The British Psychological Society
DECP Annual Professional Development
Event
Bournemouth 11th January 2008
• “What can they do that we can’t?”;
Integrating clinical and educational
psychologists in School and Community
Support teams in Brighton and Hove’s
Children’s and Young People’s Trust.
• Jenny Cross, Senior Educational Psychologist and
School and Community Support Manager (West)
• Bruce McEwan, Kerry Taylor and Shoshanah Lyons,
Highly Specialist Child Clinical Psychologists
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Brighton and Hove form a Children’s
and Young People’s Trust
• In October 2006 the B and H CYPT formed with the integration of
health services for children alongside education and social care
• New multi- agency School and Community Support team is formed
for each of the 3 areas; West, Central and East
• Each managed by a Senior or Principal Educational Psychologist
• Principal EP already in post but two new posts recruited from
existing maingrade EP team
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Members of the area School and
Community Support Teams
• Manager (Principal or Senior EP)
• Educational Psychologists
• Child Clinical Psychologist
• Primary Mental Health Workers
• CAMHS Family Support Worker
• Education Welfare Officers
• School Nurses (including service manager)
•
Literacy and Speech and Language Support Teachers
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(About 30 staff in each area team)
• To reduce the number of statements being issued and the number of
children attending special schools and agency placements
• To develop early intervention community mental health services to
support children , young people and their families
• To deliver high quality joined up services to children and young
people which are tailored to local need
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Priorities within the Children and
Young People’s Plan
Based on the five key outcomes from Every Child Matters
From 25 priorities the following are key for our team;
• To reduce the number of children being permanently excluded from
school
• To increase the inclusion and participation of children with a range of
learning and SEB difficulties in mainstream education including
Children in Care
• To reduce the number of children experiencing family breakdown
and being taken into care
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Background
• CAMHS locally undergoing a strategic review
• Commissioner noted as part of review that there was a gap in the
multi-disciplinary mental health tier 3 team in that no clinical
psychologists were present
• Our local CAMHS service had not been able over many years to
retain and develop child clinical psychology services
•
NICE guidelines had published evidence on the effectiveness of
Cognitive Behaviour Therapy and other talk therapies offered by
Clinical Psychologists
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• National context of developing earlier, more preventive mental
health interventions in community settings
• Commissioning decision to locate the child clinical psychology posts
within the school and community teams as part of Community
CAMHS
• Primary mental health workers (also in new team) had already
established effective tier 2 service into which the CP’s and new
CAMHS family support workers are placed
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Recruiting child clinical psychologists
to the 3 area teams
• Joint planning between the School and Community Support
Managers and Clinical Director of Clinical Psychology Services in
Sussex Partnership Trust; job descriptions, recruitment and
secondment arrangements
• The recruitment process; what kind of experience and
personal/professional attributes sought? Why might these posts be
attractive to clinical psychologists?
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The recruitment pitch
• The clinical psychology appointments are new posts created within
the recently formed multi-agency area School and Community
Support teams
• A key focus of this work will be to increase the capacity of schools to
recognise and support the emotional and psychological needs of
children and families in their area.
•
The work will also include enhancing parenting capacity and
enabling children and young people to stay safely in their own
homes and schools and pre-empt the need to enter the care system
• Working directly with children and young people and indirectly
through schools and with other colleagues the post-holders will be
expected to draw on a range of psychological therapy approaches
including cognitive behavioural therapy and at least one other
modality.
