Understanding

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“The idea of inpatient care requires a huge leap of faith for the child, family and referring professional alike. We do not underestimate this process but truly believe that, for the small number of deeply troubled children and families whose lives have become strained beyond endurance, an inpatient admission may offer a real hope of respite, understanding and the possibility of change.”

Collingham Child and Family Centre. Read more here

Singing from the Same Song Sheet



Young people need to feel able to face their difficulties in order to learn how to understand them, work through them and move forward in their lives. Such problems are no doubt worrying, but not completely destructive if they can tap into their skills and available support to manage them, and move beyond them. This theme involves giving young patients information in a clear, relevant and manageable (too much can feel paralysing) way, and supporting them to manage their symptoms and treatment. For this to happen, involved professionals and family members also need to gain understanding. Primarily, young people need to understand themselves and be able to make the choices that are most compatible with their self-knowledge, in order to maximise their potential, their future happiness and see themselves as worthwhile and valuable.
‘Shared decision making’ is the phrase which is often used today. It’s the exchange that takes place between young people and dedicated ward staff which aims to reach a joint choice. This conversation involves all parties understanding what’s important to each other when making plans, with the young person always at the heart of things.

Your support provides a caring space for young people to process the things that are troubling them. With warmth, you can help keep their feelings, scope of options and behaviour malleable, as you nurture fruitful emotional ground around them with the compassion of your mindfulness and thoughtfulness. This can emotionally regulate the young person, even if they’ve experienced the most gruelling of traumas. They can heal from past trauma by facing it in the here-and-now, reconnecting with a place in themselves that was never traumatised - their own internal compass, which is always at hand however obscured by their troubles.
Young people, especially adolescents, often have a desperate, intense sense about them which can sometimes cause adults to act in restricting and restraining ways. It can all feel starkly bewildering. 11 to 14 year olds can seem rebellious and occasionally express moody and defiant behaviour which parents (or carers) can struggle to make sense of. Indeed, the young person themselves probably won’t fully fathom why they think, feel and act in certain ways either. They may seem intolerant and find it hard to compromise. Boys who were previously gentle and even-tempered may become much more aggressive. And, as if all that wasn’t enough to deal with, there are also the dreaded acne outbreaks!
While they are generally more chilled out and tolerant, and begin to develop greater ability to compromise, 15 and 16 year olds have their own share of woes - even without additional emotional difficulties. There’s loads of pressure from mates (and maybe genuine curiosity) to experiment with cigarettes and alcohol and to try drugs. They start to explore and (hopefully) accept their own sexuality too, and maybe form sexual relationships that involve strong feelings they may never have had to deal with before. It’s a fraught time; loads of choices and directions are presented and it can be hard to work it all out.

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On top of all this, the adolescent's intense self-consciousness about being different, ‘mad’, ‘bad’ or ‘weird’ may make it difficult for them or their parents to seek help. Unfortunately, the young person responds to their parent’s anxiety with even more acute anxiety, and then their anxieties intensify each other. While we can appreciate this angst, a parent's most important task is to get an understanding of their child’s experience and what it means to them, and connect with them in ways they can be of most support.

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It’s at this time a friendly helper is needed, someone who can help promote and maintain the family’s individuality, qualities and skills; remaining focused on positives rather than on deficiencies, while paving the way forward. A CAMHS ward is an ideal opportunity to get this special care. This theme is all about the young person (and involved family members) making the most of their time on the ward, by getting a good understanding of their current situation, what led to it and the choices available to them. Young people feel more secure, and are more able to accept help; if they sense that everyone is acting authentically and are tuned in to their world.
Young people's behaviour has meaning and purpose – it's rarely random. Putting understanding into action involves having interactions with young people that genuinely reflect your understanding of them - not merely the clinical ‘facts’ or knowledge about them, but their inherent uniqueness which unfolds organically in the here-and-now. This takes empathic imagination.

As we say in Wardipedia: "Imagination is the invisible but powerful engine of ward staff’s empathy, creativity and effectiveness. Ward staff continuously use their imagination to see things from each patient’s unique perspective and to create skilfully-tailored responses to help them recover."
“Children find out who they are and what’s meaningful to them in part when adults are able, without an agenda, to listen in a relaxed way and to reflect back their understandings and share their knowledge of the world.”

