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Sessions held on the phone: some ideas and helpful pointers for clinicians

By Avon and Wiltshire Mental Health Partnership NHS Trust Be Safe Service

In the context of this unprecedented national situation, it seems increasingly likely that telephone calls will become the safest way in which we are able to remain supportive and in contact with families and hold appointments over the next period of time. This document is intended to give clinicians some helpful ideas about how to manage calls and some creative ideas in response to this situation. Making calming and continuing contact with young people and their families is likely to serve a very important stabilising function at this difficult time.

I found this a helpful read- https://www.childrenscommissioner.gov.uk/2020/03/17/supporting-children-during-the-coronavirus-outbreak/

Our primary contact will be the parents, but it may feel possible to have helpful talks and appointments with young people over the phone. If we are talking with young people it might be helpful to establish who is around and available after the call should the young person feel distressed or need support and remind them that if we feel worried we will call parents/carers to let them know following the call.

Be aware that some resources are not appropriate for everyone and may go out of date as the advice changes so please check appropriateness before recommending.  and you may have many more to add.

General wellbeing checks over the phone

Exploring creative ways to stay busy in the home

  • Building in time in which children and young people can play or be in their rooms having quiet time alongside time when parents and children come together to feel more connected might help structure the day.
  • Thinking of something new and novel that could be done each day e.g. tidying rooms, helping with any chores, garden work or DIY, starting any creative projects together, researching new topics on the internet, arts, and crafts, board games, cooking. If children or young people are off from school, they are likely to be given home packs so parents might help children and young people to structure their time around this.
  • Regular mealtimes and bedtime routines might be even more important in times of uncertainty than they are normally.
  • Helping families to think about ways to do any exercise in the home might also be really helpful and finding fun videos online to help do this. https://youtu.be/d3LPrhI0v-w

Managing uncertainty and anxiety –

  • Recap on any emotional coping strategies already covered in sessions might be helpful alongside exploring family strengths and resources.
  • It’s important that parents keep up to date with announcements from the government and public health England (https://www.nhs.uk/conditions/coronavirus-covid-19/) but it might also be worth highlighting that reading lots about the situation on social media can also increase anxiety in ways that may not be manageable or helpful for some parents. It might be helpful to, therefore, think with parents about striking a balance around this and monitoring how social media is affecting parents’ own mood and anxiety.

Free resources to assist with calming and reassurance – 

https://blog.calm.com/take-a-deep-breath

Assessing risk and safety planning on the phone –

  • Calls can establish if any new concerns or any risk issues have emerged or increased and how to have the parents managed these. Clinicians need to update risk information on care notes so that if other clinicians need to take over calls and support if primary clinicians themselves are not at work. Remind parents that they must let us know if new concerns emerge and that we will be endeavoring to provide those in most need with additional support.
  • Remind young person and parents of any agreed safety or risk management plans. Check if they have printed copies of these at home and if not send out. It might be that any existing safety plans need to be amended to reflect more time being spent in the home.
  • If there is a history of self-harm or suicidality parents should remove all sharps and all medications should be locked away as per any risk planning.
  • Parents of young people with siblings or other foster children need to be reminded about bedrooms and bathrooms being private spaces and that supervision of children and young people needs to be tight whilst everyone is in the home all the time.
  • It might be helpful for families to agree a family plan or contract at this time that helps them to deescalate conflict should this arise and how people can have space and calm down if they are not leaving the house
  • If children are off school and the safety plan advises that they should not be left unaccompanied we will need to think supportively and creatively with parents who may be on low wage incomes, liaise with social care and other agencies such as citizen advice to help parents feel able to stay at home to support young people who are deemed at risk.

Useful places to signpost families for mental health support

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Love in the time of COVID?

By David S. Prescott, LICSW, & Kieran McCartan, Ph.D.

Please note this is a joint blog with ATSA/SAJRT blog site, take care, Kieran.

Like everyone else, we’ve had our share of worries and concerns as we enter the rising side of the COVID-19 curve. Canceled trainings, travel, and classes, ensuring the safety and wellbeing of loved ones have shaped the lives of many for a long time to come. For many of us, it’s the state of not knowing that is the most frustrating. On the other hand, there are some areas of good news, such as indications of decline in some areas, and medical advances in others. And proving the axiom that “Alone I travel faster; together we travel further”, the word “caremongering” has entered our lexicon.

At this writing, numerous state chapters of ATSA, regional branches of NOTA (NOTA Scotland) and ANZATSA have had to cancel or postpone their conferences, workshops, seminars and trainings.. Ditto with the otherwise seemingly indestructible NAPN conferences. Many trainers are taking to web-based and videoconferencing technologies, where the questions of the day involve the best ways to break participants up into small group discussions and paired practice exercises. Everywhere we look, discussions abound about how to balance the needs and rights of our clients with our own obligations for self-care and safety. These discussions have ranged from how many clients in group therapy in some areas to whether or not clinicians can work with videoconferencing platforms and which methods adhere to confidentiality laws. Additionally, these discussions raise questions of access to online technology, which can be a challenge to some of our clients because of the conditions to their license conditions, the speed of internet in certain areas and whether professionals can work from home (i.e., access to encrypted networks and client reports).

