The British Psychological Society DECP Annual Professional Development Event Bournemouth 11

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January 2008

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“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

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Jenny Cross, Senior Educational Psychologist and School and Community Support Manager (West)

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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 3

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 (About 30 staff in each area team) 4

• 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 5

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 6

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 7

• 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 8

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 11

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 12

• 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 13

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 14

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 15

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 16

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 17

• 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? 18

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!) 19

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 21

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 22

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 23

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 25

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 26

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” 27

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 28

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 29

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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