sense of membership, belonging, care, accountability and civility. Young people develop civility, thoughtfulness and a considerate nature in the midst of caring and respectful behaviour. It’s important that everyone’s aware of the rules of the milieu environment, and the consequences of not adhering to them. (Dogra & Leighton 2009)
“Removal from social difficulties in the external environment and exposure to the inpatient milieu can produce rapid gains in functioning (socialisation and academic achievement) and self-esteem. Nevertheless, young people with significant social impairments may not be able to make effective use of such a socially orientated therapeutic environment. This highlights the importance of comprehensive pre-admission evaluation of the child’s suitability for treatment in a psychiatric inpatient setting. It is important that this evaluation focuses on the child’s strengths and strengths in the family environment.”

Source: NHS England read more here
A CAMHS ward based on ‘Milieu therapy’ works to provide:

  • Containment/safety - the ward provides a safe emotional and physical place to explore worries and difficult feelings.

  • Structure – the programme is carefully structured so there is a predictable routine each day.

  • Support – the young people receive support from peers, their family and staff, and are encouraged to support other young people in turn.

We explore these therapeutic principles throughout the site, especially in the Relational and Physical Safety theme.

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Typical tasks undertaken, by ward staff including staff nurses, healthcare assistants (HCAs), occupational therapists and teachers, within a therapeutic milieu:

  • Looking after the basic care of children and young people on the ward, including their safety, nutrition, comfort and cleanliness.

  • Maintaining the way space and time are organised in the unit, through activity schedules and programmes.

  • Maintaining the physical organisation and tidiness of the environment.

  • Providing structured nursing and psychiatric assessments of individual children and young people.

  • Providing individual counselling relationships with specific children.

  • Maintaining a healthy group dynamic amongst patients, through active early interventions and group work.

  • Providing specific psychological treatments such as Cognitive Behavioural Therapy (CBT) or anxiety management.

  • Providing and monitoring medications.

  • Taking part in team meetings, case conferences and presenting assessments.

  • Managing interactions with families at visiting times, including informal but intense communications from distraught or angry parents.


 

Source: National CAMHS Support Service - read more here

 
Treatments on offer often include:

  • Cognitive Behavioural Therapy (CBT)

  • Regular individual therapy

  • Therapeutic group work

  • Sibling, parent and family work

  • Social skills work

  • Anger management

  • Relaxation

  • Anxiety management

  • Psychosocial interventions

  • Life skills work

  • Dialectical Behaviour Therapy

  • Therapeutic groups for parents

  • Groups with child and parent/s together

  • Psycho-education for both young people and families on the reason for admission, including depression, risk to self, drugs and alcohol, psychotic symptoms, psychosis, bipolar or an eating disorder.

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Young people develop civility, thoughtfulness and a considerate nature in the midst of caring and respectful behaviour.

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“I've found there’s a simple way to retain children’s attention, and through this to inspire them: the more activities you get through when they are learning, the more different approaches you take to the same problem, the more they will retain that heightened state of alertness and near excitement they’ll need to make them associate learning with pleasure.”

Phil Beadle, Secondary Teacher of the Year 2004

Could Do Better!: Help Your Kid Shine At School
“I think mindfulness meditation is helpful for people who have mental health problems and learning disabilities. It has helped me to let go of stress, anxiety and my fear of falling down onto the ground. It has helped me in the community and also at home. Mindfulness is about being more aware of your thoughts and changing how you think about things and how you think about yourself. It looks at what is happening now and not worrying about the past or the future. I learned about mindfulness because I did a course which taught me how to practice it. I practice it everyday at home. It has helped me to feel at peace.”

Source: a service user via cnwl.nhs.uk - read more here
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The Benefits of Feel-Good Activities



  • Seeking help and receiving it provides valuable advice and relief from problems.

  • Mindfulness and meditation promote relaxation while alleviating anxiety, through focusing on the present and regulating breathing.

  • Being with animals provides comfort and an opportunity to be responsible and caring.

  • Giving challenging activities a go promotes motivation and an ‘I can’ attitude.

  • Creative interests keep all areas of the brain active and offer distraction.

  • Charity and voluntary work develops empathy and promotes feelings of fulfilment.

