Child and Family Mental Health Lecture 8 PDF

Child and Family Mental Health: Dr Suzy Beak Class Prep: To do with audio!!! Background 10-20% of children and adolescents worldwide experience mental health conditions No single cause for onset of mental hea...

Child and Family Mental Health: Dr Suzy Beak Class Prep: To do with audio!!! Background 10-20% of children and adolescents worldwide experience mental health conditions No single cause for onset of mental health difficulties: a combination of biological, familial and environmental factors Child/adolescent unique risk factors: Pressure to conform with peers Media influence and gender norms Harsh parenting and bullying Greater risk: adolescents from minority ethnic/sexual backgrounds and existing conditions, poor living conditions, stigma and discrimination Importance of Early Intervention Half of all mental health conditions start by the age of 14 (Kessler et al., 2007) Suicide is the third leading cause of death in 15-19 years old (Kessler et al., 2007) Adolescent-onset for affective disorders is associated with more severe and functionally impairing outcomes (Andersen & Teicher, 2008; Birmaher & Axelson, 2006) Untreated anxiety disorders in children and adolescents explain the majority of adult anxiety disorders (Gregory et al., 2007) Untitled 1  Mental Health Presentations in Youth By age: Separation anxiety, selective mutism and simple phobias more common among children. Generalized anxiety disorder, panic disorder and social phobia more common among adolescents (Carr, 2004; Freeman et al., 2004; Klein & Pine, 2002) Physical symptoms may be commonly reported in youth e.g. stomach ache, bed wetting By sex: Anxiety disorders are more prevalent in boys than girls (Carr, 2004; Freeman et al., 2004) Depression is more prevalent in adolescent females than males (Lewinsohn et al., 1993; Kessler et al., 1993) Infancy and Middle Adolescence Trauma and Life Early Childhood Childhood Transitions Drug abuse Sleep Conduct Physical child Mood problems problems abuse problems Toileting Attention Emotional Eating problems and over- abuse and disorders activity neglect Intellectual, problems Psychosis learning and Sexual abuse (ADHD) Personality communication Separation Fear and Disorders Autism and and Divorce Anxiety Developmental Problems Foster Care Disorders Repetition Grief and Attachment Problems Bereavement (e.g. OCD) Somatic Problems Interventions Untitled 2  Majority of research supports CBT, behavioural therapy - with emphasis on parental involvement. Anxiety Disorders → CBT Depression (inconclusive evidence) → CBT, IPT or Family Therapy Eating Disorders → Family Therapy for Anorexia and Bulimia / CBT for Bulimia ADHD → Parent Training, Medication, CBT Further Assessment: System Intervention ASD Assessment Family Therapy → w/one therapist or a therapist and Risk Assessment reflecting team Medication Assessment School based intervention Individual Therapy/Support Parenting CBT Parenting groups Psychotherapy Parenting sessions Narrative Liaison with Other Agencies DBT (Dialectical Behavioural Social Services Therapy) School CAT (Cognitive Analytic Therapy) Adult Mental Health Services IPT (Interpersonal Therapy) Special Educational Needs Medication Services Treatment Adaptations Parental Involvement Parents as positive resource / co-therapist at home Parents role in maintaining / accommodating child’s difficulties Thinking about their own beliefs / behaviour patterns / mental health Untitled 3  Considering how much to involve them in sessions Cultural considerations Thinking about confidentiality Schools Liaising with SENCOs / teachers Exploring school performance Exploring impact of current difficulties at school Depression → RCT Evidence 10 RCTs to date Less promising outcomes → effect size approx. 0.35 TADS (March et al., 2004) Combined (73%) > Fluoxetine (62%) > CBT (48%) = Placebo (35%) Suicidal thinking improved most in combined rx group ADAPT (Goodyer et al., 2007) SSRI = SSRI + CBT Anxiety → RCT Evidence Generic Anxiety Disorder Protocols → e.g. Coping Cat Includes CBT techniques applicable to any anxiety disorder e.g. problem- solving, relaxation, exposure Trials typically include SAD, SocP, and GAD Children of 7yrs+ Overall approx. 55% remission rates (Cartwright-Hatton et al, 2004; In- Albon & Schneider, 2007 - meta-analyses) Combined (81%) > CBT (60%) = Sertraline (55%) > Placebo (24%) Disorder Specific CBT Protocols: Untitled 4  OCD 6 RCTs to date - e.g. POTS trial (2004) CBT associated with 40-88% rate of remission Gains maintained over fl/u periods up to 24 months CBT greater effect sizes than SSRIs ( Watson & Rees, 2008 PTSD Smith et al. (2007) → CBT vs WL for PTSD following single-event trauma Remission rates: 92% CBT, 42% WL SAD and GAD Payne et al., (2011) Notes: Working with Children Children and Adolescent Mental Health Service CAMHS Typically ages 5-18 Tier system Current initiatives to improve access to care and acknowledge growing crisis Transforming C&YP Mental Health Provision: A Green Paper (2017) CYP-IAPT Future in Mind (2015) Mentally Healthy Schools Tier 1 Tier 2 Tier 3 Tier 4 Early Early help Specialised Inpatient Intervention CAMHS Provision Untitled 5  and Targeted Incl. Eating Prevention Services disorder services Provided by schools Children’s Centres Health Visitors School Nurses GPs, etc. CAMHS Team Crisis in CYP Mental Health 50% of all MH problems are established by the age of 14 1 in 10 children aged 5-16 have a diagnosable MH problem 1.4 million CYP sought NHS help for MH problems in 2022 Number of referrals have risen