This presentation was made with slides kindly provided by:

Sue DolbyMelinda EdwardsKonrad JacobsKaren SteinhardtPenny Titman

National Council for Child Health and Well-beingRCN, 16th June 2010

Dr Konrad JacobsDepartment of Paediatric PsychologyChildren’s Hospital Oxford

Chair Paediatric Psychology Network

Emotional and Behavioural difficulties in Children and Emotional and Behavioural difficulties in Children and Young People with (chronic) Health Conditions Young People with (chronic) Health Conditions

The Role of Paediatric Clinical PsychologyThe Role of Paediatric Clinical Psychology

Paula, aged 15Paula, aged 15

15 year old girl with ALLParents divorced; Arguing13 year old sister self harms; seen by CAMHSRefuses to come out of the car outside the hospital for chemo treatmentConsultant oncologist wants to sedate her to force her to have treatment and is talking to legal servicesReferral to Clinical Psychology

Jenny, aged 11Jenny, aged 11

Jenny has type 1 diabetes and needs to inject herself with insulin and take pin prick blood tests 4x daily.

At her clinical review her overall blood test (Hba1c) suggests poor control placing her at high risk of diabetic complications.

She says she doesn’t believe she really needs all the treatment as she goes without injections and eats chocolate frequently with little perceived effect. She is very angry with her diagnosis and her mother for constantly nagging her or telling her off for not carrying out her care. Her mother explains that she has 2 other younger children that take a lot of her time and she can’t understand why Jenny won’t look after herself as she knows children much younger than Jenny can manage their care.

Michael, aged 6Michael, aged 6

Michael has recently been diagnosed with an aggressive form of Juvenile Arthritis

He has to have weekly Methotraxate injections and monthly blood tests

It takes 2+ hours for Michael to have his injections; His mother gets upset/tearful; His father gets angry

Alice, 13Alice, 13

Alice has widespread idiopathic chronic pain syndrome

She frequently attends her GP surgery, Paediatrician and local A&E; There is no medical treatment for her condition

She has stopped going to school, has limited mobility, uses crutches, has disrupted sleep, panic attacks and low mood

Her mother has had to give up her job to care for Alice; The family have had to adapt completely to Alice’s disability;

National Service Framework for Children in Hospital National Service Framework for Children in Hospital (DoH, 2004)(DoH, 2004)

“Much can be done to help children and young people with long term conditions experience an ordinary life. A key element of this support should be good mental health input to maximise emotional well-being and prevent or minimise problems.”

In standard 6

“Attention to the mental health of the child, young person and their family should be an integral part of the children’s service, and not an afterthought…It is therefore essential for a hospital with a children’s service to ensure that staff have an understanding of how to assess and address the emotional well-being of children”.

In standard 7

Paediatric PsychologyPaediatric Psychology

‘Paediatric psychology as a field of research and practice has been concerned with a wide variety of topics in the relationship between the psychological and physical well-being of children, including behavioural and emotional concomitants of disease and illness, the role of psychology in paediatric medicine, and the promotion of health and prevention of illness among healthy children’

Roberts, Maddux & Wright, 1984

Impact of an ill child in the family Impact of an ill child in the family

“Families facing serious paediatric illness are essentially ordinary family facing extraordinary stressors”

Kazak, 1997

Adopting a frameworkAdopting a frameworkto enable working at allto enable working at all

levels of the systemlevels of the system

(Kazak, 2006)(Kazak, 2006)

Why is Paediatric Psychology a growing field?Why is Paediatric Psychology a growing field?

Better understanding of the impact on children and familiesUser perspective: psychosocial issues as important as the medical issuesMore research to validate the role of psychology – interventions improve psychological and health outcomesNational guidelines (e.g. NICE; CF trust; ARMA)Cost reductionImproved treatment outcomesImproved short to medium term survival rates

Structure within British Psychological SocietyStructure within British Psychological Society

British PsychologicalSociety

BPS

Other divisionsEg occupational

Division of Clinical Psychology

DCP

Other divisionsE.g. educational

Faculty of Children and Young People

FCYP

Paediatric Psychology

Network

Grouping of clinical child psychologists working in medical health care settingsApproximately 220 FTE and > 340 Clinical Psychologists working in Paediatrics across UKApproximately 86 Psychology Services to Paediatrics across the UK26 different specialist areasIncreasing number of life span posts and posts in transitional care/young people

Paediatric Clinical Psychology in the UKPaediatric Clinical Psychology in the UK PPN Survey, 2008PPN Survey, 2008

Models of Service Provision in the UKModels of Service Provision in the UK

79 % Dedicated Paediatric Psychology Service

7% Integrated in multi-disciplinary mental health teams (liaison)

9% CAMHS-based (Child and Adolescent Mental Health Service)

5% Community based (e.g. Palliative care)

PPN Survey, 2008PPN Survey, 2008

Many similarities with Many similarities with corecore CAMHS work, but also differences….. CAMHS work, but also differences…..

Initial focus on physical health, symptom management and adaptation/coping Integrated within paediatric

health teams Joint/close working within

paediatric team Regional/specialist tertiary

service

Focus on diagnosis of psychopathology and treatment.

Referral to ‘outside’ service

Less access to medical plan/ communicationRare presentations in the

context of CAMHS prioritiesLocal service

Paediatric PsychologyPaediatric Psychology CAMHSCAMHS

Who do we work with?Who do we work with?

Directly with children and young peopleWith families (parents, siblings, grandparents)With medical teamsWith outside/voluntary agencies With the wider organisation

Types of referrals to Paediatric Psychology ServiceTypes of referrals to Paediatric Psychology Service

Preparation for medical proceduresPain managementAdjustment (child & family)Information givingDisclosureConsent issues /decision making

Adherence to treatment Transition to adult services Trauma Grief & loss Psychogenic / non-organic symptoms

Adopting a developmental approach......Adopting a developmental approach......

Policy & law

Cultural context

School & community

Health team /provider

Family & peers

Child,

Adopting a Systemic Approach......Adopting a Systemic Approach......

Developmental change

Using a variety of strategies......Using a variety of strategies......

Cognitive behaviouralSystemicSolution focusedNarrativeAttachmentMotivational interviewingEtc

Some challenges over the next few years......Some challenges over the next few years......

Financial challenges facing the NHS: impact on psychosocial care?

Guidelines (Voluntary organisations / NICE / PPN)

kjacobs@nhs.net