Source: Weissbourd, 2010

"I am enough of an artist to draw freely upon my imagination. Imagination is more important than knowledge. Knowledge is limited. Imagination encircles the world."

~ Albert Einstein
"In my view, we should seek to understand the lived experience of young people. Acting to change a person’s thoughts and feelings so they are more in tune with unhelpful home, school or community factors is oppressive."

Rachel Sempija, social worker - read more here
"We must redouble our efforts to support children and young people and ensure that they are getting the help they need."

Brian Dow from Rethink Mental Illness
“If you can react with empathy and non-judgment, you’ll help counter the stigma around mental illness that might be making it difficult for them to seek help. Empathy means you listen – really listen – and be in that moment with them. Be genuinely curious about what the situation is like for them rather than making assumptions. With empathy, you are more likely to work on what they would consider as potential next steps, rather than taking their control away and making it less likely that they will talk to you again in the future.”

Dilys Haner

Primarily, young people need to understand themselves and be able to make the choices that are most compatible with their self-knowledge, in order to maximise their potential, their future happiness and see themselves as worthwhile and valuable.

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A Good Grasp of What’s Happening



Understanding and trust in the ward setting are dynamic; everyone involved in the young person’s care needs a good grasp of what’s happening and what the best way forward is – including the young person of course. From the start of a young person’s admission, staff aim to gain understanding around their current emotional world, which leads on to the individual tailoring of treatments and interventions. Every young person on the ward has individual needs, and each requires different responses from staff.

Being understood feels great and young people thrive when they're shown real understanding and acknowledgement.

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Research into attachment has compellingly evidenced that there’s so much more to young people than their behaviours, and that to truly relate to and appreciate them we can’t just depend on an assessment of their behaviour. What’s vital to ask yourself is: ‘What’s at the heart of this young person beyond their words or behaviours?’ Plus, it helps to remember that a lot of so-called ‘misbehaviour’ stems from strong emotion/s the young person is feeling. Sometimes, what’s required is a willingness to look beyond surface behaviour. The bottom line is that young people who are in need of treatment should never ever be dealt with punitively, or locked up due to a lack of compassionate understanding, or a shortage of beds, for example.
Young people not only want to be seen and heard; they want to be understood, and to understand themselves as well. Before coming to the ward they may have spent time searching the web for information and advice on their thoughts, feelings and behaviour, with varying results. In fact, one survey of youngsters suggests 62% have done a general internet search on issues such as depression. Young people are turning to the internet for advice on mental health instead of talking to their school nurse or GP, it is claimed (source).
Young people love it when staff really notice them, and pay attention in a warm and curious way to what they’re doing.

What’s required is to build a relationship with each young person and create a sense of tangible belonging, and understanding is the impetus for this. Being caring means being mindful of a young person’s needs and trying to see their world through their eyes, and appreciating how holistic it is, their mental health needs are part of them, not the sum of their life. Strong collaborations with young people are what achieves this. The therapeutic relationship “…should be based upon seeing a real human being and all the potential within, not just what they are doing at that precise moment,” says Sarah Newton, a fabulous author and speaker on how to connect, engage and motivate young people. “We should see the qualities in them and not just the behaviour in front of us. These relationships must be based on trust, understanding and equality. We have no right to control another person through rewards, punishment, blaming or shaming. These practices will not produce long term success” (Newton, 2012). If the young person is going to feel able to have trust and feel understood, they need to see staff as being robust enough to cope with the entirety of their current experience.

Everyone involved in the young person’s care needs a good grasp of what’s happening and what the best way forward is.

