What Good Looks Like in Psychological Services for Children and Young People with Physical Health Needs Dr Janie Donnan, Consultant Clinical Psychologist and Chair of the Paediatric Psychology Network of the Faculty of Children and Young People BPS Office, London, 9th March 2017 1

Plan for the Afternoon What Good Looks Like Overview Views and Experiences of children, young people, parents/carers and staff Integration of Physical and Emotional/Mental health Posters: examples of good practice Discussion and Questions

Twitter #whatgoodlookslike @psych_cypf @theppn_uk

What Good Looks Like Summer 2015 the Faculty for Children & Young People (BPS) published a suite of papers entitled “What Good Looks Like in Psychological Services for Children, Young People and their Families” as part of the Child & Family Clinical Psychology Review. The papers were supported by Young Minds and included participation young people Paper 5 = specific paper describing good psychological services for children, young people and families in physical health

What Good Looks Like Paper 5 outlines what a high quality service looks like based on: the most recent government drivers and guidelines the evidence base Over 30 years clinical experience of paediatric psychology services in specialist and general hospitals in many medical/surgical teams Key emphases of the paper are: To outline and describe the key elements of a good paediatric psychology service To reinforce the recognition within policy and evidence base of the need to integrate psychology services within physical health services (which can be impacted on by the complexity of funding systems) To reinforce the need to continue to develop and deliver high quality embedded services within both Specialist Tertiary Paediatric Hospitals and District General Hospital Services (which can have more variable access to such services)

Why include psychological services within physical health? CYP with physical health needs: 4x more psychological distress than healthy peers (Hysing et al 2007) so potentially vulnerable group – examples of good practice: Long Term Needs: Anxiety/low mood impacts on adherence (Gray et al 2012) – good evidence for efficacy of psychological interventions Anticipating Vulnerability: 1 in 5 children admitted to PICU develop clinically significant PTSD (Rennick et al 2014) – responding to trauma appropriately increases resilience; and earlier detection = earlier treatment; Standardised Care Pathways: Medically unwell babies : early psycho-social interventions to promote bonding and parent-child interactions = improved infant brain development and reduced stress (McCusker et al 2007) Improved medical science = many more CYP surviving therefore increased need for psychological support and intervention

Economic Benefit McGrady and Hommel (2015) “behaviour change interventions for adherence in young people = significant reduction in health care utilisation = highly cost effective” Evans et al 2015 “cost-effectiveness of a 3 week MDT pain rehabilitation intervention for children = reduction of health care costs from $61,988 to $14,189 and reduction of cost of parental missed work from $12,229 to $1,189 Kings Fund (2016) poor management of ‘medically unexplained symptoms’ and ‘mental health conditions in people (all ages) with long term physical health problems’ costs NHS England more than £11 billion annually

Strategic Context “a preventative approach addressing the child’s and family’s emotional needs alongside their physical health needs helps increase satisfaction with care (National Service Framework for Children in Hospital (NSF, 2004) “Psychological support and good mental health input seen as an integral and key components of the care of CYP with serious or long-term conditions, to maximise emotional well-being” (NDP, 2009) NICE and SIGN guidelines: evidence base for psychological care as part of overall management Integrating approaches to physical and mental health identified as key priorities (Mental Health Taskforce in NHS England, Kings Fund, 2016)

Good psychological services in physical health care should … “deliver psychological interventions at every step of the journey: at diagnosis, during treatment and supporting living with a physical condition: promoting resilience, preventing psychological difficulties and treating complex psychological issues” “…consider a wide variety of factors in the relationship between the psychological and physical wellbeing of children and young people” “… consider behavioural and emotional impact of disease, illness and acute physical trauma on children, young people, their families, the staff who care for them and the systems within which they function e.g. school”

Whole Systems Approach

Key Aspects of Whole Systems Approach Integrated and embedded Focussed and Timely Interventions Evidence Based Psychological Therapies Long Term Conditions Acute Presentations Targeted/Preventative Anticipate Vulnerability Assess Risk Children, Young People AND parents/carers and families Equitable access: specialist/centres, DGHs and across all medical conditions

Key Aspects of Whole Systems Approach Wider Care Circle Psychoeducation and Technology Teaching, Support and Consultation To whole healthcare community and systems around the child: clinical staff, education, local authority and parents/carers Clear Care Pathways Between child and adult physical health services Between community and specialist For specific treatments/assessments Measure Outcomes Develop quality services through research, policies, standards

Wider Care Circle: Psychoeducation/Technology/Staff Teaching (some examples)

“The service has completely transformed things for me in the sense that I am able to view myself as having a skill set or tools that I can use. I can, in turn, equip my son with the same. It has had an immediate effect and a change in pattern will hopefully mean I can sustain this long term. I have learned so much and would thoroughly recommend the service. I am very grateful for the help I have received. Thank you” Voices “My son was a baby when he went through 2 heart surgeries. The help we received form our psychologist was very helpful. We had sessions together as a couple and on a 1:1 also. Some of the sessions were at our son’s bedside which was good as it lowered our anxiety about leaving him for a session. Also in a private room was good also”

Good psychological services for children and young people with physical health needs and their families will: Demonstrate the delivery of psychological interventions at different levels to improve patient resilience, prevent psychological difficulties, treat complex psychological issues and provide a cost effective service. Deliver hospital and community teaching, develop information resources and patient pathways, attend work/steering groups and multi-disciplinary team meetings, and provide consultation, supervision and targeted services to staff; plus highly specialist psychological assessments and interventions with CYPF. Demonstrate a non-stigmatising, collaborative approach, prioritising children, young people and families’ goals for intervention, encouraging feedback and working in partnership with Child and Adolescent Mental Health and Community Paediatric Services. Anticipate vulnerabilities and deliver preventative interventions, for example, group work. Demonstrate good governance of psychological treatments provided by psychology and non-psychology staff including CNSs, counsellors, hospital play specialists and community health teams.

Good psychological services for children and young people with physical health needs and their families will: Implement goal-based outcomes for interventions with CYPF and staff and evaluate consultation, supervision and teaching. Be proactive in learning from referrals and the involvement of service users both in developing policies and implementing changes to the wider service. Provide value for money, with a mix of grades, and a range of skills, stratifying referral complexity and making use (through supervision) of the skills of other professionals. Play a central collaborative role in research and audit. Work closely with commissioners of physical health services and psychology colleagues at national, regional and local levels to develop care standards and integrated care pathways.

Benefits ... Improved adherence = shorter/fewer admissions, reduced risk of morbidity and mortality Individualised preparation for surgery = less anxiety, faster recovery, better post operative care Psychological pain management = less medication, less anxiety, less admissions, better functioning Psychologically informed and trained staff = broad based psychological interventions delivered more widely, better adjustment, adherence and self care Well supported staff = better patient care, less burnout, reduced sick leave, increased capacity for compassionate working

Thank You for listening Any Questions / Comments ppn@bps.org.uk