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The posts and the applicants
• These community based posts outside a clinical setting and
infrastructure are unusual
• The tasks and challenges also different from usual CAMHS
services;
• Recruiting CP’s into a team where another type of applied
psychologist; EP’s are present is also unusual
• In each area team only 1 CP to represent profession and develop
innovative services from scratch; a challenging responsibility
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What we were seeking in the
candidates
• Capable of working at level 8a) – range of relevant experience (with
adults) as well as children and young people
• Commitment to work in a more community based and less
clinical/medical model
• Interest in working in a multi-disciplinary team alongside other
psychologists
• Strong emphasis on interventions and evidence based outcomes
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• Desire and skills to develop innovative capacity enhancing role to
tier 1 and 2 colleagues (teachers, school nurses etc) ; consultation,
training, “psycho-educational” approach, joint work etc
• Highly developed interpersonal communication and problem-solving
skills including diplomacy, tact, conflict management, assertiveness,
humour, resilience etc
• A range of experiences/skills between the 3 candidates to support
each other to develop comprehensively
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Why these posts were attractive
to applicants
• Unlike Educational Psychology – many qualified CP’s emerging
from courses each year and posts in child clinical psychology sought
after - competitive field compared with Older People and Learning
Difficulties post
• Two of our appointees wanting to return to public sector posts from
working with children in private/voluntary sector
• Innovative community posts
• Brighton had not had Child CP posts for some time – new
opportunites for qualified people living in area
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What EP’s anticipated
• Anticipation of the arrival of CP’s by EP’s included curiosity –
genuine question of “what can they do that we can’t?”
•
“Can we apply for those posts?” (ie what is the job/role and could I
do it and would the grass be greener in the clinical field?)
• A feeling of envy of CP’s starting with a “blank slate” and no
straightjacket of statutory role and deadlines overtaking the work
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Our hopes and expectations of Clinical
Psychologists as managers/EP’s
• Energy, new ideas, a different kind of applied psychology which
might have a ripple effect and support EP’s who were keen to work
differently
• Applied psychology focused on interventions, outcomes and
change, with a strong emphasis on data and evaluation
• An excitement about having an additional resource locally an
innovative psychology service to offer to schools and families
• A hope that the presence of clinical psychologists could educate
schools and referrers as to the wider range of roles and
contributions which EP’s might have and offer
• Possibilities of creative and shared new forms of service delivery as
EP’s and CP’s combined skills, frameworks and roles
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What CP’s imagined EP’s to be
• Not clearly formed – Had only met 2 EP’s between them during
their training and careers to date - are they typical?
•
Seeing EP’s as probably mainly concerned with schools,
cognitive/educational assessment and learning, probably on
individual level, and not very involved with emotional/clinical
functioning or family issues
• A genuine curiosity open-mindedness and desire to build links
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• What do we see as the areas of professional
overlap between Educational and Child Clinical
Psychology Practice?
• Where, if anywhere, is there professional
distinctiveness?
• If we looked at large samples of each are there
some CP’s and EP’s who share more with
each other than they do with their “own”
professional base?
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Participatory exercise
• Individually take 5 mins to note on your sheet;
• What theoretical psychology, psychological methods and core
competencies do each profession draw on?
• What contexts and context specific knowledge do both need to be
familiar with?
• Are there any roles or contributions which only EP’s or only CP’s
could fulfil?
(We will collect these at end so please aim for legibility!)
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In pairs or threes
• Take another 5 minutes to discuss what you have each written and
compare notes
• Plenary. 10 mins to find out from you how much is seen as
distinctive to one or other profession versus what is shared.