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Helping Young People Discover Their Recovery Compass



Recovery is about a young person’s whole life, not just their symptoms and behaviour. Conversely, trying to modify their behaviour with anger, criticism and commands can cause heightened rage and/or fear reactions. The human brain has primitive emotional alarm mechanisms in the lower parts. Without emotionally responsive and consistent interaction, a young person’s higher brain can rapidly be overtaken by these mechanisms. As you will know all too well, they’re working out the limits, and so clearly and reasonably setting boundaries is essential. One example where conveying clear boundaries and expectations is critical is when caring for the hurting child who has come from a family where nearly everything was ambiguous and jumbled. Saying exactly what you mean, and meaning what you say as much as you can, is another way to bring some clarity and avoid mixed messages.
“We are each born with an inner toolbox of resources that we can draw on throughout our lives. Helping children learn to trust the internal compass of their intuition will help them steer away from trouble and toward beneficial opportunities.”

Susan Stiffelman, 2015

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While we’re on the subject of the brain, more specifically the growth of the teen brain, the magic of Magnetic Resonance Imaging (MRI) has given neuroscientists a much better understanding of what really goes on at this important time in human development. It turns out the idea that the brain is fully formed by late childhood is a huge myth. Instead, MRI technology has shown that different parts of the brain mature at different rates. In the early teenage years, the brain goes through another dramatic growth spurt. This explains the similarity between ‘terrible twos’ and the ‘traumatic teens’! But we can have loads of empathy for adolescents, because basically, their brains aren’t yet able to fully regulate emotions. One of the last parts of the brain to develop is the pre-frontal cortex, which is often described as ‘the brain’s policeman’ or ‘moral compass’, and is still under construction beyond the age of twenty. It’s an important aspect of the brain, because it gives us the ability to control emotions and make sound judgements.
"Childhood is a time of innocence and naïveté, and that innocence needs to be protected. As children get older and engage more with the wider world, we need to help them balance their natural openness and trust with an awareness of potential dangers in that world. At appropriate ages and in appropriate ways, we can encourage them to be aware of how other people are behaving toward them and to trust their own feelings and intuition. We can embody this in our own behavior, letting them know when we see people acting in ways that seem disrespectful, deceitful, or strange. We can ask them how they felt in certain situations, and support them in their feelings. Naming troubling behaviors as we see them is an important life lesson, and developing a discerning eye that is able to see how others are behaving toward us is a learned skill."

Jon Kabat-Zinn, PhD, scientist, writer, and meditation teacher
"By teaching children how their brains work and then giving them the tools to help it to stay balanced particularly in stressful situations, we believe we can create a generation of children who know how to manage their own mental wellbeing."

– LAURA EARNSHAW, MYHAPPYMIND
The Royal College of Nursing’s Practice Principles for working with young people (RCN, 2008)

  1. Make sure the young person is fully informed and involved - explain your role, how often you’ll see them and your role in relation to other team members.

  2. Use appropriate forms of communication - provide written information that’s age appropriate and/or online resources.

  3. Personalise any interaction with the young person - use a degree of self-disclosure such as an interest in things like sport and music, which may facilitate communication.

  4. Take time to listen and emphasise with the young person - use active listening and open questioning.

  5. Demonstrate trust and honesty - be genuine and honest about the care you’re providing.

  6. Set boundaries to care - explain the context of your role and professional boundaries and limits of confidentiality.

  7. Make sure the environment is appropriate for the young person - make sure first impressions are positive, such as putting teen magazines in waiting areas.



This is from a brilliant resource called 'Working within child and adolescent mental health inpatient services: a practitioner's handbook'

Recovery is about a young person’s whole life, not just their symptoms and behaviour.

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“People need safety and clarity to be able to relate to one another. The need for clarity in human relationships and organisations has been proven frequently by a great deal of research: essentially, people do not work well in climates with high levels of ambiguity and uncertainty.”

From 'What Works in Developing Children’s Emotional and Social Competence and Wellbeing?' (link) by Katherine Weare and Gay Gray, 2003

Happy Boundaries


As the above quote emphasises, experts agree that adolescents feel safest when they know what the limits are. They actually don’t expect total freedom to do exactly what they want. However incongruous it may seem, deep down they actually want you to set out the appropriate parameters despite the fact that they may challenge you. Shared rules don’t have to mean unquestioned control. In fact, they’re most effective, not when made as definitive statements, but when explored together, with questions.