by 53% since 2019 Untitled 6  Numbers increase in low income families, LAC (45%), LGBTQ community, YP with disabilities Anxiety most common disorder Services for CYP under resourced and stretched - many CYP not accessing appropriate treatment Post code lottery CYP-IAPT Aims to improve existing CAMHS services, not replace them Improving access, accountability, awareness, participation and ensuring it’s more evidence based Current Context Global pandemic ?Greater impact on CYP 400,000 children sought MH support during pandemic (Royal College Psychiatrists, 2021 article) Lockdown - closure of schools, lack of adequate transition, absence of socialising Returning to social world post lockdown - what is the new normal? Ukraine war / conflict within Israel/Gaza Global warming Cost of living crisis Social media Why work with Key things to consider children? Role of parent Working with wider system - schools Untitled 7  Benefits of early Utilising play and creativity intervention Child focused Evidence base Need for adaptation - use of jargon, Working within the language used system - schools, Adjusting pace of sessions parents Allows clinicians to utilise creativity Challenges working with CYP Balancing engagement of YP and parent Safeguarding Confidentiality Working within a system - separated parents? Engagement - child often brought to session/may not have the language to explain experiences Establishing boundaries whilst remaining playful Substitute parent? Our own experiences of being a child - what are you bringing with you to the work? What to cover in an assessment? Assessment Check in - does YP know why CYP-IAPT - “choice appointment” they are here? How did they feel Discussed with family re. about coming today? Whose idea outcomes of assessment & was it? what support/interventions Family context are available Family tree Untitled 8  Setting up the appointment Parental mental health Consider child’s perspective - Parenting style Who are you? Why am I here? School Use of visuals and creative tools Learning needs Observations in the room - how Friendships do they interact with parent? How much movement do they seek in ?bullying the room? Current difficulties Strength focused Agree / disagree with parent’s Opportunity to build rapport view? Establishing goals - 3 wishes What would X view be? Outcome measures - RCADS, Previous input - relationship to SDQ help ? Need for further assessment Goals Learning - cognitive assessment (WISC) Neurodevelopmental difficulties - Autism, ADHD Consider Resources Jargon Drawing CAMHS Likes / Dislikes Clinical Use of colour to describe how you’re feeling Psychologist Play materials for younger child Assessment Feeling faces, emoji cards - adapt to interests / age Confidentiality Family tree Choice Appointment If I had a magic wand… CBT Untitled 9  Anxiety Formulation Needs to be collaborative - “initial” / “shared” understanding Consider how this is presented to child / parent / school Adapting - visuals; hot cross bun model, thought bubbles Intervention Majority of research supports CBT for anxiety and depression Reynolds et al (2012) Weisz et al (2006) Wolpert et al (2006) Other approaches - IPT adolescents, narrative therapy Use of externalising - worry monster Collaborative Consider role of parents Role of Parents “Principle customer” (Wolpert et.al, 2005) - act as gatekeeper Child’s psychological needs and help seeking behaviour likely to be significantly mediated by beliefs and perceptions of parent Important to offer parent their own space to share concerns ?Parents own MH needs Role as co-therapist Maintaining progress outside of sessions Between session tasks How to juggle when parents are separated? How do you fit in? Untitled 10  Distinguishing Helpful / Unhelpful Spidey Senses Thoughts Turn on your spidey senses FRIENDS-LD: Red and green hats Super-focused senses of smell, plus “thoughts” for “red and green sight, hearing, taste and touch thoughts” identification, sorting and helps Spiderman to keep tabs on changing those around him Using Props to Aid Relaxation Can you do the same? What can you see, hear, smell? Feedback Use of standard outcome measures Individual rating scales - how anxious are you feeling now? SDQ - parents, teachers can complete RCADS - parents and children over 8yrs Feedback re: sessions Thumbs up / down Emojis Goals Notes: Working with Adolescence WHO defines ages 10-19 Period of transition and physical changes Brain development Identity - sexual, gender Untitled 11  CAMHS service work up until 18th birthday Gaps in service between CAMHS and AMH 16-25 services Brain Development During Adolescence Mismatch between development of limbic system and prefrontal cortex Limbic system - pleasure seeking, rewards, emotional responses, sleep regulation Prefrontal cortex - decision making, organisation, planning Develops at later stage Parts of brain not fully developed until 25 Biological Maturity Precedes Psychosocial Maturity More risk taking behaviours Difficulties concentrating and remembering routine tasks Pleasure seeking behaviour - higher sex drive Poor impulse control More susceptible to peer pressure Why work with Adolescents? High rates of MH difficulties Need for early intervention 50% MH conditions Capacity for change onset by 14 years Supportive evidence base Globally 1 in 7 10-19yr olds Increased risk factors surrounding experiences a MH disorder adolescence Suicide is the 3rd leading substance use cause of death in 15-29 years old (WHO, 2024) impulsivity Untitled 12  Rates rising in under 25s risk taking behaviour UK suicide rate in girls