  • Socialising develops bonds and connections outside the family.

  • Having conversations helps to put problems in perspective and prevents emotions being bottled up.

  • Music relaxes, distracts from worries and allows for self-expression.

  • Space and peace calm stress chemicals and relax the mind.

  • Exercise releases feel-good endorphins, boosts energy and reduces stress.

  • Regular and good-quality sleep reduces stress levels and improves wellbeing.

  • Team sport improves social bonding and helps to let off emotional steam.

  • Family games promote bonding, improve self-control and morality and are fun.

  • Being outdoors promotes feelings of wellbeing.

  • Accurate goal-setting reduces negativity and disappointment.

  • A job gives a sense of purpose and financial reward.

  • Family mealtimes offer social bonding, positive interaction and spontaneous discussion.

  • Trust-building activities on the ward help to build the therapeutic relationship between the young person and staff members.


 

Source: adapted from Downshire & Grew 2014

Teenagers Translated: How to Raise Happy Teens
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Doing Things Together



Ward groups offer time to reflect with others, and an opportunity for safely trying out new behaviours and ways of interacting. It all starts with a predictable structure and reasonable rules - and making these clear so everyone knows where they stand. Oh yes, and having fun, lots of therapeutic fun! In a relaxed environment, staff can engage in activities whilst staying attentive to everyone’s whereabouts and needs.

An A to Z of Ward Leisure and Therapeutic Activity



A. Arts and crafts, Anxiety management, Assertiveness group.

B. Breakfast club, Bedroom tidy up, Board games, Books, Badminton, Basketball, Baking, Bingo, Beauty sessions, Boys’ group.

C. Community group, Cognitive Behavioural Therapy, Compassion Focused Therapy, Computers, Core stability exercises, Cookery, Cards, Chill out time in bedroom, Cycling, Complex medication management, Creative therapies, Changing behaviours, Conservation projects, Café.

D. Debrief groups, Dietician-led sessions, DVD Night, Dialectical Behaviour Therapy (DBT), Drumming, Dietetic home leave group (menu planning for home leave), Drama, Drug and alcohol work, Duke of Edinburgh Awards Scheme, Dance and movement.

E. Education sessions, Expressing emotions, Expression-through-play.

F. Football, Fitness programmes, Free time, Fishing, Family therapy, Flower meadow planting.

G. Goal setting, Gym sessions, Gardening, Game consoles, Girls’ group.

H. Hobby sharing, Hair and beauty sessions, Healthy living and eating sessions, Horse riding, Have your say group.

I. Internet, Indoor climbing, Interactive stimuli.

J. Jokes! Journaling.

K. Keeping safe group, Kite flying, Karaoke.

L. Lunch/ sandwich club (OT), ‘Listening posts’ providing young people’s poetry.

M. Mindfulness, Music, Moving forward group, Multisystemic Therapy (MST), Musical instruments, Menu planning group (OT), Morning meeting, Music room including mixing table and keyboard, Multi-faith room, Morning social break for staff & young people, Mindfulness group.

N. National Navigation Award Scheme.

O. Occupational Therapy-led sessions, Orienteering, Out and about group.

P. Physical activity, Pets as therapy, Parent group, Problem-solving activities, Pool, Physiotherapy, Post meal support, Physio education group, Pottery, Prosocial problem solving skills training, Preparing for future, Play therapies, Psychometric assessment, Parental work, Psycho-education.

Q. Quiz time, Quiet area.

R. Relaxation, Rugby, Rounders, Reading.

S. Social activities including shopping and visits to local attractions, Swimming, ‘Step Ahead’ planning group, School, Skills sessions, SMART Soccer, Sensory room, Self, Spiritual care, Study time, Stop & Think, Speech and language therapy, Self-esteem group, Social skills.

T. Teacher-led classes and support, Table tennis, Team games, Team-Building group.

U. Understanding emotions group, Ukulele.

V. Visiting time, Violence reduction and anger management.

W. Ward outings, Wii dance, Woodwork, Walks and sports and exercise

X. X-ercise??

Y. Young people-led activity, Yoga with tutor, Youth club.

Z. Zoo trips, Zoo days.
“The Base also offers various enrichment activities such as outdoor education, cooking and drumming which many young people report they enjoy.”

