Interventions in Child Clinical Psychology Flashcards
What is a clinical child psychologist?
An applied practitioner trained in the psychological assessment, treatment and management of children and young people with physical illness, disabilities, emotional, behavioural and other difficulties
Child mental health services - tier 1
Early intervention and prevention
Schools Children's centres Health visitors School nurses GPs
Child mental health services - tier 2
Early help and targeted services
Child mental health services - tier 3
Specialised CAMHS
Eating disorder specialists
Outpatient services
Child mental health services - tier 4
Inpatient provision
Can’t be helped in the community
Need round the clock support
How do we get to an intervention?
Assessment information is gathered from multiple sources
A case is formulated
Formulation
Application of psychological theory to create shared understanding of the problem
Parent-child relationship in psychological interventions
Many psychological interventions are aimed at the family level
This is build on the understanding that the parent-child interaction is key
Parents can be the most effective agents for change for the child
Why is an evidence base with children difficult to obtain?
This is a very broad area that is often under researched due to the nature of the complexity of the work and obtaining ethics
Some areas have more evidence for a particular model than others such as CBT for anxiety, but that doesn’t mean there aren’t other approaches
Main interventions for behavioural and emotional problems
Timid to Tiger
Behavioural Exposure
What does theory tell us about behavioural and emotional problems?
Children want attention from caregivers which leads them to feel loved
Real-life experiences shape children’s behaviour via positive and negative reinforcement
What does inappropriate behaviour represent?
An unmet need
What could the function of inappropriate behaviour be?
Gain attention or elicit care Avoid task demands Gain tangible reinforcement (praise) Reduce feelings of discomfort (anxiety) Provide interesting stimulation
If a child is avoiding school, why might this be and what can you do about it?
They might be gaining attention from avoiding school
An intervention could be to praise them when they do go to school
How do we come up with interventions?
Assume the behaviour is functional
Look at how it helps the child
See how their needs could be met in another way which doesn’t involve the inappropriate behaviour
Parenting programmes
Target parents
Based on principles of behaviourism
Focus on instructing the ‘how to’ of parenting
Use principles of reinforcement
Positive attention and praise for desirable behaviour
Setting clear and reasonable limits for undesirable behaviour
What is the Incredible Years programme?
Traditionally for parents of younger children (<10 years)
12-week programme
Utilises the parents as therapists - aims to raise confidence and offer support
Uses a tiered system
Incredible Years - Play (bottom tier)
10 mins a day Praise, no criticism Child led Questions are banned Teaching is banned Commentary on playing - gives attention to the child and provides learning opportunity without testing
Incredible Years - Praise
Specific, labelled and timely
Enthusiasm
Avoid ‘sting in the tail’ (see what you can do when you make the effort)
Reward systems (sticker charts) - keep them positive, one behaviour at a time and specific
Reinforcement
Incredible Years - Limit-Setting
Specific, clear instructions Tone of voice, eye contact Consequences Role-play to demonstrate principles Reinforcement
Incredible Years - Ignore
For undesirable behaviour - removes reinforcement
No touch, no talk, no eye contact
Positive self-talk for parents
Play and praise teach child how to get attention appropriately
Ignore teaches child inappropriate means are ineffective
Incredible Years - Time Out (top tier)
Selective and limited use
Used to help child calm - self-regulate
Key principles Don't call it the naughty step No warning 1 min per year of life up to 5 Calm and quiet before coming out
Sanders et al. (2014)
Triple P (positive parenting programme) - medium effect sizes for child social, emotional and behavioural outcomes, parenting practice, efficacy and satisfaction
Coates, Taylor & Sayla (2014)
Reduction in ADHD symptoms, co-morbid conduct problems and increased parenting self-esteem with parenting programmes
Chen & Chan (2016)
Reduced risk factors and enhanced protective factors associated with child maltreatment with parenting programmes
Timid to Tiger Programme
Programme for parenting an anxious child (primary school aged)
What is the Timid to Tiger Programme based on?
Two theoretical approaches…
CBT
Behavioural parent training
Use of behavioural principles relating to parenting in the Timid to Tiger Programme
Positive reinforcement - praise and reward for confident behaviour
Negative reinforcement - ignore used for excessive reassurance seeking
Social learning - modelling brave behaviour
What do all parenting programmes assume is the major function of problematic behaviour?
To gain the caregiver’s attention
What ensues after the problematic behaviour and what do parenting programmes do about it?
A cycle of reinforcement
Parenting programmes teach caregivers to give attention, praise and rewards for desirable behaviour and ignore undesirable behaviours
What are the main interventions when there is disruption in the relationship with the caregiver, emotion dysregulation, understanding others perspective, insecure attachment?
Play based
Dyadic Developmental Psychotherapy (DDP)
Reflective parenting/mentalising
Why are behavioural interventions sometimes criticised?
Because they do not address the parent-child relationship
When are attachment interventions used?
When we suspect that attachment difficulties are the key to the problem
What does theory tell us about attachment interventions?
Children need a sense of security and coherence from their caregivers
Sensitive-responsive caregiving allows child to develop positive internal working model
If the caregiver is responsive and available, what does that do to the self?
Makes them feel worth and loveable
What do attachment interventions aim to do?
Re-establish the connection between the child and caregiver
Improve attachment, trust, and self-esteem by helping the child’s internal working model to become more secure
What is Theraplay?
Emotionally tuned in, two-way, physical play
What does Theraplay replicate?
Early child-caregiver relationship - meeting the child’s attachment needs
What does Theraplay seek to do?
Repair the attachment through this specific play that is not child led
Four dimensions of Theraplay…
Structure
Challenge
Engagement
Nurture
Structure in Theraplay
Adult is in charge - reassures the child, teaches them to be in control of self, not everyone else
Order, predictability, rules and routines - contrasts with unruly and chaotic environments
Addresses inner and outer disorder
Who is structure in Theraplay useful for?
Children who are overactive, undirected, over-stimulated, or who want to be in control
Engagement in Theraplay…
Child-focused, intensive and personal - attunement
Seen and felt
Involves pleasant stimulation - allow child to understand surprises can be positive
Who is engagement in Theraplay useful for?
Children who are withdrawn, avoidant of contact
What is integration?
Overlap between models of intervention
Play - which aspects of play are similar across the two interventions
Boundaries - creating security for the child and how each intervention might do this similarly and knowing where they might differ
What are parenting programmes shown to increase?
Sensitive responding
What have parenting programmes shown limited evidence for?
Impact on child’s representation of themselves
O’Connor et al. (2013) - quote
Effective parenting interventions seek to alter multiple dimensions of the parent-child relationship