For young people who’ve experienced negative control by others, control issues sadly endure. They come to associate any sense of control with pain, and therefore, are internally inclined to resist all perceived control. Of course, modelling a shared agreement works a lot better than dictating universal institutional rules. Plus of course, the best time to reason with teenagers is when they’re not in an emotional state.
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Everyone needs to follow the boundaries that are established, not just the young person. Indeed, following boundaries and rules yourself is one of the best ways to teach them!, If young people see you as basically reasonable; they will be more inclined to keep within the boundaries you’ve set. Whereas no discussion and no negotiation is likely to accumulate resentment.
When they feel understood, young people are more able to take on board other people’s perspectives.

Young people like to know where they stand and having clear boundaries and rules gives them security and helps them understand what is acceptable. This involves explaining why certain rules are in place, and being clear about what’s expected of them. Doing so builds respect and understanding, and staff act as good role models. By following and accepting your boundaries, they can develop a sense of independence and self-control, which are essential skills. Guiding and supporting young people in ways that support their dignity is a wonderful gift, helping their emerging wellbeing and their emotional and social intelligence.
“You need to be told what’s happening clearly and precisely. It’s what you think about all the time, so if staff aren’t clear to you about your care, or about why something is a certain way, it’s confusing.”

Source: A young person quoted in YoungMind's Where Next 2
Well-meaning statements such as “You have so much to live for” or “You need to focus on the positive” are often perceived as hurtful to a young person. “It can be easy for comments that sound neutral or even caring to us to sound very judgmental to someone dealing with mental-health challenges.”

Dilys Haner, a senior manager of clinical research and development at Kids Help Phone

Young people like to know where they stand. Guiding and supporting in ways that support their dignity is a wonderful gift, helping their emerging wellbeing and their emotional and social intelligence.

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Understanding the Young
Person’s World



Knowledge of child, adolescent and family development is fundamental to assessment and intervention, as it guides the team’s understanding of a young person’s needs, behaviour and attachment relationships. We strongly support the government’s suggestion that everyone working with children, young people and families should have a common set of skills and knowledge. CAMHS staff should be supported and encouraged to enrich their specialist skills, with a broader understanding of child development, mental health and psychological wellbeing.

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“Caring's also about remembering how it feels to be a child and putting yourself in your kids' shoes sometimes. It means lightening up, being playful, and having a laugh.”

Sue Atkins, parenting expert, 2007
“No subject is taboo in mental health; it is okay to ask about self-harm, suicidal thoughts, substance use, sexual or other abuse, eating behaviour and so on, as long as these subjects are broached sensitively.”

Source: Pryjmachuk & Trainor, 2015 - nursinginpractice.com 
As you’ll know, if assessment, intervention and treatment approaches are going to be of real help, it’s crucial to try to understand the young person’s own world. For example, all young people have an inherent spirituality (which isn’t necessarily experienced in relation to a particular religion or faith - see Wardipedia) which should be thoughtfully appreciated and included to achieve a truly holistic picture of their needs (Aldgate 2006). Young people’s current language, views and cultures need to be integrated into the training and development of staff. Likewise, professionals sometimes find it hard not to use mental health or medical jargon, or language that isn’t age-appropriate. The team might like to discuss how to turn medical words into young people’s language. Learn to speak their language, and they’ll be more receptive.  Co-operation and mutual respect come from knowing how to read the messages young people communicate, and responding to them with kindness and inspiration.
“As teens are figuring out who they are, they want to have control over, not just their personal lives, but also over how and when to disclose personal information. They want to control both the type of information they reveal and when and how they reveal that information. In fact, a 2004 study published in Communication Reports found that teenagers are especially sensitive when adults request information in a direct manner, so the key to getting the information you want is to be subtle and use conversation openers... When using conversation openers, keep in mind that the goal is to keep your questions gentle and non-judgmental. Always go for a soft and interested tone in your voice; loud voices beget screaming teenagers.”

