Child and Adolescent Psychotherapists are making significant contributions to services that have been identified as national priorities.
Working in Schools
Child and Adolescent Psychotherapists have been instrumental in developing and delivering innovative ways of working in schools in many areas of the country, adapting their core skills to the needs of working in universal services. This has included: consultation and training in emotional development and child mental health for staff; working with children in groups, including alongside school staff; direct therapeutic work for children and parents; whole family work in schools; making specialist assessments and referrals to other professionals; using infant observation skills to undertake thorough observations of children to feedback important information to staff, parents and the network and provision of reflective practice groups for teachers to help with early identification and prevention and with developing tailored strategies to address children’s difficulties.
Children Who Are Looked After and Others Who Have Suffered ACEs
Children who are in the care of local authorities are one of the most vulnerable groups in society. The majority of children who remain in care are there because they have suffered abuse or neglect. At any one time around 60,000 children are looked after in England, although some 90,000 pass through the care system in any year. CAPTs in all services work with looked-after children and many work in specialist looked-after children services. CAPTs also work in residential settings providing long-term care and others are closely involved with the family courts providing assessments. CAPTs can offer long-term therapy where this is needed, but also consult to the networks around patients to maintain their stability and capacity to think about the needs of the child. These approaches are also needed for work with other groups of children who have suffered traumatic or Adverse Childhood Experiences, including those who have experienced Domestic Abuse, and refugee children.
Perinatal and Infant Mental Health
CAPTs, with their in-depth training in early social and emotional life, and in infant observation, are key professionals in the multi-disciplinary early years field, both in terms of direct work with infants and families, and in training, supervising and consulting to a wide range of professionals and agencies in health, social care and the third sector. All CAPTs at the point of qualification will have the ability to offer either psychoanalytically informed perinatal and parent-infant work, family work or group work. The competency framework for mental health in the perinatal period*, commissioned by HEE from the Tavistock & Portman NHS Foundation Trust, was produced by an expert reference group which including CAPT.
As part of the ACP's response to the Health and Social Care Committee Inquiry into the First 1000 Days of Life we produced a report a report which detailed the work being undertaken by Child Psychotherapists across the UK in relation to the critical first 1001 days.
For children and young people with eating disorders a strong multi-disciplinary team is essential to work with them and their families. Particularly where difficulties with eating are enduring, a CAPT offers understanding about the young person’s state of mind and how this is being expressed in their relationship with food, and with those around them. CAPTs are able to work with young people who may be in a very disturbed state, for extended periods where necessary, often when manualized treatments such as CBT-E have not been effective. CAPTs working in this way in community settings can help to prevent the escalation of problems and potentially avoid an expensive and disruptive in-patient stay.
Adolescents in Crisis
Presentations for self-harm and attempted suicide can be resource intensive, potentially using ambulance, A&E, crisis team and inpatient resources. Estimates of direct and indirect costs are difficult to establish but it is notable that a relatively small proportion of individuals who present at A&E with deliberate self-harm may use a disproportionately large amount of resources**. The availability of regular psychotherapy sessions provide depressed and self-harming children and adolescents with a containing structure for their very intense emotions. As the therapeutic work progresses it provides a benign frame of reference within the mind and patients are less likely to lean heavily on other services. An audit of children being seen as intensive training cases by trainee child and adolescent psychotherapists showed a decrease in the level of perceived risk in 48% of cases during the period of treatment***.
Multi-Agency Working Across Sectors
The ability of professionals and organisations to work in a multi-disciplinary and multi-agency way that focuses on the needs of the service user, rather than the needs of the worker or service, is of crucial importance for CYP. Emotional and behavioural problems, as well as child protection issues, may be identified in a range of settings from school to primary care. Meeting the needs of children for physical and mental health care, education, housing and welfare services requires a co-ordinated multi-agency response that puts the needs of the child at the centre. CAPTs have an understanding of the highly complex processes within and between institutions and an ability to hold networks together around patients, particularly those who create significant anxiety for professionals and agencies. CAPT training enables them to represent the child’s experience in relation to his/her family placement, special educational needs and therapeutic needs, and to support the emotional well-being of staff in all agencies.
** “9 repeat attenders were responsible for nearly a quarter of all attendances”. Nadkami, A., Parkin, A. & Dogra, N. (2000). Characteristics of children and adolescents presenting to accident and emergency departments with deliberate self harm. Journal of Accident and Emergency Medicine, 17, 98-102.
*** Robertson, K (2007) Audit of intensive cases held by child and adolescent psychotherapists in training at the Tavistock Clinic at November 2006. Unpublished audit report.