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The path to joint/complementary work
so far
• First Clinical Psychologist appointed to East area team in August
2007; ( Dr Bruce McEwan)
• Next two appointments to West and Central team made in
November 2007; (Dr Kerry Taylor and Dr Shoshanah Lyons)
• East and Central team are co-located with rest of community mental
health team; West not yet, but all 3 CP’s sit alongside area EP
colleagues to facilitate integration and developing communication
• Two new EP’s joined team this Autumn; both of whom bring mental
health experience
• Decision to treat the teams professionally as combined applied
psychology team to share training and service development days etc
where appropriate
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Induction and networking
• Close working of CP’s with Clinical Lead for the existing Primary
Mental Health Worker team and developing links with tier 3 CAMHS
teams who have reorganised to fit our 3 area teams
• Participating in the review and re-design of the PCT CAMHS;
agreeing referral criteria and boundaries/links between community
CAMHS and clinical CAMHS
• Meeting other members of School and Community Team, team
days, cluster meetings with groups of schools. Explaining the role of
a CP and identifying possible joint projects with others – ongoing
• Meeting with S and C managers to clarify priorities, supervision
arrangements, professional links with other CAMHS services
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Some early egs of joint work between
CP’s and EP’s
• East area CP has formed strong link with an EP who works 0.5 with
Youth Offending Team and who offers innovative and systemic
approach to her work in schools, including Video Interaction
Guidance
• This CP/EP duo have jointly delivered a 3 day training course to
youth and drugs workers on Solution Focused Interventions in which
both felt complementary contributions from the other and which was
well received by participants
• CP and EP have offered new HT of a secondary school joint
consultation and problem-solving around reducing exclusions, and
are exploring developing a regular consultative/reflective process for
the school to use with them
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Co-delivering INSET on
positive behaviour managment
• Both West and Central CP’s have supported an EP colleague to
deliver, for the first time, INSET materials to large group of Teaching
Assistants on Understanding and Managing Behaviour in the
Classroom
• Experience valued and enjoyed by both CP and EP
• Reflections by CP and EP…….
• Both CP and EP found it a good way to get to know each other and
plan to do more of similar training together later in year.
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More egs of emerging joint work
between EP’s and CP’s
Joint individual assessment of emotional/behavioural
problems
•
An EP consulted with the Central area CP about how to assess for specific
clinical presentations in a young girl
•
Hypotheses and working formulations were drawn up pooling EP/CP
perspectives
•
Psychometric/clinical measures decided on, administered by EP and
interpretation of clinical material guided by CP
•
EP interviewed the girl/ CP/EP did joint interview with parents, CP did
school observation
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Reflections by CP
• Great opportunity for both CP and EP learn about the breadth of the
other’s repertoire and use of therapeutic models
• EP was guided on use of a new technique “exernalisation”
• Both CP and EP learned about new test material and their
interpretation
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CP’s contribution to vulnerable children
not part of a school system
• Both Central and West CP’s have become involved with young
people identified as most vulnerable in the area through the area
panel;
• E.g. Young woman (15) already known to CAMHS tier 3 who is not
attending school, is using alcohol and drugs heavily, and has very
difficult relationship with mother who wants her taken into care and
“sorted”
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Exploring areas of possible joint
service development
Under early discussion
EP’s with time for Early Years development work to join with CP’s to
develop new services around children’s centres (Triple P parenting –
group and individual, training for health visitors around support to
parents re sleep and behaviour management)
CP’s to join EP’s with remit around SEAL to develop possible group
interventions for children identified as needing targeted support and
possible groups for parents to reinforce emotionally literate
approaches at home
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CP’s/EP’s to offer training and consultation to Learning Mentors
Once EP’s have undertaken course in CBT to offer support to CP’s to
deliver basic training in CBT approaches to colleagues in the CYPT
Some EP’s may go on to do more intense CBT training – possibilities of
an EP in each area team being the “mental health” specialist
Developing support systems to Headteachers and other school staff
experiencing secondary trauma
Possibly CP’s joining EP’s in Critical Incident responses within CYPT
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Future possibilities
• Brighton and Hove will be an interesting place for trainee EP and
trainee CP’s to have placement experiences
• We are keen to explore recruitment of generic applied psychology
assistants to support EP’s and CP’s in developing innovative
projects locally
• If successful in our Pathfinder bid for Targeted Mental Health in
Schools funding we will make these appointments to work alongside
SEAL with input from University of Sussex as well as our EP’s/CP’s
• These are very early days; we will do more systematic evaluation of
the impact of integrating Clinical Psychologists and Educational
Psychologists over time
• All things are possible!
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