Greenberg & Powell-Lunder, 2010
Through mindful and sensitive work, the team, always working at the young person’s pace, forms a relationship with them where the young person can begin to explore their thoughts, feelings and behaviours, and gradually work through their difficulties. The team can seek to interpret their countless distinct, sometimes baffling expressions and to trust their adeptness to come up with ways to respond appropriately. Focus, curiosity, and compassion are vital to this work.
"You should only have to tell your story once, to someone who is dedicated to helping you, and you shouldn’t have to repeat it to lots of different people."

The Future in Mind Report about improving Children and Young People’s Mental Health

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Working with Misunderstandings



“Communication is the best way to avoid misunderstandings”, says Sue Palmer in her groundbreaking book Toxic Childhood, “Encouraging children to talk things through helps them solve their problems, understand other people's point of view, avoid conflicts and prevent disagreements escalating into fights.”

These lists might help as you endeavour to meet your patients where they are:
Certain experiences are virtually guaranteed to provoke adverse reactions in young people. These include:

  • Criticism

  • Condescension

  • Lack of gratitude

  • Unfairness

  • Being ignored

  • Unrealistic goals / deadlines


Adapted from Downshire & Grew 2014

Teenagers Translated: How to Raise Happy Teens
However, there are plenty of other day-to-day triggers that do the job equally well:

  • Fear of missing out (FOMO)

  • Accepting a ‘no’ from parents  (or staff)

  • Exam performance / pressure

  • Identity / image

  • Materialism

  • Friendships

  • Troublesome relationships

  • Misunderstandings

  • Uncertainty

  • Fear of failure

  • Peer pressure

  • Choices / decisions


Adapted from Downshire & Grew 2014
Normal pre-teen and teenage behaviour

  • Shutting the door and shutting parents out.

  • Being monosyllabic.

  • Being slow to react and being oblivious to others' feelings.

  • Needing to sleep a lot.

  • Feeling embarrassed to be seen with a parent in public.

  • Rejecting guidance and doing the opposite.

  • Oblivious of time and deadlines.

  • Winding up parents and siblings - sometimes deliberately.

  • Being angry and sarcastic.

  • Being forgetful.

  • Hogging the computer or TV, oblivious to anyone else wanting them.


 
Lee N and Lee S. 2009

Nurture by Nature



Here's a useful list of personality types and qualities which you might spot in your patients and therefore help you be more adaptive in your interactions:
THINKING

  • Convinced by logic

  • Objective - don't take things personally

  • Want fairness and justice


FEELING

  • Convinced by how they feel

  • Sensitive — take most things personally

  • Want harmony and affection


JUDGERS 

  • Like order and structure

  • Find comfort in rules

  • Decisive - state opinions frankly

  • Prefer to finish projects


PERCEIVERS

  • Like flexibility

  • Find rules limiting

  • Curious — ask lots of questions

  • Prefer to start projects

EXTROVERT

  • Jump into new situations

  • Like variety and action

  • Energised by interaction


INTROVERT

  • Wait and watch before getting involved

  • Are life’s specialists

  • Energised by introspection


SENSORS

  • Realistic and practical

  • Like games with rules

  • Work at a steady pace

  • Accept things as they are


INTUITIVES

  • Imaginative and creative

  • Like make—believe and fantasy

  • Work with bursts of energy

  • Interested in how things could be

These types are based on the Murphy-Meisgeier system which is the children's strand of the Myers-Briggs Type Indicator assessment. The tests are shorter and more child-friendly than the adult ones. A professional qualified in the system can carry out an assessment. Parents, teachers and others can request a report to better support the child; a career report outlining jobs that play to the child’s strengths; and a ‘know yourself’ report for the child.

'Nurture by Nature' by Paul Tieger et al looks at each type, and gives tips throughout childhood; about how to understand the child, and also support them in areas that don't come naturally.

Source: Paul Ackerley in Psychologies Magazine, Nov 2015

If assessment, intervention and treatment approaches are going to be of real help, it’s crucial to try to understand the young person’s own world. Learn to speak their language, and they’ll be more receptive.