One opportunity that we all have in these uncertain times is to work on our messaging. As the world talks about “social distancing”, we are painfully aware of the elements of social isolation that have long been recognized as a risk factor for offending and re-offending. Professionals in our field find themselves in a subtle bind: Social isolation is a risk factor in some respects, and yet social distance is a protective factor in others. How do we ensure that we don’t approach clients as if they are one more surface to sanitize?

Maybe it’s time to move beyond focusing on the construct of social distance and turn our message in other directions. Instead, we might think of this in terms of promoting “physical distance and safety” and “creating a healthy space”. From a prevention perspective, social distance can facilitate abuse and create the conditions where people at risk of committing an offense, whether for the first time or as part of an ongoing pattern may be more likely to do so. For this reason, we should also think of increased social isolation as an opportunity for us to intervene and talk about prevention.

Of course, creating and transmitting healthy and safe spaces can begin with maintaining a positive and hopeful attitude (which itself is a protective factor against illness) and with being careful with media coverage. In some ways, the rapidly escalating strong emotions inspired by media coverage may be a bigger risk factor for negative outcomes all around. As one comedian observed, “If I don’t watch the news, I’m uninformed. If I do watch it, I’m misinformed.”

The messaging from leaders is also a lesson for all in our field and provides an opportunity to reflect on what messages our clients and colleagues get from us. One world leader has already tried to monetize the eventual vaccine. Another has blithely reminded us that many of our loved ones will die. Yet another, from Ireland — a country that knows about staring directly into the eyes of violence, starvation, and despair— reminded his country that “Together we can save lives.” This last example gives us an opportunity to reframe our message to our clients, ourselves, and each other: at the very least, we’re all in this together. That’s one small step we can take to reduce social isolation.

Finally, there is one small message that we can remind ourselves about providing excellent assessments and treatments to people who have abused. For years, our field has grappled with providing the best evidence-based services, while implementation science has reminded us that optimizing service delivery can take years. Every time we’ve thought about the importance of implementing best practices, we’ve also thought about how long it takes to implement even the most basic of safety interventions, such as handwashing and seat belt usage. One silver lining to the Coronavirus crisis is that at least handwashing is up. As with reducing sexual violence, simply getting people to talk about the issues and forge a way forward can change lives for the better.

Many organizations have offered advice for professionals in this field;

British Psychological Society: https://thepsychologist.bps.org.uk/volume-33/april-2020/coronavirus-psychological-perspectives

British Association for Counselling and Psychotherapy: https://www.bacp.co.uk/about-us/contact-us/faqs-about-coronavirus/

Centers for Disease Control: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html

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Yorkshire-Humberside NOTA roundtable

By Jenny Greensmith-Brennan, Safer Lives

You may have heard that the NOTA conference is to be held in Leeds this year. It is common practice that the local branch is involved in the sourcing of speakers, venues and entertainment, amongst other things. This was proving difficult in Yorkshire as the local branch had not met for 18 months and had no Chair or Secretary to get things moving again.

After discussions with the General Manager, a small group of local members decided to reconvene the branch but with a different ethos. One of collectivism, as little hierarchy as possible and roles for any person who wanted them. There is a variety of reasons for this, but they are for another day.

We arranged a branch event on February 28th and 27 people attended. We asked if people e would be happy to informally talk about their work, to share their roles with others so we all could go away having learned something.

Andy Green chaired the day and six people spoke for 10/15 minutes each. This included those working in custodial settings, the community, with young people, with adults, with those who have harmed, with those who have not harmed., academics, researchers, public sector and private sector workers. There was a mild amount of panic as some realised PowerPoint was not readily accessible but once we were passed that we talked and we ate and we drank (it was a Friday, there was a pub involved)

Kieran McCarten kindly came up from where he’d last managed to lay his head and spoke about the role of hope in what we are all trying to do; support people to move on from their past harmful behaviours or to seek a hand in not harming in the first instance.

The bonus of the day, for me anyway, were the conversations with people I’d never met before. The faces I could now put to names. There appeared to be an enthusiasm to support each other just for the sake of support.

It was simply a very good day. All it needed were a few emails to get 27 people in a room to talk about where we go from here. 27 people who had to organise their overloaded diaries to join us. We spent the last hour of the day figuring out how we could involve more people. How we would communicate, what we wanted our branch to be about, how we ensured fairness of future meeting locations and ideas to be discussed.

Perhaps most importantly, should Humberside really be known as East Yorkshire?

It was evident that we are branch members recovering from years of austerity that applied brakes to anything above the ‘day job’. Not all who were at the meeting will get funding to attend the Conference. One person had needed to take a day’s leave to simply attend this meeting. As an ex probation officer who now has the luxury of more choice when organising my diary and priorities, I understand the pressures on some people in the room. The parallel with some of our clients and service users is not lost. When barriers are in place to any kind of development or reflection it may be easier to stay exactly as you are. With that in mind, I reiterate the thanks to all who attended, speakers, listeners, and doodlers. We’ve got this.

I do hope to see you in Leeds this year.