Source: ward staff via here
“Keeping busy is important and we have lots of activities on offer! The centre has an allocated occupational therapist and activity planner, who organise activities on and off the unit each week.”

Source:  tewv.nhs.uk
“Planned groups are an opportunity to impart psycho-education material, and working as a team we can buffer any tensions and conflicts, and help sustain rules and find solutions.”

“If you provide your child with lots of imaginative, exploratory activities, you will activate the seeking system in her brain.  When this system is working, your child will have an appetite for life, curiosity, and the drive and motivation to make her creative ideas into a reality.”

Margot Sunderland, Child Psychologist

The Science of Parenting
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yponline

 

Young people are spending more time playing and socialising online than watching television programmes, according to an annual Childwise survey tracking children's media behaviour in the UK.

Among those watching TV, the Netflix on-demand service was more popular than any conventional television channel.

There was also a surge in children's ownership of tablet computers, up by 50% compared with last year.

The average time spent online is now three hours per day, compared with 2.1 hours watching television.

Children go online to watch videos, listen to music, play games and research their homework - and older children use it for social networking, particularly among girls.

The study reveals that however young people are accessing the internet, YouTube is the dominant destination.

The video-sharing website is used every day by almost half of all five to 16-year-olds, most often through a mobile phone or tablet, to watch video clips, listen to music and use games-related material.

They particularly want to see "funny" content on YouTube, but about a third watch "how-to" videos, including how to play computer games.

YouTube is also a popular way of watching television programmes, used by 74% of young people, compared with about 40% of this age group who watch programmes through the BBC iPlayer, which is the most popular of the broadcasters' on-demand services.

Apart from YouTube, other popular online destinations are Snapchat, Instagram, Minecraft and Facebook.

The study also suggests the technologies that are disappearing. A shrinking number of young people listen to music via a CD player, with mobile phones now the leading medium.

It also warns that printed magazines are losing their appeal, with diminishing numbers of regular readers.

 

Source: BBC News | http://www.childwise.co.uk/
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A Day in the Life of a Young Person On a Unit



To give you an idea of what it’s like to stay on a unit, here’s one young person’s account of a day on the ward. Source: withuinmind.nhs.uk

“On a week day I get up at 8.30am, get dressed, then go to the dining room where I have breakfast and sit with my friends. I then watch TV or play on the Wii until 9.30am when education starts.


In education we learn lots of different subjects. We usually start with a wordsearch or puzzle to wake us up! Then we have a break at 10.30am until 10.45am, when we usually sit and chat. We go back into education again until 12pm when we break for lunch and finish education at 1.45pm.


In the afternoon we can choose the activities we want to do. I like arts and crafts, baking and playing table tennis. On Mondays and Thursdays at 2pm we have ‘group’ for an hour, which is when we do activities with the psychologist and other members of the team.


In ‘group’ we have a chance to express ourselves without any pressure. It’s really fun and we even get chocolate biscuits! After this, we spend some more time on the ward or go out for a few hours.


At 5pm we have dinner and then I like to have one-to-one time, which is when we’re able to talk to a member of staff in private. We then have an opportunity to have a nice relaxing bath before going to bed at 10pm.


On weekends we can get up later than during the week. I usually get up at 9.30am and help cook the communal breakfast. In the afternoon we can go on trips. My favourite trips are to the cinema, the park, bowling and the seaside. Family and friends visiting is easier at weekends as we aren’t in education or groups. In the afternoons, I like to bake and draw. We also get to stay up till 10.30am at weekends.


My time on the unit has really helped me, as I was able to discuss my problems with staff. I’ve made some really good friends and now feel happier and better about myself.


Please remember, there’s no need to be scared, it’s not forever.”

Interview with a former CAMHS unit patient



JS: “What was your life like before you came onto the unit?”
YP: “Horrible, I wasn’t catching buses or going to public places.”
JS: “When someone first asked you about coming into the unit, what did you think? What were your worries?”
YP: “Scared, I didn’t know what it was going to be like.”
JS: “What sorts of things happen on and off the unit?”
YP: “School, outings, ice skating, cinema, groups.”
JS: “What changes have you made in your life since coming to the unit? What things are you doing now that you weren’t doing before?”
YP: “Getting on buses, going to public places, made new friends, achieved my goals, college.”
JS: “What would you say to someone who is worried about coming here to the unit?”
YP: “It’s really good, they help you a lot. There’s no need to be scared.”