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Making Sense of It All


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While some young people are organised and have some ownership of their issues, others will feel chaotic, confused and overwhelmed. They may fluctuate a great deal in the way they behave, feel and relate to others. They may sometimes be cooperative and communicative, and at other times, express themselves through anger. What really helps is a commitment to tolerating the massive anxieties and raw panic that stimulates young people into sometimes attempting to reject and disrupt the help they need. They should be helped to recognise that it’s normal to experience all sorts of different feelings, including anger.

When we understand a young person’s anger process, we’re able to deescalate rather than inadvertently provoke the situation. “We’re also able to support them in learning how to handle the situation themselves.” says Sarah Newton, a leading authority on how to connect, engage and motivate young people. “It’s always a really good idea to talk through volatile situations after asking… what they thought they could have done, how perhaps they could have got their anger out in a constructive way that doesn't hurt anyone (or their feelings) and what you can do to help them.” (Newton 2012).
The care approach is tailored to each person’s needs. It bears in mind the basic notion that everyone works together to try to make sense of the young person’s past and present experiences and formulates suitable goals. This empowers the young person to attain some congruence and control.
When staff are fully present, fully in the ‘now’, it allows young people to understand that their needs are being met in the present, and that staff are focusing on them, not on other things that are happening. This helps young people to feel a special connection to you and the ward environment.

You’ve probably realised by now that what underlies all of the COLOURFUL themes is mindful, caring relationships. Positive therapeutic connections thrive when we begin to make sense of the ways in which a young person and their carers understand themselves and the world around them.
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Everyone works together to try to make sense of the young person’s past and present experiences and formulates suitable goals. What really helps is a commitment to tolerating the massive anxieties and raw panic that stimulates them into sometimes attempting to reject and disrupt the help they need.

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Coming, Staying and Moving Forward


The following are some helpful views from young people, parents and staff about what is needed before, during and after an admission. They come from YoungMinds’ ‘Where Next? New directions in inpatient mental health services for young people Report 2’ (View it here)
Pre-admission

  • Clear communication between services in the community is needed to prevent young people being passed around, and to raise the understanding of the role of different agencies.

  • Linked to this, clear communication between community services and inpatient services is needed to ensure that young people at risk of crisis in the community are engaged and supported appropriately - allowing admission to be a last resort.

  • Clear information about sources of help, and mental health problems, is needed for young people and families to give them more opportunity to help themselves.

Admission

  • Inpatient services should be accessible, to prevent young people having to wait for help in the midst of a crisis.

  • Information is needed about inpatient services and what to expect from them for young people, parents and carers. This needs to be given in different ways, at different times.

  • Consent to treatment should be gained in a meaningful way, with young people feeling informed about what they are consenting to.

  • Extra support in the first few days of admission would allow young people to be eased into their stay.

During stay

  • Clear information about treatment and care, the roles of different members of staff and the rules and boundaries of the unit is needed for young people.

  • A dialogue between staff, young people and parents/carers would allow greater involvement in care, as appropriate.

  • Staff need to be approachable and accessible to young people, and available to give support when this is needed, for example in dealing with the difficult behaviours of other young people.

  • Units need to offer a range of individual and group therapeutic activities to allow the most appropriate treatment for that person. Where unit resources are limited, staff should try to build links with outside agencies, e.g. voluntary groups, to give access to extra resources and local leisure facilities.

  • The service to be age-appropriate so that young people receive the care most suitable for their developmental stage, and feel included in the group ethos of many inpatient units.

During Stay (cont.)

  • Education to be available and well supported, including access to further education options for young people over 16.

  • A comfortable, welcoming environment, ideally with gender segregated areas, single bedrooms, and enough space to have visitors and spend time with them privately. The environment must address both privacy and safety needs, e.g. by providing somewhere to make private phone calls and lockable cupboards for personal belongings.

  • Discharge

    • Young people to be involved in discharge planning, to give them an aim and help them build plans for their future.

    • Close working with outside agencies to allow a smooth ‘handover’, and provide support for young people, helping them gradually reintegrate back into ‘normal’ life.

    • Joint working and planning between health and social services to cater for young people who are not going back to families/carers.

