This Months Speaker: Dr Kevin Beardsworth, a Clinical Psychologist working within the CAMHS Tier 3 Service in Essex, as well as previously being on the interview panel for Herts and Essex Clinical Courses.
An explanation of the tiers within the CAMHS service:
Tier 2 is more community based.
Tier 3 consists of specialist child mental health professionals.
Tier 4 is highly specialist inpatient units.
Working within the CAMHS team means that a wide range of services are involved in cases, including schools and often Social Services. The CAMHS teams work with children and adolescents up to the age of 17 years, at which age if they need further input they are usually transferred to adult services.
A Case Study was presented and discussed:
The GP sent a referral letter for a 6 year old boy, ‘William' saying that he was defiant and found it very hard to make friends.
An initial, generic assessment was carried out by the Clinical Psychologist, including:
A genogram and additional family history (particularly any behavioural or mental health problems), details of pregnancy and delivery (questions regarding any traumas, breathing difficulties, etc), milestones and development as a baby, positive and negative life events, physical problems/accidents and a description of the presenting problem and when the reported difficulties started.
William's mother reported the following difficulties:
‘Poor concentration, always on the go, does things on purpose…spoils it for the rest of the family, school complains and I have to go and pick him up, tantrums, he's ruined my life…something is wrong with him…was difficult to manage from the moment he was born'
The Family History: William is the oldest of 3 children; the other two children, aged 4 and 5, are by another father and Sarah, the mother, describes him and their 2 children as great. William's father was abusive to Sarah after she had William. Sarah's own mother left the family when Sarah was 4. Sarah was raised by her father but left home when she was 16 following a huge argument. Sarah refuses contact with her father and brother, but would not say why. Her father suffers from depression.
Sarah used alcohol and drugs during her pregnancy with William; she suffers from depression and is on Prozac but and has never had any counselling.
Issues regarding Williams presenting problems:
- Attachment Issues
- Drug use during pregnancy-could indicate neurodevelopmental issues
- William was born 6 weeks early
- Was late walking and talking
- Difficult in nursery
- Physical problems include asthma and grommets
When considering the formulation for William, the following features were discussed:
- Is the difficult behaviour present in all situations?
- Is it ADHD?
- Could the mother receive intervention; would she accept it?
- Concern for William's welfare? – is he being neglected, emotionally abused?
With these in mind, referrals are made to the following agencies:
- Social Services: duty to protect the child, emotional abuse.
- Play Therapist (for individual and attachment work)
- Paediatrician
- Systemic family psychotherapist
- Psychiatrist - to rule out a label, or even give one
- Adult CMHT - referral for the Mother
- Cognitive Assessment to be carried out by the Clinical Psychologist, who is also the Care Co-ordinator.
- Teachers are also informed and a meeting could be set up.
From the cognitive assessment it was found that William had a specific learning difficulty in the domains of auditory processing and working memory, meaning that he struggled to make sense of instructions. This assessment could only be carried out by Clinical Psychologists and was significant in understanding William's needs.
The NTGPG thanked Dr Beardsworth for the interesting case study and discussion he presented.
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