Source: bch.nhs.uk

My time on the unit has really helped me, as I was able to discuss my problems with staff. I’ve made some really good friends and now feel happier and better about myself.

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Featured Tools and Ideas


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Normalising the Experience for Young People 

While young people wanted more activities to keep them busy, chatting with staff about normal, everyday subjects was seen as very important. An inpatient stay is not a usual part of development, so many staff acknowledged the importance of normalising the experience for young people. Some young people found a constant focus on ‘mental health’ detrimental, and wanted their treatment and care to be integrated into the context of their lives.

Source: Where Next by YoungMinds


Music therapy reduces depression in children and adolescents

Researchers have discovered that music therapy reduces depression in children and adolescents with behavioural and emotional problems.

Read more here


“Time to Shine”

The Wirral CAMHS Primary Mental Health Worker Team developed a skill-based, five-week Mindfulness Group. The group was originally called the Mindfulness Group, but the young people involved weren’t keen on this name and quickly renamed the group “Time to Shine”. The group started as a result of feedback we’d had from other young people that had been involved in our CAMHS service, who suggested there was lots to gain from meeting other young people in similar situations and having a forum of mutual support and understanding.  Having listened to the young people over four months, we ran two Mindfulness groups for any young person between 12-16 presenting with mild-moderate anxiety or low mood.

More: here


Listening for Holistic Wellbeing

It’s well known that music can lift our spirits; but now science has shown it also has a physical effect on our bodies. As we listen, music works on the autonomic nervous system, which is responsible for controlling blood pressure and heartbeat as well as the limbic system, responsible for feelings and emotions. A review of 23 studies involving almost 1,500 people found music helped to reduce blood pressure, heart rate and anxiety in heart disease patients.  Music can benefit our psychological wellbeing too. Research from the University of Missouri, published in The Journal Of Positive Psychology, found for the first time that upbeat music could have a very positive effect on our wellbeing.

More: psychologies.co.uk


 Creating A Living-Learning-Leisure Balance

The team works in partnership with each young person and their parents or carers to establish what treatment works best for them. They also encourage the young people to express themselves creatively and have established a successful arts programme. Young people also benefit from an on-site school and are encouraged to take part in a range of fun activities including cookery, IT and games, which not only enhances their treatment but also supports their rehabilitation by building confidence and developing social skills. The service also has access to the Woodland Retreat; an innovative on-site annexe for young people to use as a learning or leisure base.

From withuinmind.nhs.uk


Social Skills Group

A social skills group based on a positive approach where the focus is on the young person’s strengths, rather than on their difficulties. Topics explored within the group include bullying, anger, friendship and loneliness. These emotive subjects are presented in an approachable and non-confrontational way. The group is very structured and combines using worksheets with games and relaxation. It uses cognitive behavioural techniques to help young people identify feelings, both their own and those of other people.  (Holmes et al 2011)


Local Garden Expert

“We appreciate regular visits from a local gardener who helps guide us on the use of our allotment. The allotment includes vegetables, herbs, flowers and a sensory garden. Vegetables and herbs are used in our weekly cooking sessions. Young people participate in planning, planting, maintenance and harvesting and benefit hugely from the encouragement and knowledge of our local expert.”

From simmonshouse.org


Aims of Occupational Therapy

 

  • Provide a supportive rehabilitation service, which encourages individuals to maximise their potential in, and through, day-to-day activities connected with daily life.
  • Encourage creativity and promote the use of meaningful activities in everyday life.
  • Increase individuals’ skills and levels of independence, both whilst on the unit and in the future.

 

Adapted from camhsnottinghamshirehealthcare.co.uk




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Mindfulness as a standard part of the school curriculum.





COLOURFUL Themes Menu

Caring Relationships
Opportunity and Expression
Leisure and Therapeutic Activity
On and Off the Ward
Understanding
Relational and Physical Safety
Family and Friends
Unique Recovery Journeys
Leisure and Growth