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    Featured Tools and Ideas


    Click on the headings to read more and add a selection of ideas and tools to you own "Palette"

    Anxiety Clinics

     

    For young people in Year 7 presenting with symptoms suggestive of moderate anxiety, a new anxiety clinic has been launched across the East Riding. The service aims to help children understand the physical and psychological symptoms of anxiety, and enable them to develop positive coping strategies based on a Cognitive Behavioural Therapy (CBT) approach.

    Source: yorkshirecoastradio.com - read more


    art performance by young people

    Expressive performance by young people  - arts based projects ‘Ask Don’t Tell’ and ‘ARTiculate’ at Barnet CAMHS and Youth Services

    “I was delighted to be invited to the evening and very much enjoyed the performances.” Said Maria Kane, chief executive of Barnet, Enfield and Haringey Mental Health NHS Trust (BEH MHT). “It’s really important to hear from those who use mental health services using different methods - arts-based work like ‘Ask Don’t Tell’ and ARTiculate give young people a powerful voice we should all be listening to. The work was extremely moving, powerful and entertaining.”

    The young people involved in the performance are going on to create a DVD of their work for use in schools, to help others understand what it’s like to deal with mental health issues. Barnet CAMHS are running participation groups for young people, parents and carers, with the sessions offering them an opportunity to share their experiences and shape the future direction of the service.

    Dr Carolyn Webber, Clinical Psychologist, Project Lead for The Children and Young People’s Improving Access to Psychological Therapies programme (CYP-IAPT) and Acting Head of the Clinical Psychology Service for BEH MHT said.  “Drama, words and art are all really effective ways for young people to explore, express and understand their feelings.

    “Sharing those feelings with an audience is daunting and these young performers have really worked for many weeks devising a piece of drama calling on us - the parents and professionals - to listen to what they have to say without judging them.”

    Source: beh-mht.nhs.uk - see here


    Ward intro videos

    Young People have told Islington CAMHS that they find videos interesting and sometimes find remembering information from videos easier than reading text. They’ve taken this feedback on board and have created some videos based on young people’s ideas about what to expect when coming to CAMHS.

    Source: islingtoncamhs.whittington.nhs.uk - see here


    Ward Community Rules Expectations

    Ward Community Rules Expectations (whereas rules are often one-sided and imposed, expectations are inclusive and promote a culture of mutual respect)

    This is an example of an impressive list of social expectations everyone is encouraged to stick to. What’s truly fab about it is that young people themselves, working alongside staff, came up with it. Such an idea-generating activity can be a notably remedial and neutralising activity in its own right:

    • Be respectful to others.
    • No bullying behaviours.
    • Violence to others or property will not be accepted.
    • Attending your education sessions or purposeful activities.
    • Going to bed on time.
    • Looking after your personal hygiene and keeping your bedroom tidy.
    • We expect that everyone, both staff and young people, will treat everyone with respect and encourage positive interaction.
    • Use words to express the feeling or impulse, otherwise the ‘violence’ will be split off or acted out.

    Source: tewv.nhs.uk - see more here


    Written materials

     

    In a study conducted by YoungMinds (2003), young people emphasised the need for written materials to:


    What to bring into hospital

    Young people staying at a CAMHS centre came up with the following really helpful list of items they felt others might want to bring with them:

    • Clothes (not too many as you can always get different ones from home).
    • Pyjamas and slippers.
    • Toiletries including shampoo, toothbrush, hairbrush, makeup, toothpaste, shower gel and soap.
    • Mobile phone and charger.
    • Pictures and posters for your room.
    • CDs and DVDs (but not too many as your ward will probably already have lots).
    • Any school or college work that you might have (don’t worry, your ward will make contact with your school or college if you don’t have any).
    • Anything to do with your interests e.g. music for the piano or specific art equipment.
    • Teddy or other items that bring you comfort.
    • Crossword or puzzle books if you like doing these.
    • Laptop / iPad if you have one – although it’s best to discuss this with your ward first as they may prefer you to use the ward computer/s instead – for a number of very good reasons.

