Second Edition Miranda Wolpert, Rita Harris, Sally Hodges, Peter Fuggle
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19 GETTING ADVICE Context: There is an increased interest in the promotion of resilience, to build the ability of a community (school/family) to prevent, support and intervene successfully in mental health issues. Initiatives such as HeadStart (a £75-million project funded by the Big Lottery Fund), the Penn Resilience programme and others seek to help young people and families to help themselves. A proliferation of digitally based support (e.g. via email, phone and web) is increasingly becoming available and being used to support young people in their communities. There is increasing academic interest (e.g. community psychology) in how we can more effectively draw on strengths in families, schools and wider communities. School-based interventions have been shown to support mental health (Wong, Kady, Mewton, Sunderland, & Andrews, 2014), peer support can promote effective parenting (Day, Michelson, Thomson, Penney, & Draper, 2012) and integration of mental health in paediatric primary care can support community resilience (Rahman, Surkan, Cayetano, Rwagatare, & Dickson, 2013). The wider government policy can impact positively or negatively on the emotional wellbeing of the child within the family – the government initiative to have a Family Impact Assessment of all government policy is welcomed if it proves effective.
outlined above (p.12) found that the most frequently occurring (modal) number of sessions of young people and parents attending NHS outpatient CAMHS was one, with many being seen for less than three contacts. In the majority of these cases, where data were available, the clinician reported that the ending was by mutual agreement between the provider and young person or family members. Whilst it was not possible to determine from existing data whether the majority of these leave satisfied, nor how many are referred elsewhere, practitioner reports suggest at least a proportion of this group find relatively few contacts, even one single contact, enough to normalise their behaviour, reassure families that they are doing the right things to resolve the problem without the need for extra help and to signpost sources of support.
it should be noted that due to the variability in actual resource use of those who were provisionally allocated to this group in the payment system pilot data, the 28% potentially allocated consumed 24% of the total resources in the payment systems analysis (see p.15 above). If we assume that around 30% would benefit from only limited resource to allow coping and the average amount of resources used was equivalent to two face-to-face sessions then the amount of resource use would be equivalent to 8% of total resource given other assumptions outlined in Table 2 on p.16 above. It is important to note that this is only conjecture at the moment. This framework must be tested and we do not want to make extravagant claims of cost savings without evidence. Need: Within this grouping would be children, young people and families adjusting to life circumstances, with mild or temporary difficulties, where the best intervention is within the community with the possible addition of self-support. This group may also include, however, those with chronic, fluctuating or ongoing severe difficulties, for which they are choosing to manage their own health and/or are on the road to recovery. Provision: The THRIVE model of provision would suggest that wherever possible, this provision should be provided within education or community settings, with education often (though not always) the lead provider and educational language (a language of wellness) as the key language used. It is our contention that health input in this group should involve some of our most experienced workforce, to provide experienced decision making about how best to help people in this group and to help determine whose needs can be met by this approach. Support within getting advice should build on existing family resources. In particular if the difficulty seems to be in a secure context then draw on these strengths. Coping is defined as there being sufficient resilience in person and community (context) so as not to be such high risk as to need intervention if not asking for more intervention. Key elements of getting advice might include providing families with research or experience-based information related to the difficulties presented to the professional – information is relayed in such a way as to enhance the self-efficacy of the family and increase the chance of taking appropriate ameliorative action; using the interview to draw out the options available to the family and inviting the family to consider the pros and cons of each of the options; making suggestions for limited changes in aspects of the child’s and family’s routines; helping to identify extant proximal resources both within their social network or support agencies, voluntary groups etc., 20 drawing on resources such as the Youth Wellbeing Directory 10 to identify relevant resources; an invitation for re-contacting the service is embedded in the offer of any advice if things do not improve or they deteriorate. There are occasions where the young person or family may say they are “coping” and not seek further input, but the professional feels more input is required and the risks of intervention are outweighed by the risks of non-intervention. This would include occasions where there are major risks for the young person, such as of placement or school breakdown; there are significant concerns about deterioration or the context is not deemed safe for the young person or their family. If these factors applied then consideration should be given as to whether the needs of the young person and/or family should be more appropriately conceived of as falling into one of the other needs-based groupings such as getting help, getting more help or getting risk support. 10 www.youthwellbeingdirectory.co.uk Yüklə 1,66 Mb. Dostları ilə paylaş:
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