I have an initial assessment for a teenager who has anxiety about going to school. She hasn’t been attending for five weeks. Her parents are emailing school every morning requesting that work is sent home for her, which school are not responding to as they want her to return to school. It turns out the young person was being bullied by a young group of girls in school. Her father has a general anxiety disorder.
I try and set up a meeting in school for everyone to meet, so we can try and negotiate an agreed plan for her return. It’s not going to be easy, as communication appears to have broken down between school and parents, who are considering making a formal complaint as they feel school should be sending work home to their daughter.
They do not appear to be taking positive steps in encouraging their daughter back into school and have stopped her going out of the house, concerned that if people see her outside on a school day, they will get into trouble with education welfare. As a result the teenager’s anxiety has worsened and her mood is low, as she has become isolated and appears to be anxious also about leaving the house.
As I’m working in an NHS multi-disciplinary team with health professionals, I have been nominated to attend a two year post graduate diploma in Cognitive Behavioural Therapy (CBT) to enable me to work with children and young people with depression and anxiety. Part of the course requires me to video my sessions with young people so I can evidence my therapeutic alliance with the young people and to reflect on my development of CBT skills. Today I spend most of it trying to work out how to set up the video recorder and how I will transfer my recording on to an encrypted memory stick. The computers at work do not appear to be compatible with my memory stick.
I feel nervous at the thought of seeing myself on video and although I have been a qualified social worker for many years, starting a new course and being observed and assessed again is testing my confidence. It’s a different way of working for me and requires me to reflect on my current practice and style of working with young people.
This morning I spend time responding to telephone calls made by professionals in the community who are working with children and young people every day and who have concerns regarding a young person’s mental health.
We call this aspect of our service telephone consultations and it means a professional can talk to me and we can decide by having a case discussion what the concerns are.
Then we can decide whether it’s appropriate for them to refer the young person to our service or whether there may be other services that would be more beneficial depending on the issues.
One of the phone calls is from a GP, who has seen a parent with a child who is five years old.
The parents report that the child ‘has frequent meltdowns when asked to do something they don’t want to do’ and the parent says it’s very difficult to get the child into school in the mornings. With this information alone, it’s really difficult to assess what’s really happening for this child. However, in the first instance I recommend the GP signposts the parent to Barnardo’s family centre who are commissioned to support parents with family relationships and child development.
I also recommended the parent meet with the child’s special educational needs coordinator in school to share her concerns and to gain a school perspective, to identify whether there are any problems in school which could be impacting on the child’s behaviour and reluctance to attend school.
Today my colleague and I run a Self Esteem Group for teenagers. It’s a group that runs for two hours every week for six weeks and we usually have 8-10 young people who are referred to the group.
It’s very satisfying meeting young people and seeing them support each other and although initially they appear very quiet and anxious being in a group setting, it’s lovely to see over the weeks how their confidence growing and friendships forming.
The group session today is about self-care, so we do some group exercises on generating ideas and examples on how to get a good night’s sleep, ways to relax, maintaining a balanced diet, recommending ways to exercise and we finish the session with a guided relaxation exercise.
It’s a challenge encouraging a group of teenagers to close their eyes and sit comfortably while listening and focusing on a relaxation exercise and at times I can hear giggles and laughter. The home task is for them to go away and practice one aspect of self-care that was discussed in the group and to come back the following week and feedback.
Today is interesting, as I am also a long-arm practice educator for a final year social work student. She is based in an adult disability team and she is undertaking a direct observation, which I have to assess.
I observe her carrying out a needs-led assessment, which is procedural and involves a lot of paperwork to be completed with the service user.
It reminds me how lucky I feel to work within a multi-disciplinary team where it does feel more creative and flexible in achieving good outcomes using a variety of methods of engaging with people, rather than completing lots of forms in evidencing whether a service user has met criteria to be eligible for homecare services.
Continuing my role as practice educator helps keep me informed of social care issues and requires me to reflect on theory to practice, research and values when I carry out supervision with my student and when marking her direct observations and reflective analysis.
In the afternoon, back to the office to meet a young person who is a guest editor for our CCAMHS Newsletter. We produce the newsletter termly and it is aimed at young people and professionals in promoting good mental health.
The newsletter tries to keep young people, families and professionals informed about our what’s going on in our service and what we provide. It helps demystify what we do and who we are and hopefully makes our service feel more approachable and accessible to all those who need to use it.