    Source: adapted from a list from tewv.nhs.uk




    e-learning resource

    An e-learning resource to help health visitors and school nurses improve their understanding of children’s needs

    “We are developing a new e-learning resource to help health visitors and school nurses improve their understanding of children’s needs. It has six sections covering emotional wellbeing and mental health issues as well as looking at meeting the needs of children with additional health needs or disabilities.

    The resource will be useful for the continuing professional development of both experienced and newly qualified health visitors and school nurses. It will contain information about best practice and self-assessment questions as well as links and suggested further reading for those needing more depth...

    It has been created in a partnership between the Community Practitioners and Health Visitors Association (CPHVA), the School and Public Health Nurses Association (SAPHNA), Health Education England, E-learning for Healthcare and Public Health England.”

    Viv Bennett, Public Health England's Chief Nurse. From here

    The resource is available via the E-Learning for Healthcare website.


    NHS Choices

    NHS Choices website: Young people and mental health

    This information hub on the NHS Choices website offers young people advice and help on mental health problems including depression, anxiety and stress.

    View it here


    Alnwood Comic

     

    Here’s a fun and creative way to present info. This is a comic, which was produced by young people for others coming to the ward: Al goes to Alnwood

     

     


    Sorted! Books

     

    Sorted! self-help book collections are available in main public libraries and selected school and college libraries to help young people with specific concerns. The books have been chosen by young people for young people, and are recommended by health professionals. Anyone can use the books, and they are likely to be useful for parents, carers and anyone working with young people.

    Source: warwickshire.gov.uk - see it here


    Moodleton

    A funky, interactive online guide for young people on all things to do with CAMHS.

    Source: covwarkpt.nhs.uk - see it in full here


    Acknowledging students’ psychological state

    A 'traffic light’ method has been successfully used by several schools that wanted their teachers to gain a greater insight into the psychological state of students at different stages during the day. The hope was that by gaining this — usually hidden — information, teachers would be able to modify their practice in order to help students to enjoy a better climate for learning and thereby enter their Effective Learning Zone.

    The system works by every teacher being issued with green, amber and red traffic light symbols for student use. When prompted, students hold up the traffic light that best sums up how ready they feel to learn. This gives them an immediate and confidential way to give feedback to the teacher about their readiness for learning.

    From 'Creative Teaching and Learning Toolkit' by Brin Best & Will Thomas (2007) Read more here


    ‘Passport’ style brief of young people’s mental health

    NHS England: ‘Passport’ style brief of young people’s mental health launched

    A ‘passport’ style brief of key facts that children and young people using mental health services can use to help them avoid repeating their history and preferences has been launched.

    The ‘passport’ idea, which includes clinical information as well as key personal preferences, has been developed by young people, parents and carers and can now be used across care settings either on paper or on mobile phones.

    The idea came from a group of young people, parents, carers and professionals working with NHS England on improving integration between services. The group highlighted their frustrations about needing to repeat their history when accessing multiple services.

    Find out more here


    MindEd

    MindEd is a free educational resource on children and young people’s mental health for all adults.

    The MindEd Core Curriculum is aimed at all adults working as professionals or volunteers with children and young people. It offers e-learning to inform about the mental health and wellbeing of children and young people, what goes wrong and what can be done to help.

    The 'Specialist CAMHS Entry Level' part of the curriculum is aimed at anyone starting to work in child mental health. It introduces some of the major presentations seen in specialist and targeted CAMHS and describes the processes involved in specialist CAMHS assessments. More advanced users will also find topics of interest.

    View it here: minded.org.uk


    High risk groups

    High risk groups

    Groups at higher risk than their peers for mental health problems include:

    • Young offenders and children from a criminal background.
    • Children who are being looked after by local authorities or who have recently ended a period of public care.
    • Children with learning difficulties.
    • Children with emotional and behavioural difficulties.
    • Children who have been sexually, physically or emotionally abused.
    • Children with a chronic physical illness.
    • Children with a physical disability.
    • Children with sensory impairments.
    • Children of parents with mental illness.
    • Children of parents with a substance abuse problem.
    • Children who have experienced or witnessed sudden and extreme trauma.
    • Children who are refugees.

    Source: Department of Health - read full guide here


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